Iatrogenic Adrenal Insufficiency Clinical Pathways

Iatrogenic adrenal insufficiency (IAI) is a potentially serious but preventable complication of prolonged systemic glucocorticoid therapy in pediatric patients. This clinical pathway provides standardized, evidence-based guidance for identifying patients at risk for adrenal suppression, evaluating adrenal recovery, and safely managing stress-dose steroid recommendations across inpatient, ICU and emergency care settings.

IAI clinical pathways

• Iatrogenic Adrenal Insufficiency Risk Assessment and Stress Dose Steroid Recommendations Clinical Pathway

About our IAI clinical pathway

The Iatrogenic Adrenal Insufficiency Risk Assessment and Stress Dose Steroid Recommendations Clinical Pathway was developed by pediatric endocrinology providers at Children’s Hospital Colorado in collaboration with a multidisciplinary team, including hospitalists, pharmacists, nurses and subspecialty providers.

This pathway is intended to support frontline healthcare providers caring for pediatric patients with recent or chronic systemic steroid exposure. The pathway includes practical guidance for identifying patients at risk for IAI, determining when stress-dose steroids are indicated, interpreting cortisol testing and performing ACTH stimulation testing.

Clinical recommendations within the pathways are based on current literature, institutional expertise and multidisciplinary review. The pathways also provide guidance for morning cortisol screening thresholds, ACTH stimulation testing protocols and stress-dose steroid administration to support timely and evidence-based care.

The pathway applies to inpatient, ICU and emergency department settings and are designed for patients with potential iatrogenic adrenal insufficiency due to systemic glucocorticoid exposure.