Iatrogenic adrenal insufficiency (IAI) is the most common form of adrenal insufficiency in adult patients, although its overall exact prevalence remains unclear. IAI is associated with adverse clinical outcomes, including adrenal crisis, impaired quality of life and increased mortality; therefore, it is imperative that clinicians maintain a high index of suspicion in patients at risk of IAI to facilitate timely diagnosis and appropriate management. Herein, we review the major causes, clinical consequences, diagnosis and care of patients with IAI. The management of IAI, particularly glucocorticoid-induced (or tertiary) adrenal insufficiency, can be particularly challenging, and the provision of adequate glucocorticoid replacement must be balanced against minimizing the cardiometabolic effects of excess glucocorticoid exposure and optimizing recovery of the hypothalamic–pituitary–adrenal axis. We review current treatment strategies and their limitations and discuss developments in optimizing treatment of IAI. This comprehensive Review aims to aid clinicians in identifying who is at risk of IAI, how to approach screening of at-risk populations and how to treat patients with IAI, with a focus on emergency management and prevention of an adrenal crisis.

医源性肾上腺功能不全（IAI）是成人患者中最常见的肾上腺功能不全形式，但其总体确切患病率仍不清楚。IAI 与不良临床结果相关，包括肾上腺危象、生活质量受损和死亡率增加；因此，临床医生必须对有 IAI 风险的患者保持高度警惕，以便及时诊断和适当的治疗。在此，我们回顾 IAI 的主要原因、临床后果、诊断和护理。IAI 的治疗，特别是糖皮质激素引起的（或三级）肾上腺功能不全，可能特别具有挑战性，必须在提供足够的糖皮质激素替代品的同时，尽量减少糖皮质激素过量暴露对心脏代谢的影响，并优化下丘脑-垂体-肾上腺的恢复轴。我们回顾了当前的治疗策略及其局限性，并讨论了优化 IAI 治疗的进展。这份全面的综述旨在帮助临床医生确定谁有 IAI 的风险，如何对高危人群进行筛查以及如何治疗 IAI 患者，重点是应急管理和预防肾上腺危象。