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Review
. 2024 Apr 12:15:1353543.
doi: 10.3389/fendo.2024.1353543. eCollection 2024.

Challenges in the postsurgical recovery of cushing syndrome: glucocorticoid withdrawal syndrome

Catherine D Zhang  1 , Adriana G Ioachimescu  1   2
Affiliations
Review

Challenges in the postsurgical recovery of cushing syndrome: glucocorticoid withdrawal syndrome

Catherine D Zhang et al. Front Endocrinol (Lausanne). .

Abstract

Glucocorticoid withdrawal syndrome is a challenging clinical phenomenon that can complicate the postsurgical recovery of Cushing syndrome. It is characterized by physical tolerance and dependence to supraphysiologic glucocorticoid exposure during active Cushing syndrome followed by the abrupt decline in cortisol levels after surgical treatment. The symptoms of glucocorticoid withdrawal often overlap with those of postoperative adrenal insufficiency and can be difficult for patients to cope with and for clinicians to treat. This mini review will discuss the clinical characteristics, pathophysiology, and management of glucocorticoid withdrawal syndrome while highlighting recent data in the field.

Keywords: adrenal insufficiency; cushing disease; cushing syndrome; glucocorticoid withdrawal syndrome; mild autonomous cortisol secretion (MACS).

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
A suggested approach to glucocorticoid dosing and glucocorticoid withdrawal syndrome management after surgical treatment for Cushing syndrome. ACTH, corticotropin; GC, glucocorticoid; GWS, glucocorticoid withdrawal syndrome; HPA, hypothalamic-pituitary-adrenal; TDD, total daily dose.
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