Intended for healthcare professionals

Letters Avoiding acute adrenal crises

Guidance is needed on inhaled glucocorticoids and acute adrenal crises

BMJ 2012; 345 doi: (Published 06 November 2012) Cite this as: BMJ 2012;345:e7436
  1. Scott D Mackenzie, clinical research fellow1
  1. 1Queen’s Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, UK
  1. s.mackenzie{at}

Wass and Arlt highlight several strategies to prevent morbidity and mortality from acute adrenal crisis,1 including the recognition and management of iatrogenic adrenal suppression; this is increasingly important given the rise in glucocorticoid prescriptions in the UK.2 Clear guidance, particularly regarding inhaled glucocorticoids, is lacking.

The authors highlight the need for patients on long term steroids, …

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