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CPE-008 · Context triggers
AI-10: Glucocorticoid exposure
Glucocorticoid exposure. Evaluates glucocorticoid at or above a prednisone equivalent of about 5 mg/day for 3–4 weeks or more, by any route (oral, high-dose inhaled, injected or topical).
Condition
- glucocorticoid at or above a prednisone equivalent of about 5 mg/day for 3–4 weeks or more, by any route (oral, high-dose inhaled, injected or topical)
- OR megestrol or chronic opioid use
What it reports
- Glucocorticoid-induced adrenal insufficiency is possible, particularly if the dose is reduced or stopped or illness occurs
Recommended next steps (for physician review)
- Do not stop glucocorticoids abruptly; physician to plan any taper
- Provide sick-day guidance and consider testing, with hydrocortisone held before a morning cortisol
Diagnostic boundary
- Does not diagnose; the engine gives no taper or dose.
Evidence
- EV-ES-GCAI-2024Beuschlein F, Else T, Bancos I, et al. European Society of Endocrinology and Endocrine Society Joint Clinical Guideline: Diagnosis and therapy of glucocorticoid-induced adrenal insufficiency. J Clin Endocrinol Metab. 2024;109(7):1657-1683.Supports: Glucocorticoid exposure by any route can suppress the axis; do not stop abruptly; cross-reactivity of prednisolone in cortisol assays
Cases where this rule fires
Open a case to see this rule fire with real inputs, then change the values until it stops.
ADR-FX-09
Prednisone 10 mg for eight weeks, now tired
Glucocorticoid exposure.
ADR-FX-10
Repeated joint injections and high-dose inhaled steroid
Non-oral routes count.
ADR-FX-13
Hypotension after stopping long-term prednisone
Chronic glucocorticoid exposure and sodium 124.
ADR-FX-23
Megestrol use and fatigue
Megestrol has glucocorticoid activity.
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