Abstract
Objective of the Review: To discuss the current idea of the aetiology, diagnosis and management of secondary adrenal insufficiency (SAI). Key Points. The article describes key causes of the disease, including iatrogenic causes, discusses the widely studied effect of adrenocorticotropic hormone suppression by glucocorticoids and a lesser studied autoimmune hypophysitis induced by check point inhibitors. Special aspects of SAI diagnosis, principles of replacement therapy and cases of unjustified glucocorticoids prescription are given in detail. Risk classification for disease development if glucocorticoids are prescribed for other conditions is presented; an algorithm for management of this group of patients is described. Conclusion. If diagnosed untimely and treated incorrectly, SAI is a severe condition with a high risk of addisonian crisis and death. As the diagnosis is very often challenging, due vigilance is warranted, especially in high-risk groups (patients on long-lasting glucocorticoid therapy). At the same time, unjustified treatment should be avoided if diagnosis is not verified. Keywords: secondary adrenal insufficiency, secondary hypoadrenocorticism, aetiological diagnostics, glucocorticoid therapy.
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