Withdrawing corticosteroids: the stress of the last milligrams

Suppression of the hypothalamo-pituitary-adrenal axis (HPA) is a classic co mplication of corticosteroid therapy. There is some controversy over the co nditions necessary to recover normal HPA activity Most agree that the total duration of treatment the maximal dose, the total cumulative dose and the the rate of withdrawal are ail important factors in predicting HPA suppress ion. Recent studies provide evidence contradicting this opinion. It is now demonstrated that HPA activity is completely recovered as soon as the predn isone dose falls below 5 mg per day, that adrenal function is totally block ed for doses above 7.5 mg per day, and that an intermediary response to syn actene is obtained for daily doses of 7.5 to 5 mg. It is thus reasonable to conclude that corticosteroid therapy can be safely withdrawn when the dail y dose is less than 5 mg and, if a higher dose is given, a temporary increm ent would be indicated in case of stress.