Evidence Gaps
The review team took around 2.5 years to draw up the guidance amid some concerns about the quality of the evidence base, which they mainly rated as “low” or “very low.” “I think we all, going through the literature, were quite astonished at how bad the evidence is for a problem as global as that,” said Dr. Beuschlein. “But that’s how it is — sometimes, even in the absence of strong evidence, you have to give some kind of guidance.”
Nevertheless, the authors have called for more research to establish risk factors contributing to the development of and susceptibility to adrenal insufficiency, a greater understanding of glucocorticoid withdrawal, and identification of glucocorticoids retaining immunosuppressive and anti-inflammatory properties that have less effect on HPA axis suppression and an improved adverse effect profile.
Patient-facing materials on GC-AI are also in development and will be made available via the ESE Patient Zone this month.
Next year, the societies plan to publish a joint guideline on diabetes in pregnancy. That will be followed in 2026 by guidance on arginine vasopressin resistance and arginine vasopressin deficiency and a guideline on male hypogonadism in 2027.
Funding for the development of joint guidelines was provided by the societies and did not involve support from other bodies.
Dr. Beuschlein declared funding from the German Research Funding Agency, the Swiss National Science Foundation, University Medicine Zürich, the Vontobel Foundation, the Swiss Heart Foundation, and consultancy work for Bayer AG. Dr. Else declared membership of the advisory board of Merck and Company. Dr. van Hulsteijn declared no conflicts of interest.
A version of this article appeared on Medscape.com.