Minimizing the risk of glucocorticoid-induced adrenal insufficiency

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

How to conduct glucocorticoid treatment to minimize the risk of glucocorticoid-induced adrenal insufficiency?

This is really important because the goal is to prevent and to mitigate risk, and the ways you can do this are (1) to use the lowest dose possible, (2) to use the shortest duration of therapy, (3) to avoid bedtime or evening administration, (4) to avoid other drugs that interact, which can increase the levels of adrenal insufficiency or increase the metabolism of glucocorticoids, especially in children, because they’re more prone to developing glucocorticoid adrenal insufficiency. Also, talk to your colleague or the specialist who prescribed the therapy for the primary condition that they’re using it for to see if there’s an alternative or a glucocorticoid-sparing agent that will minimize the prolonged or high-dose usage of glucocorticoids. These are some of the factors that can really minimize the risk of adrenal insufficiency.

And last one will be if they’re getting repeated administrations in their joints, to make sure they’re not getting multiple joint injections at one time to prevent prolonged excess exposure to glucocorticoids.