Which one of the following is the true statement regarding adrenal suppression secondary to steroid therapy?
Supression of hypothalamo pituitary axis occur depending on the dose and duration of therapy. It occurs when hydrocoisone (>20-25mg/day) or equivalent is given for more than 2-3weeks. Prednisolone is 5 times more potent than hydrocoisone and therefore 5 mg prednisone is equivalent to 25 mg Hydrocoisone. Thus, suppression of HPA should be expected in any patient who has received > 5mg prednisolone/day for more than 2- 3 weeks. With the administration of steroids adrenal coex atrophies, and stoppage of exogenous steroid can precipitate a withdrawal syndrome. Withdrawal syndrome is characterized by fever, malaise, weakness, pain in muscles and joints, and reactivation of the disease. When subjected to stress these patients undergo acute adrenal insufficiency. Ref: Essentials of Medical Pharmacology, 5th Edition, Page 265; Pharmaceutical Innovation: Revolutionizing Human Health By Ralph Landau, Page 245; Asthma Care in the Community By Jill Waldro, Page 58
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 > 5mg, Prednisolone daily
Following cessation, the stress response normalizes after 8 weeks