During which condition should corticosteroids be administered to minimize adrenal insufficiency?

Administering corticosteroids during high-stress situations is crucial for minimizing adrenal insufficiency because the body's demand for cortisol increases significantly in response to stress. In healthy individuals, the adrenal glands naturally produce more cortisol during stressful events. However, for patients receiving corticosteroids, especially those on long-term therapy, the adrenal glands may not respond adequately due to suppression of the hypothalamic-pituitary-adrenal (HPA) axis.

In stressful conditions—such as surgery, trauma, or severe illness—the risk of adrenal crisis escalates if the body cannot produce enough cortisol on its own. Therefore, it is vital to increase corticosteroid doses during these times to mimic the body’s natural response and prevent complications associated with adrenal insufficiency. In contrast, administering corticosteroids only during times of symptom exacerbation, at a specific time like bedtime, or independently of stress levels could leave patients vulnerable to adrenal insufficiency during critical periods.