Hypothalamic-pituitary-adrenal function one week after a short burst of steroid therapy

"Steroid burst therapy" is commonly used for various acute medical conditions, but its suppressive effect on hypothalamic-pituitary-adrenocortical (HPA) function and the time period for recovery of HPA function is not fully known. We therefore evaluated the HPA function in 10 normal adults before and after a short burst of Prednisone (40 mg/three times daily for 3 days, then tapered over the next 4 days). HPA function was evaluated by iv administration of 100 micrograms of ovine CRH (oCRH) and blood samples for ACTH and cortisol assay were obtained at -30,0,10,15,30,60,90, and 120 min. On another day, 250 micrograms synthetic ACTH (Cosyntropin) were given iv and blood samples for cortisol were obtained at 0,30,60, and 90 min. Basal and peak levels of ACTH and cortisol before and 1,2, and 3 weeks after discontinuation of prednisone in response to oCRH iv are shown below (see Table 1). All values are mean (SEM). Peak levels of cortisol after iv administration of Cosyntropin at week 0 were 922(56.8), week 1 899(63.7), week 2 861(70.9), and week 3 855(53.0). There was no significant difference noted in the levels of ACTH and cortisol in response to oCRH before and after prednisone treatment. Pre- and posttreatment responses of cortisol to Cosyntropin administration were also similar. In addition, cumulative responses (area under the curve) and the change from baseline (delta) before and after administration of prednisone were similar for ACTH and cortisol. We conclude that HPA function is normal 1 week after discontinuation of a short burst of prednisone. These findings suggest that administration of additional steroids may not be required during periods of "stress" for those patients who have previously received similar steroid burst therapy, if at least 1 week has elapsed after such treatment was given.