What is a valid dosing strategy to avoid HPA suppression in patients on long-term corticosteroid therapy?

A valid dosing strategy to avoid hypothalamic-pituitary-adrenal (HPA) suppression in patients on long-term corticosteroid therapy involves administering a systemic corticosteroid during high-stress situations. This approach aligns with the body's natural response to stress, where cortisol levels rise to help manage the situation. In patients who have been on long-term corticosteroids, the HPA axis may become suppressed due to the external steroid source. During periods of stress—such as surgery, trauma, or severe illness—the body's demand for cortisol increases, and providing supplemental systemic corticosteroids can help mimic the physiological response and prevent adrenal crisis, which can occur when the body is unable to produce adequate cortisol due to HPA suppression.

In contrast, administering corticosteroids only at night may not adequately meet the physiological needs during the day and could worsen suppression. Discontinuing corticosteroids during stressful periods is not advisable, as it increases the risk of adrenal insufficiency when the body requires heightened levels of cortisol. Increasing the daily dosage of corticosteroids does not typically avoid HPA suppression; rather, it can perpetuate the cycle of suppression and dependency. Therefore, the strategy of administering systemic corticosteroids during high-stress situations is the most effective and beneficial approach to manage dosing while mitigating the