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Practical guidance for stopping glucocorticoids.

Faran Khalili1,2, Morton G Burt1,2

  • 1Southern Adelaide Diabetes and Endocrine Services, Flinders Medical Centre, Adelaide.

Australian Prescriber
|August 27, 2025
PubMed
Summary
This summary is machine-generated.

Glucocorticoids used short-term can be stopped abruptly. Prolonged use requires gradual tapering to prevent adrenal insufficiency, with cortisol testing guiding cessation for some patients.

Keywords:
HPA axisadrenal insufficiencydrug taperingglucocorticoid withdrawal syndromeglucocorticoids

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Area of Science:

  • Endocrinology
  • Pharmacology

Background:

  • Glucocorticoids are commonly prescribed medications.
  • Short-term use (less than 3-4 weeks) generally does not require dose tapering.
  • Prolonged use can lead to hypothalamic-pituitary-adrenal (HPA) axis suppression.

Purpose of the Study:

  • To outline the management of glucocorticoid cessation.
  • To identify criteria for tapering versus abrupt cessation.
  • To describe methods for assessing HPA axis recovery.

Main Methods:

  • Review of literature on glucocorticoid withdrawal.
  • Clinical guidelines for HPA axis assessment.
  • Case studies illustrating different cessation protocols.

Main Results:

  • Abrupt cessation is safe for short-term glucocorticoid users.
  • Prolonged use necessitates gradual tapering to avoid adrenal insufficiency.
  • Morning serum cortisol testing can guide cessation in some patients.
  • Adrenocorticotrophic hormone stimulation tests may be required for persistent HPA axis dysfunction.

Conclusions:

  • The duration of glucocorticoid therapy dictates the cessation strategy.
  • HPA axis assessment is crucial for safe glucocorticoid withdrawal after prolonged use.
  • Individualized patient monitoring and testing ensure optimal outcomes.