Adrenal Insufficiency

To the Editor: The concise review of adrenal insufficiency by Dr. Oelkers (Oct. 17 issue) 1 was excellent, but the corticotropin stimulation test is even less valuable than he suggests, and the incidence of clinically significant secondary adrenal insufficiency due to long-term glucocorticoid therapy is much lower than generally believed. 2 – 5 What does Dr. Oelkers recommend for patients receiving exogenous glucocorticoids? My data suggest that the adrenal function of such patients need not be tested except when there are clear-cut clinical indications, since in such patients the physiologic value of the biochemical tests is poor and clinical adrenal insufficiency is rare. . . .