Practical guidance for stopping glucocorticoids.

Abstract

Glucocorticoids can be stopped abruptly, without tapering, in patients prescribed them for less than 3 to 4 weeks. Prolonged glucocorticoid use (more than 3 to 4 weeks) can cause hypothalamic-pituitary-adrenal (HPA) axis suppression, necessitating gradual stopping (tapering) to prevent the consequences of adrenal insufficiency. For some patients on prolonged glucocorticoids, the dosage can be tapered and stopped without testing serum cortisol concentrations. For some patients on prolonged glucocorticoids, morning serum cortisol testing can be used to assess HPA axis recovery and guide glucocorticoid cessation. Further testing of the HPA axis, with an adrenocorticotrophic hormone stimulation test, and referral to endocrinology services may be required in patients with repeated low cortisol concentrations despite a prolonged period at a physiological glucocorticoid dose.