Oral Glucocorticoid Withdrawal and Assessment of the Hypothalamic-Pituitary-Adrenal Axis

Oral glucocorticoids are widely used in clinical practice and represent the basis for the treatment of numerous inflammatory, autoimmune and respiratory diseases. However, its therapeutic actions are counterbalanced by side effects, which include the risk of developing cortico-adrenal insufficiency. Glucocorticoid potency, dose, and duration are important but imperfect predictors of hypothalamic-pituitary-adrenal axis suppression. In general, the longer the treatment time with glucocorticoid and the greater its potency, the greater the risk of suppression. In these circumstances, it is necessary that the dose reduction be gradual and the hypothalamic-pituitary-adrenal axis be tested throughout the process of dose reduction and withdrawal. There is currently no clinical guideline defined by scientific societies for reducing the dose of glucocorticoid, with different schemes proposed in the literature. This article therefore intends to present an up-to-date and practical review of how to safely discontinue corticosteroid therapy.