Adrenal insufficiency

Also known as: Addison disease · adrenal crisis

Free to read — no account needed. Sign in only to bookmark this disease and track your study progress.

United StatesADA/Endocrine Society/AACE

Current

Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline

Endocrine Society · 2016

This Endocrine Society guideline addresses how primary adrenal insufficiency is diagnosed and how glucocorticoid and mineralocorticoid replacement is managed in adults.

It was developed with the European Society of Endocrinology and the American Association for Clinical Chemistry as co-sponsors. source
Its scope is limited to primary adrenal insufficiency; secondary and critical-illness-related adrenal insufficiency are excluded. source

Verify against original ↗

EuropeEASD/ESE

Current

ESE and Endocrine Society Joint Clinical Guideline: Diagnosis and Therapy of Glucocorticoid-induced Adrenal Insufficiency

European Society of Endocrinology (ESE), joint with Endocrine Society · 2024

This joint ESE/Endocrine Society guideline advises clinicians managing adults on long-term supraphysiologic glucocorticoid therapy, covering tapering and the recognition of glucocorticoid-induced adrenal insufficiency.

It addresses glucocorticoid tapering strategies and how to evaluate recovery of adrenal function. source
The guideline notes that roughly 1% of the population uses chronic glucocorticoid therapy, making this a common clinical problem. source

Verify against original ↗

US vs EU key differences

Disease scope differs: the 2016 US guideline addresses primary adrenal insufficiency (Addison disease), while the 2024 joint ESE/Endocrine Society guideline covers glucocorticoid-induced adrenal insufficiency arising from exogenous steroid therapy. source
Diagnostic anchor differs: the primary adrenal insufficiency guideline makes the 250 µg corticotropin stimulation test the reference standard, with a peak cortisol below 500 nmol/L (18 µg/dL) confirming deficiency, whereas the glucocorticoid-induced guideline works from graded morning cortisol bands (above 300 nmol/L suggesting recovery, below 150 nmol/L indicating continued replacement). source
The 2024 guideline adds guidance the 2016 one has no reason to cover: when not to test at all (supraphysiologic dosing, courses under 3–4 weeks) and a two-phase glucocorticoid taper that slows to 1 mg prednisone decrements near physiologic dosing. source
Both documents converge on stress-dose glucocorticoids, with the primary adrenal insufficiency guideline specifying doubling hydrocortisone for fever above 38°C, tripling above 39°C, and parenteral hydrocortisone plus an emergency card and injection kit for crisis. source

What changed recently

No recorded changes yet for this disease.

See the full update feed for changes across every system.