How do you discontinue steroid therapy in patients who have been on it for less than 3-4 weeks and the underlying condition is controlled?
0%Stop
0%Taper
The European Society of Endocrinology and the Endocrine Society have issued joint guidelines for managing glucocorticoid-induced adrenal insufficiency. Key recommendations include:
No tapering is needed if steroid therapy is <3–4 weeks regardless of the dose.
For therapy >3–4 weeks, tapering is advised to minimize withdrawal symptoms and aid hypothalamic-pituitary-adrenal recovery.
For doses >40 mg prednisone equivalent, reduce by 5–10 mg weekly.
For doses <40 mg, reduce by 2.5 mg every 1–4 weeks for 10–20 mg daily doses, and by 1 mg every 1–4 weeks for <10 mg daily doses.
Switch from long-acting to short-acting steroids for tapering.
On reaching a physiologic dose (4–6 mg prednisone equivalent), either taper further while monitoring symptoms or check morning serum cortisol (>10 µg/dL allows stopping; <10 µg/dL requires continued tapering and retesting).
Routine dynamic testing is discouraged, recommended only when there's uncertainty about adrenal status. The guideline also covers adrenal crisis management and risks associated with inhaled, topical, or intraarticular steroids. This guideline highlights the need for clinical judgment and individualized patient management during tapering.
European Society of Endocrinology and Endocrine Society Joint Clinical Guideline: Diagnosis and therapy of glucocorticoid-induced adrenal insufficiency | European Journal of Endocrinology | Oxford Academic (oup.com)