Iatrogenically-Mediated Glucocorticoid Deficiency

Iatrogenically-mediated glucocorticoid deficiency

Iatrogenically-mediated glucocorticoid deficiency is a condition that occurs when prescribed glucocorticoids are abruptly withdrawn. Signs and symptoms include weakness, nausea, vomiting and hypotension.

Secondary adrenal failure is an inferior and confusing term for what should be more appropriate termed iatrogenically-mediated glucocorticoid deficiency,

Secondary adrenal failure incorrectly implies that all of the hormones made by the adrenal gland, including mineralocorticoids and adrenal sex hormones, are deficient, which is not the case. Patients with iatrogenically-mediated glucocorticoid deficiency, in fact, are deficient in glucocorticoids, but not in mineralocorticoid or adrenal sex hormones.

Comparison with primary adrenal insufficiency

In contrast with patients with iatrogenically-mediated glucocorticoid deficiency, patients with primary adrenal insufficiency do have a mineralocorticoid and adrenal sex hormones deficiency because in primary adrenal insufficiency the entire adrenal cortex is not functioning.

Note that the adrenal medulla is not affected in either primary adrenal insufficiency or in iatrogenically-mediated glucocorticoid deficiency.

I hope that Venn diagram below makes this clearer: