Primary prevention
It is important to use the lowest dose of glucocorticoid for the shortest time needed to treat an underlying disease and to re-evaluate the dose and need regularly.[29] Administration of corticosteroids in the morning rather than at night, especially when using short-acting corticosteroids, will help mimic the normal diurnal cortisol rhythm and allow for corticotropin-releasing hormone and adrenocorticotropic hormone secretion. An alternate-day corticosteroid regimen can also help prevent adrenal suppression.[30] The use of superpotent topical corticosteroids should be limited to 50 grams per week for a maximum of 2 to 4 weeks to reduce the risk of Cushing's syndrome and pathological adrenal suppression.[31] Whenever possible, alternative non-systemic routes of administration should be considered, and every effort should be made to minimise systemic absorption.
Secondary prevention
In diseases for which glucocorticoids have traditionally been part of the treatment armamentarium but for which there are non-corticosteroid management options, consideration should be given to these alternatives after weighing up possible risks and benefits. An example is the use of disease-modifying antirheumatic drugs for rheumatoid arthritis.[60]
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