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Adrenal suppression refers to decreased cortisol production as a result of negative feedback on the hypothalamic-pituitary-adrenal axis, caused by excess glucocorticoids.
The most common cause of adrenal suppression is sudden cessation of exogenous glucocorticoids. It can also occur when endogenous glucocorticoid excess is corrected.
Risk factors for adrenal suppression include:
The higher the corticosteroid dose and the longer the therapy, the greater the risk of adrenal suppression.
In a normal feedback loop, the hypothalamus responds to the level of cortisol.
In adrenal suppression, when corticosteroids are given and enter the bloodstream, the hypothalamus receives the message that there are adequate corticosteroid levels. It therefore does not release ARH and ACTH, which would “send the message” to the adrenal glands to make their own glucocorticoids. The adrenal glands therefore become inactive.
Symptoms of adrenal suppression include:
Adrenal suppression can lead to adrenal insufficiency, a potentially life-threatening side effect of corticosteroid use. When adrenal insufficiency occurs, the adrenal gland atrophies and fails to make corticosteroids. Exogenous glucocorticoids may be needed.
The primary test for adrenal insufficiency is the ACTH stimulation test. It measures the response of the adrenal glands to adrenocorticotropic hormone (ACTH). Blood cortisol levels are measured before and after an injection of synthetic ACTH. If the adrenal glands don't produce enough cortisol in response, it suggests adrenal insufficiency.
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