Glucocorticoid weaning in glucocorticoid-induced adrenal insufficiency
File(s)
Accepted version
Author(s)
Lazarus, Katharine
Sharma, Angelica
Meeran, Karim
Type
Journal Article
Abstract
Glucocorticoids, used for their potent anti-inflammatory effects, are now amongst the most highly prescribed drugs, with over 7.5 million prescriptions issued annually in the UK for the management of immune or inflammatory conditions across multiple medical specialties. Long term use is associated with adverse effects, including suppression of the hypothalamic-pituitary-adrenal (HPA) axis, which can lead to glucocorticoid-induced adrenal insufficiency (GI-AI). Although it has long been known that glucocorticoids suppress the HPA axis, recent evidence has demonstrated that tapering of glucocorticoids allows the HPA axis to recover, preventing the need for long term glucocorticoid replacement therapy. Tapering too rapidly is associated with glucocorticoid withdrawal syndrome (GWS) whereas a slower taper may result in excess exposure to glucocorticoids with their well-known undesirable effects. The optimum duration and rate of taper is unknown.
In this review, we discuss risk factors for the development of GI-AI, explore the barriers to weaning and recent evidence that weaning glucocorticoids enables recovery of the HPA axis and full cessation of glucocorticoids. We also highlight the current gaps in the literature in managing patients with GI-AI and propose a pathway for safely stopping glucocorticoids, thereby avoiding the adverse effects associated with prolonged glucocorticoid use.
In this review, we discuss risk factors for the development of GI-AI, explore the barriers to weaning and recent evidence that weaning glucocorticoids enables recovery of the HPA axis and full cessation of glucocorticoids. We also highlight the current gaps in the literature in managing patients with GI-AI and propose a pathway for safely stopping glucocorticoids, thereby avoiding the adverse effects associated with prolonged glucocorticoid use.
Date Acceptance
2026-08-04
Citation
BMJ Medicine
ISSN
2754-0413
Publisher
BMJ Publishing Group
Journal / Book Title
BMJ Medicine
Copyright Statement
Copyright This paper is embargoed until publication. Once published the author’s accepted manuscript will be made available under a CC-BY License in accordance with Imperial’s Research Publications Open Access policy (www.imperial.ac.uk/oa-policy).
License URL
Publication Status
Accepted