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HPA Axis Suppression — SCE Rheumatology MCQ

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EasyRheumatology PharmacologyHPA Axis SuppressionSCE Rheumatology

A 55-year-old woman with RA on long-term low-dose Prednisolone (5 mg daily for 3 years) develops adrenal insufficiency symptoms when her Prednisolone is stopped abruptly for surgery. What is the mechanism?

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Correct answer: B — Chronic exogenous glucocorticoid use suppresses the hypothalamic-pituitary-adrenal (HPA) axis; abrupt withdrawal can cause adrenal crisis with hypotension collapse and potentially death

Even low-dose Prednisolone (≥5 mg daily for >3 weeks) can suppress the HPA axis. BSR guidelines and anaesthetic guidance recommend that patients on long-term glucocorticoids should NOT have their steroids stopped abruptly. For major surgery parenteral hydrocortisone cover (typically 50-100 mg IV at induction then 25-50 mg 8-hourly for 24-72 hours) is recommended. Gradual tapering (typically 1 mg per month below 10 mg) allows HPA axis recovery. Morning cortisol testing and/or Synacthen testing can assess adrenal reserve before stopping steroids. Patients should carry a steroid emergency card.

Reference: BSR 2025 csDMARD guidelines; RCP/RCoA perioperative steroid guidance