Adrenal insufficiency: identification and management—summary of new NICE guidance

### What you need to know Adrenal insufficiency is the inadequate production of the hormone cortisol from the adrenal glands. Global prevalence ranges from 0.4/100 000 (South Korea) to 15-22/100 000 (Nordic countries) for primary adrenal insufficiency, and 14-28/100 000 (Spain and UK) for secondary adrenal insufficiency.1 It is often unrecognised, which can lead to adrenal crisis and, if not identified and treated, death. From July 2018 to July 2020, NHS England National Reporting and Learning System identified 78 incidents related to adrenal insufficiency, including two deaths and six incidents of severe harm to patients across England.2 Care is variable across the UK but there is a lack of understanding on who is at risk of adrenal insufficiency, how to test for it, and how to manage a life threatening adrenal crisis promptly. Here we summarise newly published guidelines from the National Institute for Health and Care Excellence (NICE). NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the guideline committee’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets. ### GRADE Working Group grades of evidence