4
Management
Recommendation 2.4
➤ We recommend against routine testing for adrenal insufficiency in
patients on supraphysiologic doses of glucocorticoids, or if they are
still in need of glucocorticoid treatment for the underlying disease.
(GCP)
Recommendation 2.5
➤ We suggest that patients taking long-acting glucocorticoids (e.g.,
dexamethasone or betamethasone) should be switched to shorter-
acting glucocorticoids (e.g., hydrocortisone or prednisone) when long-
acting glucocorticoids are no longer needed. (
⊕
)
Recommendation 2.6
➤ We suggest that patients on a physiologic daily dose equivalent, and
aiming to discontinue glucocorticoid therapy, either:
1. continue to gradually taper the glucocorticoid dose, while being monitored
clinically for signs and symptoms of adrenal insufficiency, or
2. be tested with a morning serum cortisol. (
⊕
)
Recommendation 2.7
➤ If confirmation of recovery of the HPA axis is desired, we recommend
morning serum cortisol as the first test. The value of morning serum
cortisol should be considered as a continuum, with higher values more
indicative of HPA axis recovery. (
⊕
)
As a guide:
1. we suggest that the test indicates recovery of the HPA axis if cortisol is >300
nmol/L or 10 μg/dL and glucocorticoids can be stopped safely;
2. we suggest that if the result is between 150 nmol/L or 5 μg/dL and 300 nmol/L
or 10 μg/dL, the physiologic glucocorticoid dose should be continued, and the
morning cortisol repeated after an appropriate time period (usually weeks to
months);
3. we suggest that if the result is <150 nmol/L or 5 μg/dL, the physiologic
glucocorticoid dose should be continued, and the morning cortisol repeated after
a few months.
