What is the recommended management step for iatrogenic Cushing syndrome to avoid an Addisonian crisis?

What is the recommended management step for iatrogenic Cushing syndrome to avoid an Addisonian crisis?

• A. Abrupt cessation of steroids.
• B. Gradual tapering of steroids.
• C. Increase the dose of steroids.
• D. Switch to a mineralocorticoid.

Answer: (B)

Chronic use of glucocorticoids suppresses the hypothalamic-pituitary-adrenal axis, so the body reduces or stops its own ACTH and the adrenal glands atrophy. If you stop steroids abruptly, there isn’t enough endogenous cortisol to meet the body’s needs, especially under stress, leading to an Addisonian (adrenal) crisis with low blood pressure and shock. The safest and most effective way to prevent that is to taper the steroid dose gradually, giving the HPA axis time to recover and re‑start normal cortisol production. The taper should be tailored to how long and how high the dose was, with slower reductions if the therapy was prolonged or high-dose, and close monitoring for withdrawal or signs of adrenal insufficiency. Abruptly increasing the dose or stopping it outright would not prevent crisis and can worsen the problem, while switching to a mineralocorticoid does not restore endogenous cortisol production.

Chronic use of glucocorticoids suppresses the hypothalamic-pituitary-adrenal axis, so the body reduces or stops its own ACTH and the adrenal glands atrophy. If you stop steroids abruptly, there isn’t enough endogenous cortisol to meet the body’s needs, especially under stress, leading to an Addisonian (adrenal) crisis with low blood pressure and shock. The safest and most effective way to prevent that is to taper the steroid dose gradually, giving the HPA axis time to recover and re‑start normal cortisol production. The taper should be tailored to how long and how high the dose was, with slower reductions if the therapy was prolonged or high-dose, and close monitoring for withdrawal or signs of adrenal insufficiency. Abruptly increasing the dose or stopping it outright would not prevent crisis and can worsen the problem, while switching to a mineralocorticoid does not restore endogenous cortisol production.