Steroid Weaning and Adrenal Recovery in different causes of Cushing

Deborah Papadopoulou; Zin Htut; Katharine Lazarus; Einas Mohamed; Wessam Osman; Karim Meeran

doi:10.1530/endoabs.117.EP2

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Endocrine Abstracts (2026) 117 EP2 | DOI: 10.1530/endoabs.117.EP2

SFEBES2026 ePoster Presentations Adrenal and Cardiovascular (3 abstracts)

Steroid Weaning and Adrenal Recovery in different causes of Cushing’s Syndrome

Deborah Papadopoulou ^1,2 , Zin Htut ^2,1 , Katharine Lazarus ^2,1 , Einas Mohamed ^1,2 , Wessam Osman ^2,3,1 & Karim Meeran ^2,1

Author affiliations

¹Imperial College Healthcare, London, United Kingdom; ²Imperial College, London, United Kingdom; ³National Diabetes and Endocrine Centre, Royal Hospital, Muscat, Oman

Background: Adrenal suppression following prolonged steroid exposure presents significant clinical challenges. The optimal strategy for steroid weaning and adrenal recovery remains uncertain. Supporting patients through withdrawal is important to reduce complications including osteoporosis and diabetes.

Case series: Four patients were referred with adrenal insufficiency. Patient 1: Had used topical clobetasol for 20 years and was referred with an undetectable cortisol. Following a rapid wean, an initial short synacthen test (SST) demonstrated a peak cortisol of 248nmol/l and ACTH 217ng/l. Four months later a repeat peaked at 368nmol/l and ACTH 23.2ng/l. Patient 2: Post adrenalectomy following a four-year history of Cushing’s. They were treated with metyrapone for four months pre-surgery. Initial SST demonstrated peak cortisol of 53nmol/l and ACTH 5.3ng/l. Following a prednisolone wean over five months, a repeat SST showed a peak cortisol of 120nmol/l, ACTH 24.8ng/l. She remains well and continues to be monitored in clinic. Patient 3: Following surgery for ectopic Cushing’s, a baseline cortisol was <28nmol/l and ACTH <5.0nmol/l with no response on SST. A slower prednisolone wean was required due to glucocorticoid withdrawal symptoms. Repeat SSTs during prednisolone weaning demonstrated HPA axis recovery (peak cortisols at seven and fourteen months were 147nmol/l and 483nmol/l respectively). Patient 4: Following pituitary surgery for Cushing’s, a slow wean from 4 mg prednisolone was started at 11 months post-surgery. The baseline cortisol was 77nmol/l and ACTH 21.6ng/l. Following a 24-week weaning protocol, she recovered her HPA axis. A repeat SST demonstrated a peak cortisol of 429nmol/l and ACTH 16.6ng/l.

Conclusion: This case series highlights the variability in adrenal recovery following steroid withdrawal, influenced by underlying pathology, duration of exposure, and weaning speed. Close monitoring with serial SSTs and ACTH, individualised weaning plans, and patient education, are critical to support recovery and reduce the risk of adrenal insufficiency.