Organizations publish joint guideline on glucocorticoid-induced adrenal insufficiency

The joint guideline is designed to help clinicians manage patients who have, or are at risk of developing, glucocorticoid-induced adrenal insufficiency. At least 1% of the global population uses chronic glucocorticoid therapy as anti-inflammatory or immune-suppressive agents.

The guideline, titled "Diagnosis and Therapy of Glucocorticoid-induced Adrenal Insufficiency," will appear in the May 2024 issues of the Societies' respective journals, The Journal of Clinical Endocrinology & Metabolism and the European Journal of Endocrinology. Patient-facing materials on glucocorticoid-induced adrenal insufficiency are also in development and will be made available via the ESE Patient Zone in May 2024.

This is the first guideline developed and published jointly by the Endocrine Society and the European Society of Endocrinology (ESE). The Societies are planning to publish a new joint guideline each year to maximize outreach as well as to cover potential differences in clinical practice between Europe and the United States.

As focal points for endocrinology and hormone research, both the Endocrine Society and ESE regularly produce clinical guidelines with recommendations for patient care, either in collaboration with other Societies or independently.

Guideline development at each Society is overseen by a clinical committee, and all guidelines are subject to a rigorous review process before being published. This is undertaken by Society members and relevant parties, such as patient advocacy groups.

Where it is considered beneficial, patient support literature is prepared alongside the guidelines to provide patients with assistance in understanding and managing their condition.

The working group behind this joint guideline was led by co-chairs Tobias Else, M.D., of the University of Michigan in Ann Arbor, Mich., and Professor Felix Beuschlein, M.D., of the University Hospital Zurich in Zurich, Switzerland.

"The Endocrine Society and ESE collaborative guidelines on glucocorticoid-induced adrenal insufficiency are an important step towards a global collaboration in guideline development. Despite having differences in access to medications and other clinical resources, the evidence for diagnosing and treating a condition is the same," said Else.

"I believe the future will bring us closer to true global guidelines, which integrate the global diversity in culture and medical practices and can be adapted locally in accordance with resources. The work on the combined guidelines brought a tremendous learning experience for me personally, and hopefully they will be a useful resource for medical providers worldwide."

"Our starting point was to define the clinical problem and knowledge gaps that come with glucocorticoid-induced adrenal insufficiency, for which we set out to provide some guidance—even in the absence of strong scientific evidence. We also wanted to make sure that we had good representation both from Europe and the U.S. to cover potential differences in clinical practice.

"In this, we were privileged to gather an excellent team of specialists with great knowledge, diligence and enthusiasm—all of which is required to get through the process of writing a guideline from scratch," said Beuschlein.

"The discussions between the panel members during the writing of the guideline, and the review process which included all members of both societies, has resulted in a level of consensus that has not been reached before. I hope that the global reach of this joint guideline goes beyond what either Society could reach independently."

In 2025, the Societies plan to publish a joint guideline on diabetes in pregnancy; in 2026, a joint guideline on arginine vasopressin resistance and arginine vasopressin deficiency; and in 2027, a joint guideline on male hypogonadism.