Adrenal suppression

Patients should be advised to be aware of recurrent symptoms of their original disease. As the dose of corticosteroids is reduced to physiological levels and below, patients should also be instructed to take note of symptoms of adrenal insufficiency. It is important that patients maintain medication compliance because an abrupt decrease or discontinuation of corticosteroid therapy may produce adrenal crisis. A subset of patients may exhibit basal adrenal function with limited adrenal reserves. Therefore, patients should be instructed to advise physicians immediately of their prior corticosteroid use so that the need for stress doses of corticosteroids can be assessed either clinically or by testing. Patients should carry some type of medical alert notification for emergencies. Morning cortisol or stimulation tests can be repeated every few months until the morning cortisol level is >497 nanomol/L (18 micrograms/dL) or the appropriate stimulation test confirms hypothalamic-pituitary-adrenal axis integrity.