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.