Systemic Corticosteroid Therapy And The Hypothalamopituitary-Adrenal Axis

Abstract

Adrenal crisis due to suppression of the HPA axis by systemic corticosteroid therapy is a much feared complication which, however, appears to be quite uncommon. In an individual patient, the status of the HPA axis cannot be reliably predicted based on the dose and duration of therapy. Further, the response to stress does not always correlate with the results of tests of HPA function. However, HPA axis suppression is generally associated with daily dosing, high doses and prolonged duration of therapy. The dose, duration and schedule of administration of corticosteroids should be tailored to the needs of the individual patient and his disease. HPA axis suppression need not be considered in acute, inflammatory diseases. In other steroid-responsive dermatoses, intermittent dosing schedules are likely to produce fewer side effects including suppression of the HPA axis. As a measure of caution, patients who have received systemic corticosteroids in the past may be administered supplemental corticosteroids during stressful situations (though not all of them will need it).