Insuficiencia adrenal inducida por glucocorticoides: tratamiento y seguimiento clínico

Abstract

Glucocorticoid-induced adrenal insufficiency is a common complication of prolonged exogenous corticosteroid use, caused by suppression of the hypothalamic-pituitary-adrenal (HPA) axis and resulting in insufficient endogenous cortisol production. Given the widespread use of glucocorticoids across multiple medical fields, a substantial proportion of the population is at risk. Although adrenal crises are rare, they can be severe or life-threatening if not promptly recognized and treated, particularly during acute physiological stress. This underscores the need for close and long-term monitoring. Recent guidelines and clinical studies recommend periodic assessment of the HPA axis using basal cortisol measurements and ACTH stimulation tests, especially in patients with persistent symptoms or without documented hormonal recovery. A significant proportion of patients may regain adrenal function even 12–24 months after discontinuing corticosteroids. Management should include patient education, crisis prevention strategies, recognition of withdrawal symptoms, and individualized adjustment of replacement therapy, including stress-dose steroids if required. In 2024, the European Society of Endocrinology and the Endocrine Society published the most up-to-date guideline, which serves as the basis for this work. This review synthesizes current recommendations and proposes a practical, evidence-based approach for the follow-up of adults with glucocorticoid-induced adrenal insufficiency.