Desteroidization as a methodology for reducing the risk of adrenal insufficiency in adult non-endocrine patients: literature data and own experience

The article presents literature data and personal experience of observing non-endocrine patients after discontinuation of glucocorticoids or their withdrawal. The use of a new term and methodology of desteroidization to prevent glucocorticoid dependence is justified. Glucocorticoid withdrawal syndrome is interpre­ted as glucocorticoid dependence syndrome. The clinical signs of iatrogenic Cushing’s syndrome and glucocorticoid-induced adrenal insufficiency in adult patients are described, as well as modern clinical guidelines for managing patients after discontinuation of glucocorticoid therapy. Our own experience of observing non-endocrine patients shows that after discontinuation of glucocorticoid therapy: a) some patients take glucocorticoids themselves, for example, dexamethasone injections after inpatient treatment for severe COVID-19 infection to improve well-being and physical performance, which led to a fatal outcome (generalized iatrogenic Cushing’s syndrome, multiple organ failure) in one case; b) others reach a certain minimum dose (for example, 5 mg of prednisolone per day) and do not want to refuse glucocorticoid therapy due to fear of relapse or exacerbation of the disease; c) the third group cannot refuse glucocorticoid therapy due to the underlying disease (our patient has been taking glucocorticoids after kidney transplantation for more than 15 years); d) the fourth group require repeated administration of low doses of glucocorticoids in the absence of the complete recovery of the hypothalamic-pituitary-adrenal system after glucocorticoid withdrawal at the first signs of adrenal insufficiency (due to stress, dental procedures, hyperthermia, dehydration, sunstroke, acute respiratory viral infections, etc.). Data of modern clinical guidelines (European Society of Endocrinology and Endocrine Society (USA) 2024) on medical management of patients with non-endocrine pathology are presented.