Adrenal suppression

As corticosteroid doses are reduced from supraphysiological to physiological levels, patients should be observed for symptoms related to their original disease state. Once physiological replacement doses are initiated, patients should also be observed for symptoms of adrenal insufficiency such as fatigue, abdominal pain, and weakness. An appropriate stimulation test can be used to assess the hypothalamic-pituitary-adrenal axis at this time. Some physicians prefer obtaining a morning cortisol level and performing a stimulation test only for those patients whose morning cortisol falls within the indeterminate range (110-469 nanomol/L [4-17 micrograms/dL]).