Symptoms of glucocorticoid-induced adrenal insufficiency

Ally Prebtani, MD, is a professor of medicine at the Faculty of Health Sciences of McMaster University.

When to suspect glucocorticoid-induced adrenal insufficiency? What are the symptoms?

Ally Prebtani, MD: The question about when to suspect glucocorticoid adrenal insufficiency… As I mentioned earlier on, looking at the dose, duration, and all those things I mentioned earlier on, is going to help you stratify what the risk is—in terms of the risk of developing glucocorticoid adrenal insufficiency.

In terms of what to look for in terms of symptoms, [this is] often nonspecific. Patients often complain of fatigue, unexplained weight loss, nausea, anorexia. Maybe sometimes they get vomiting, abdominal pain, they may feel dizzy. Just generally, they feel unwell. It is very, very nonspecific. They might have certain biochemical abnormalities. They may have hyponatremia, for example, with central adrenal insufficiency. They might have a slightly lower hemoglobin. Maybe their kidneys are not 100%. So it’s many, many things that we look at to suspect it.

The key thing is to have a high index of suspicion and a low threshold for testing if you’re concerned about this. And the best test to use is probably basal morning cortisol, and if the number is >270 nmol/L, or >350 nmol/L, they probably don’t have glucocorticoid-induced adrenal insufficiency.