Assessment of the hypothalamic-pituitary-adrenal axis function after corticosteroid therapy for MS relapses

Doses of corticosteroids usually given for relapses of MS are able to suppress the hypothalamic-pituitary-adrenal (HPA) axis. We evaluated HPA axis function using rapid ACTH stimulation and rapid overnight metyrapone tests, just after cessation of regular oral prednisone therapy for relapses in 14 MS patients. Nine additional patients treated with i.v. boluses of methylprednisolone before beginning conventional oral therapy were also evaluated. Sixteen patients had normal response to both tests and 6 patients had only a discordant response to one test. These data indicate that most patients had normal HPA axis function, which make corticosteroid replacement unnecessary after cessation of therapy for relapses.