Conclusion
Although glucocorticoids are effective anti-inflammatory drugs, long
term use at even low doses has potential to cause harmful adverse
reactions. A key principle of therapy is to use glucocorticoids at as
low as dose and for as short a duration as possible to control disease
to limit these adverse effects. However glucocorticoid withdrawal is
also fraught with risk, including loss of disease control and end-of-use
adverse effects, including the potential for life-threatening adrenal
insufficiency. Steroid sparing strategies, glucocorticoid-tapering
regimens and a low index of suspicion for HPA axis suppression are key
to the safe and effective withdrawal of long term glucocorticoids.