[en] BACKGROUND AND AIMS: Glucocorticoid-induced adrenal insufficiency (GC-AI) is a potentially life-threatening side effect of glucocorticoid therapy. Currently, there is no consensus on monitoring and treating GC-AI in inflammatory bowel disease (IBD) patients. This systematic review and meta-analysis aimed to determine the prevalence of GC-AI in IBD patients following glucocorticoid use. Additionally, a Delphi panel was conducted to develop evidence-based expert opinions on evaluating and managing GC-AI in IBD patients. METHODS: Thirty-four articles were included in this study. Of these, 26 articles reported the prevalence of GC-AI in IBD patients. Statements were generated and rated by a panel of adult and pediatric gastroenterologists using a 1-9 scale. Statements were classified as inappropriate, uncertain, or appropriate based on the median panel rating and the degree of disagreement. RESULTS: The prevalence of GC-AI across all studies was 26.9% (95% CI: 18.9-36.8, I2: 96%). The panel emphasized the importance of maintaining a high suspicion for GC-AI in IBD patients treated with systemic glucocorticoids and considering risk factors such as exogenous glucocorticoid use ≥4 weeks at doses ≥5 mg of prednisone-equivalent. Recommendations for initial screening and management of GC-AI are provided. The management of GC-AI in special populations, such as those in the perioperative setting is also addressed. The panel underscored the need to consider GC-AI assessment in clinical trial design. CONCLUSIONS: GC-AI is a serious, often underrecognized side effect of glucocorticoid use. This study presents expert opinions on the evaluation and management of GC-AI in IBD patients, emphasizing the need for vigilance and appropriate management strategies.
Disciplines :
Gastroenterology & hepatology
Author, co-author :
Law, Cindy C Y ; Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center, Mount Sinai, New York, NY, USA. ; Division of Gastroenterology, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA. ; Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
Sheskier, Rachel; Adrenal Center at Mount Sinai Health System, New York, NY, USA. ; Division of Endocrinology, Diabetes, and Bone Diseases, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Viera-Feliciano, Natalia; Adrenal Center at Mount Sinai Health System, New York, NY, USA. ; Division of Endocrinology, Diabetes, and Bone Diseases, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Delgado-Nieves, Andrea; Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Seth, Shivani; Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Hanžel, Jurij; Department of Gastroenterology, University Medical Center Ljubljana, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
Ma, Christopher ; Division of Gastroenterology & Hepatology, Department of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada.
Colombel, Jean-Frédéric ; Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center, Mount Sinai, New York, NY, USA. ; Division of Gastroenterology, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Levine, Alice C ; Adrenal Center at Mount Sinai Health System, New York, NY, USA. ; Division of Endocrinology, Diabetes, and Bone Diseases, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Spencer, Elizabeth A ; Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center, Mount Sinai, New York, NY, USA. ; Division of Pediatric Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
CORE-IBD, Collaborators
Other collaborator :
Solitano, Virginia
Sudheer Kumar, Vuyyuru
Panaccione, Remo
Sands, Bruce E
Peyrin-Biroulet, Laurent
Danese, Silvio
D'Haens, Geert R
Atreya, Raja
Allez, Matthieu
Bernstein, Charles N
Bossuyt, Peter
Bressler, Brian
Bryant, Robert V
Cohen, Benjamin L
D'Amico, Ferdinando
Dignass, Axel
Dubinsky, Marla
Fleshner, Phillip
Gearry, Richard B
Hanauer, Stephen B
Hart, Ailsa L
Kayal, Maia
Kucharzik, Torsten
Lakatos, Peter L
Louis, Edouard ; Université de Liège - ULiège > Département des sciences cliniques > Hépato-gastroentérologie
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