Which one of the following is true of adrenal suppression due to steroid therapy -
Ans. is 'c' i.e., It should be expected in anyone receiving > 5mg, prednisone daily o Any patient who has received > 20-25 mg/day hydrocoisone or equivalent for longer than 2-3 weeks should be put on a scheme of gradual withdrawl because of suppression of hypothalamic - pitutary-adrenal axis. o 20 mg hydrocoisone is equivalent to 5 mg of Prednisolone. So 5 mg prednisolone (or 20-25 mg hydrocoisone) causes hypothalmo-pitutary-adrenal axis suppression. About others options o There is atrophy of adrenal coex o Inhaled steroids can also cause adrenal suppression - Goodman & Gilman o Many patients recover from several weeks to months, however, in some indils the time to recovery can be one year or longer --> Goodman & Gilman . Measures that minimize hypothalamo - pittutary - adrenal axis suppression. Use shoer acting steroids (hydrocoisone, prednisolone) at the lowest possible dose. Use for shoest period of time. Give the entire daily dose at one time in the morning. Switch to alternate-day-therapy if possible. If possible use local preparations with poor systemic availability (beclomethasone, triamcinalone, fluticasone).
It is not associated with atrophy of the adrenal glands
It does not occur in patients receiving inhaled steroids
It should be expected in anyone receiving > 5 mg, prednisolone daily
Following cessation, the stress response normalizes after 8 weeks