What is iatrogenic adrenal insufficiency
What is iatrogenic adrenal insufficiency Iatrogenic adrenal insufficiency is a condition that occurs when the adrenal glands do not produce enough hormones, primarily cortisol, as a result of medical treatment or intervention. The term “iatrogenic” refers to health issues caused inadvertently by medical treatment, distinguishing it from primary adrenal insufficiency, which results from autoimmune diseases, infections, or genetic disorders. This form of adrenal insufficiency is increasingly recognized due to the widespread use of corticosteroids in various medical settings.
What is iatrogenic adrenal insufficiency Corticosteroids, such as prednisone and dexamethasone, are powerful anti-inflammatory and immunosuppressive agents commonly prescribed for conditions like asthma, rheumatoid arthritis, lupus, and certain autoimmune diseases. While these medications are often life-saving and crucial in disease management, their prolonged or high-dose use can suppress the hypothalamic-pituitary-adrenal (HPA) axis. The HPA axis is responsible for regulating cortisol production through a feedback mechanism involving the hypothalamus, pituitary gland, and adrenal glands.
When corticosteroids are administered exogenously over an extended period, the body’s natural cortisol production diminishes because the high levels of synthetic steroids signal the hypothalamus and pituitary to reduce or cease the secretion of corticotropin-releasing hormone (CRH) and adrenocorticotropic hormone (ACTH). As a result, the adrenal glands may atrophy or become less responsive, leading to a state of adrenal insufficiency once the external steroids are tapered or stopped. This suppression can persist for weeks or even months after discontinuation, depending on the duration and dosage of steroid therapy. What is iatrogenic adrenal insufficiency
The clinical presentation of iatrogenic adrenal insufficiency can be subtle initially but may become severe if unrecognized. Patients might experience fatigue, weakness, weight loss, low blood pressure, nausea, vomiting, abdominal pain, and hypoglycemia. In stressful situations, such as infections or surgeries, their inability to mount an adequate cortisol response can lead to adrenal crisis—a life-threatening condition characterized by hypotension, shock, and loss of consciousness. This underscores the importance of carefully managing corticosteroid therapy and monitoring for signs of insufficiency. What is iatrogenic adrenal insufficiency
Diagnosis involves a detailed history of corticosteroid use, along with laboratory tests measuring serum cortisol levels. An ACTH stimulation test can help confirm the diagnosis by assessing the adrenal glands’ ability to respond to synthetic ACTH. Imaging studies are usually not necessary unless other adrenal pathology is suspected.
Prevention and management rely on cautious use of corticosteroids—using the lowest effective dose for the shortest duration necessary—and gradually tapering the medication to allow the HPA axis to recover. In cases where adrenal insufficiency develops, temporary or long-term corticosteroid replacement therapy may be required to prevent adrenal crisis. Education about stress dosing during illness or surgery is also vital for patients with known or suspected adrenal suppression. What is iatrogenic adrenal insufficiency
What is iatrogenic adrenal insufficiency In summary, iatrogenic adrenal insufficiency is a significant consequence of long-term corticosteroid therapy. Recognizing its signs, understanding its mechanism, and implementing appropriate management strategies are essential to minimize risks and ensure patient safety.
