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Daily Medical Update
Adrenal insufficiency
Sunday, August 30, 2026
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🔬 Practice-Changing Findings
Evidence from RCTs and meta-analyses published in the
last 12 months.
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European journal of internal medicine (2026) - Meta-Analysis
Key Findings
- Across 12 studies involving 1,170 participants, adrenal insufficiency was present in 423 individuals, with a pooled prevalence of 30% (95% CI 19-45%) at the earliest assessment.
- Prevalence was lower in studies that included tapering and in those testing at least 15 days after glucocorticoid cessation (15%, 95% CI 8-26%) than at cessation (48%, 95% CI 35-62%); no specific regimen reliably prevented adrenal insufficiency.
📋 Practice Implication: Use glucocorticoid exposure history and timing of testing when evaluating patients after systemic therapy; tapering may reduce observed risk but does not eliminate the need for vigilance.
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Inflammatory bowel diseases (2025) - Systematic Review
Key Findings
- Across the included IBD literature, glucocorticoid-induced adrenal insufficiency prevalence was 26.9% (95% CI 18.9-36.8%), with substantial heterogeneity (I2 = 96%).
- The Delphi panel emphasized increased vigilance for patients with systemic glucocorticoid exposure of at least 4 weeks at doses of at least 5 mg prednisone-equivalent and issued recommendations for screening, management, and perioperative assessment.
📋 Practice Implication: In IBD care, maintain a low threshold for adrenal-insufficiency assessment after clinically important systemic glucocorticoid exposure, including around surgery and other physiologic stressors.
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European journal of endocrinology (2025) - Meta-Analysis
Key Findings
- Seven studies comprising 9,876 patients contributed to the meta-analysis; pooled mortality was approximately 2.5-fold higher than in reference populations (HR 2.51, 95% CI 1.47-4.31).
- Cardiovascular disease was the main cause of death overall, while adrenal crisis was the main cause of death in the congenital adrenal hyperplasia subgroup, which had a pooled HR of 2.88 (95% CI 1.38-6.01).
📋 Practice Implication: Long-term primary adrenal-insufficiency follow-up should pair replacement management with cardiovascular-risk surveillance and explicit adrenal-crisis prevention, particularly in congenital adrenal hyperplasia.
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Clinical endocrinology (2026) - Meta-Analysis
Key Findings
- Across six studies involving 400 patients, modified-release hydrocortisone produced significant reductions in BMI, waist circumference, total cholesterol, systolic blood pressure, and diastolic blood pressure compared with conventional glucocorticoids.
- Bone outcomes improved with modified-release hydrocortisone for lumbar-spine and femoral-neck T-scores; fasting glucose and HbA1c did not differ significantly overall, although sensitivity analysis suggested a possible HbA1c benefit.
📋 Practice Implication: Modified-release hydrocortisone is a reasonable discussion point for selected patients with metabolic or bone-health concerns, while acknowledging that the comparative evidence remains limited and larger long-term trials are needed.
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Journal of endocrinological investigation (2025) - Randomized Controlled Trial
Key Findings
- Complications occurred more often during Ramadan fasting than on non-fasting days among patients with primary adrenal insufficiency (67% vs 23%, p = 0.001), and 37% broke the fast because of a complication.
- Hypoglycaemia symptoms were reported by 37% during fasting versus 3% outside fasting (p = 0.002); continuous monitoring found hypoglycaemia was frequent in both periods, while urea levels increased during fasting but remained within normal limits.
📋 Practice Implication: Before Ramadan or similar prolonged fasting, provide individualized sick-day, hydration, glucose-monitoring, and medication counseling and reconsider fasting when risk cannot be safely mitigated.
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Summary
Recent evidence reinforces that adrenal insufficiency is common after systemic glucocorticoid exposure and remains associated with substantial long-term mortality in primary disease. Management signals include risk-based screening in glucocorticoid-treated IBD, possible metabolic advantages with modified-release hydrocortisone, and heightened precautions for primary adrenal-insufficiency patients who fast during Ramadan.
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