Evaluation and Management of Glucocorticoid-Induced Adrenal Insufficiency in IBD: An Expert Opinion

Cindy C Y Law; Rachel Sheskier; Natalia Viera-Feliciano; Andrea Delgado-Nieves; Shivani Seth; Jurij Hanžel; Christopher Ma; Jean-Frédéric Colombel; Alice C Levine; Elizabeth A Spencer; CORE-IBD Collaborators

doi:10.1093/ibd/izaf136

Evaluation and Management of Glucocorticoid-Induced Adrenal Insufficiency in IBD: An Expert Opinion

Inflamm Bowel Dis. 2025 Jun 30:izaf136. doi: 10.1093/ibd/izaf136. Online ahead of print.

Authors

Cindy C Y Law^{1

2

3}, Rachel Sheskier^{4

5}, Natalia Viera-Feliciano^{4

5}, Andrea Delgado-Nieves⁶, Shivani Seth⁶, Jurij Hanžel⁷, Christopher Ma⁸, Jean-Frédéric Colombel^{1

2}, Alice C Levine^{4

5}, Elizabeth A Spencer^{1

9}; CORE-IBD Collaborators

Affiliations

¹ Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center, Mount Sinai, New York, NY, USA.
² Division of Gastroenterology, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
³ Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
⁴ Adrenal Center at Mount Sinai Health System, New York, NY, USA.
⁵ Division of Endocrinology, Diabetes, and Bone Diseases, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁶ Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁷ Department of Gastroenterology, University Medical Center Ljubljana, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
⁸ Division of Gastroenterology & Hepatology, Department of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada.
⁹ Division of Pediatric Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

PMID: 40587340
DOI: 10.1093/ibd/izaf136

Abstract

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.

Keywords: Crohn’s disease; adrenal insufficiency; corticosteroids; ulcerative colitis.

Plain language summary

Glucocorticoid-induced adrenal insufficiency (GC-AI) occurs in approximately 25% of IBD patients after stopping corticosteroids. This study adds expert guidance on GC-AI evaluation and management, aiming to improve awareness and reduce associated risks.

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