Table 2: Open in new tab Overview of...

Considerations

Eligible Patients

Timing

Comments

Risk for developing exogenous Cushing syndrome

All patients on long-term supraphysiologic glucocorticoid therapy

At the time of initiation

There are many sequelae of exogenous Cushing syndrome. Patients should be educated on the most common and clinically significant, including weight gain, sarcopenia, hyperglycemia, hypertension, bone demineralization.

Risk for developing chronic adrenal insufficiency

Even transient adrenal insufficiency requires education to raise awareness for the need to stress dose when appropriate

Education on stress dosing strategies

Patients on long-term supraphysiologic glucocorticoid therapy who have reduced dosing to physiologic, or subphysiologic, levels.

At least at the time when dosing approaches a physiologic range.

Dedicated education should be provided to prepare patients with confirmed, or likely, adrenal insufficiency for routine and emergent stress dosing.

Education on injectable emergency glucocorticoid administration

Glucocorticoid withdrawal syndrome

Patients on long-term supraphysiologic glucocorticoid therapy who are ready to begin tapering the dose.

At the time glucocorticoid tapering begins

Some patients on long term supraphysiologic glucocorticoid therapy experience symptoms as the doses are tapered.

Table 2:

Open in new tab

Overview of topics prescribing clinicians should discuss with patients when prescribing oral glucocorticoids.

Considerations	Eligible Patients	Timing	Comments
Risk for developing exogenous Cushing syndrome	All patients on long-term supraphysiologic glucocorticoid therapy	At the time of initiation	There are many sequelae of exogenous Cushing syndrome. Patients should be educated on the most common and clinically significant, including weight gain, sarcopenia, hyperglycemia, hypertension, bone demineralization.
Risk for developing chronic adrenal insufficiency			Even transient adrenal insufficiency requires education to raise awareness for the need to stress dose when appropriate
Education on stress dosing strategies	Patients on long-term supraphysiologic glucocorticoid therapy who have reduced dosing to physiologic, or subphysiologic, levels.	At least at the time when dosing approaches a physiologic range.	Dedicated education should be provided to prepare patients with confirmed, or likely, adrenal insufficiency for routine and emergent stress dosing.
Education on injectable emergency glucocorticoid administration
Glucocorticoid withdrawal syndrome	Patients on long-term supraphysiologic glucocorticoid therapy who are ready to begin tapering the dose.	At the time glucocorticoid tapering begins	Some patients on long term supraphysiologic glucocorticoid therapy experience symptoms as the doses are tapered.

Considerations	Eligible Patients	Timing	Comments
Risk for developing exogenous Cushing syndrome	All patients on long-term supraphysiologic glucocorticoid therapy	At the time of initiation	There are many sequelae of exogenous Cushing syndrome. Patients should be educated on the most common and clinically significant, including weight gain, sarcopenia, hyperglycemia, hypertension, bone demineralization.
Risk for developing chronic adrenal insufficiency			Even transient adrenal insufficiency requires education to raise awareness for the need to stress dose when appropriate
Education on stress dosing strategies	Patients on long-term supraphysiologic glucocorticoid therapy who have reduced dosing to physiologic, or subphysiologic, levels.	At least at the time when dosing approaches a physiologic range.	Dedicated education should be provided to prepare patients with confirmed, or likely, adrenal insufficiency for routine and emergent stress dosing.
Education on injectable emergency glucocorticoid administration
Glucocorticoid withdrawal syndrome	Patients on long-term supraphysiologic glucocorticoid therapy who are ready to begin tapering the dose.	At the time glucocorticoid tapering begins	Some patients on long term supraphysiologic glucocorticoid therapy experience symptoms as the doses are tapered.

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