ReviewPituitary2022
Glucocorticoid Withdrawal Syndrome following treatment of endogenous Cushing Syndrome.
Review in Pituitary, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
38 citing papers in PubMed, 1 synthesis or guideline pooled it, 60 citations in OpenAlex.
- Psychiatric morbidity in acromegaly: a cohort study and meta-analysis of the literature.Pituitary · 2025Pooled it
- Efficacy and safety of relacorilant for the treatment of patients with Cushing's syndrome (GRACE): a multicentre, phase 3, double-blind, placebo-controlled, randomised-withdrawal study.The lancet. Diabetes & endocrinology · 2026Trial
- Inadequately Controlled Type 2 Diabetes and Hypercortisolism: Improved Glycemia With Mifepristone Treatment.Diabetes care · 2025Trial
- Osilodrostat treatment in patients with Cushing's disease of Asian or non-Asian origin: a pooled analysis of two Phase III randomized trials (LINC 3 and LINC 4).Endocrine journal · 2024Trial
- Safety of Withholding Perioperative Hydrocortisone for Patients With Pituitary Adenomas With an Intact Hypothalamus-Pituitary-Adrenal Axis: A Randomized Clinical Trial.JAMA network open · 2022Trial
- Distinct plasma protein profiles after long-term remission of Cushing's disease.The Journal of clinical endocrinology and metabolism · 2026Article
- Potential mechanisms of the glucocorticoid withdrawal syndrome.European journal of endocrinology · 2026Review
- Article
- Cognitive Assessment in Adults With Adrenal Cortisol Insufficiency: Challenges and Opportunities.Endocrine reviews · 2026Review
- Controlling cortisol excess and comorbidities in Cushing's syndrome with osilodrostat.Pituitary · 2025Article
- Article
- Rapid Adrenal Atrophy Following Excision of an Ectopic Adrenocorticotropin-Secreting Lung Carcinoid Tumor.JCEM case reports · 2025Article
- Impact of Meditation Device Use on Quality of Life of Patients Following Surgery for Hypercortisolism.Journal of the Endocrine Society · 2025Article
- A Novel Mouse Model of the Glucocorticoid Withdrawal Syndrome.Journal of the Endocrine Society · 2025Article
- Management of Osilodrostat Therapy in Patients With Cushing's Syndrome: A Modified Delphi Consensus Panel.Journal of the Endocrine Society · 2025Article
- Glucocorticoid withdrawal syndrome: Disproportionality analysis of cases using VigiBase data.Daru : journal of Faculty of Pharmacy, Tehran University of Medical Sciences · 2025Article
- High recovery rate of adrenal function after successful surgical treatment of Cushing's syndrome.Endocrine connections · 2025Article
- Osilodrostat Treatment of Cushing Syndrome in Real-World Clinical Practice: Findings From the ILLUSTRATE study.Journal of the Endocrine Society · 2025Article
- Identification of Endogenous Hypercortisolism and the Effect of Mifepristone Treatment in Patients With Difficult-to-Manage Diabetes: A Case Series.Diabetes spectrum : a publication of the American Diabetes Association · 2025Article
- Impact of hydrocortisone vs prednisone therapy on postsurgical recovery in patients with endogenous hypercortisolism: a prospective cohort study.European journal of endocrinology · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 2 institutions in 1 country.
Funding
Abstract
purposeLiterature regarding endogenous Cushing syndrome (CS) largely focuses on the challenges of diagnosis, subtyping, and treatment. The enigmatic phenomenon of glucocorticoid withdrawal syndrome (GWS), due to rapid reduction in cortisol exposure following treatment of CS, is less commonly discussed but also difficult to manage. We highlight the clinical approach to navigating patients from GWS and adrenal insufficiency to full hypothalamic-pituitary-adrenal (HPA) axis recovery.
methodsWe review the literature on the pathogenesis of GWS and its clinical presentation. We provide strategies for glucocorticoid dosing and tapering, HPA axis testing, as well as pharmacotherapy and ancillary treatments for GWS symptom management.
resultsGWS can be difficult to differentiate from adrenal insufficiency and CS recurrence, which complicates glucocorticoid dosing and tapering regimens. Monitoring for HPA axis recovery requires both clinical and biochemical assessments. The most important intervention is reassurance to patients that GWS symptoms portend a favorable prognosis of sustained remission from CS, and GWS typically resolves as the HPA axis recovers. GWS also occurs during medical management of CS, and gradual dose titration based primarily on symptoms is essential to maintain adherence and to eventually achieve disease control. Myopathy and neurocognitive dysfunction can be chronic complications of CS that do not completely recover.
conclusionsDue to limited data, no guidelines have been developed for management of GWS. Nevertheless, this article provides overarching themes derived from published literature plus expert opinion and experience. Future studies are needed to better understand the pathophysiology of GWS to guide more targeted and optimal treatments.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.