Question: I was on prednisone for 2 months due to breathing difficulties and developed Cushing’s symptoms during treatment. I then tried to taper off unsuccessfully and am now on hydrocortisone. Can profound HPA axis suppression or permanent damage be caused in such a short period of time?

Answer: Administration of high doses of prednisone or other similar drugs (called glucocorticoids) for more than 10 days can put to rest the normal pituitary ACTH producing cells and thus decrease cortisol production by the adrenals. The importance of HPA axis suppression depends mostly on the amount of prednisone (more suppression with 50 mg than with 10 mg daily) and importantly on the duration of its administration (more after several weeks than after a few days). There is also some variability between different individuals as to their sensitivity to administration of glucocorticoids. Some individuals appear to develop signs of cortisol excess and suppression of their HPA axis more than others and this may be related to the sensitivity of the cortisol receptors in their tissues. Recovery of the HPA axis may take only a few weeks when excess cortisone was of short duration, but patients on glucocorticoids for many years may require 1-2 years to recover their HPA axis while on hydrocortisone replacement (20 mg in morning).

By Dr. Andre Lacroix MD (Summer, 2012)