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Glucocorticoid-induced adrenal insufficiency — SCE Endocrinology MCQ

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ModerateAdrenalGlucocorticoid-induced adrenal insufficiencySCE Endocrinology

A 45-year-old woman with rheumatoid arthritis has taken prednisolone 10 mg daily for 8 months. She wants to stop suddenly because her arthritis has improved. 09:00 cortisol after withholding the morning dose is 105 nmol/L. What is the most appropriate management?

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Correct answer: B — Taper glucocorticoids and assess adrenal recovery with endocrine guidance

Taper glucocorticoids and assess adrenal recovery with endocrine guidance is best because long-term glucocorticoids can suppress the HPA axis, and low morning cortisol supports cautious tapering and recovery assessment. The alternatives are less appropriate because abrupt cessation risks crisis; fludrocortisone does not replace cortisol; levothyroxine is unrelated and may worsen cortisol need; metyrapone is not recovery therapy. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: NICE NG243