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CC BY-NC-ND 4.0 · Journal of Diabetes and Endocrine Practice 2024; 07(03): 129-134
DOI: 10.1055/s-0044-1788035
Review Article

Safely Withdrawing Glucocorticoid Therapy: A Case-Based Approach

Mohammed Alenazi 
1   Division of Endocrinology and Metabolism, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
2   Diabetes and Endocrine Treatment Center, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
,
Khaled Aldahmani
3   Division of Endocrinology and Metabolism, Tawam Hospital, Alain, United Arab Emirates
4   Sheikh Tahnoon Bin Mohammed Medical City (STMC), Department of Medicine, United Arab Emirates
5   Department of Medicine, United Arab Emirates University, Abu Dhabi, United Arab Emirates
,
Syed Ali Imran 
1   Division of Endocrinology and Metabolism, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Abstract

Glucocorticoids (GCs) have potent anti-inflammatory and immunomodulating effects, making them effective for treating various diseases. They are among the most commonly prescribed medications worldwide. The prevalence of GC therapy in the general population is estimated to be ∼0.9 to 3%, though it is challenging to determine precisely. The chronic GC therapy is associated with severe morbidity and increased mortality due to iatrogenic Cushing's syndrome and suppression of the hypothalamic–pituitary–adrenal axis, leading to tertiary adrenal insufficiency. Therefore, it is not recommended to abruptly stop chronic GC therapy, and a gradual tapering of GCs is generally considered the ideal approach for GCs withdrawal. However, withdrawing GCs in patients on chronic therapy can be challenging due to the difficulty in accurately assessing HPA function. In this article, we aim to provide a practical, case-based approach to GC withdrawal based on current literature and our extensive experience in this field.

Keywords

glucocorticoids withdrawal - tapering - glucocorticoids - adrenal insufficiency - iatrogenic cushing's syndrome - GCs withdrawal syndrome

Authors' Contribution

All the authors contributed equally to this study.




Publication History

Article published online:
04 July 2024

© 2024. Gulf Association of Endocrinology and Diabetes (GAED). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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