Can someone experience adrenal withdrawal after a prednisone (corticosteroid) taper of 25 mg, 25, 20, 20, 10, 10, 5, 5?

Adrenal Withdrawal After Short-Term Prednisone Taper

Yes, a person can experience adrenal withdrawal symptoms after completing a prednisone taper of 25 mg, 25,20,10,5 mg, even though this is a relatively short course. 1

Understanding Adrenal Withdrawal Risk

The risk of adrenal insufficiency after glucocorticoid therapy depends on several factors:

• Duration of therapy: Even short-term therapy (<4 weeks) can cause hypothalamic-pituitary-adrenal (HPA) axis suppression 2
• Dose: The described taper starts at 25 mg, which exceeds the threshold of 7.5 mg daily that can cause HPA suppression 3
• Tapering schedule: While this taper does gradually reduce the dose, it may still be too rapid for some individuals 1

Symptoms of Adrenal Withdrawal

Patients experiencing adrenal withdrawal may present with:

• Fatigue and lethargy
• Nausea, poor appetite, and weight loss
• Dizziness, especially when standing (orthostatic hypotension)
• Muscle weakness and joint pain
• Mood changes, including anxiety and depression
• Low blood pressure
• Hyperpigmentation (in some cases) 4

Risk Assessment

The described prednisone taper has several features that increase the risk of adrenal withdrawal:

1. The total duration appears to be 8 days (assuming one day per dose), which is less than 14 days but still sufficient to cause temporary HPA axis suppression 5
2. The starting dose of 25 mg exceeds the physiologic replacement dose (15-20 mg hydrocortisone equivalent) 4
3. The taper reduces the dose by 50% from 10 mg to 5 mg, which is a significant reduction at the lower end 1

Management Recommendations

If a patient experiences symptoms of adrenal withdrawal after completing this taper:

1. Evaluate for adrenal insufficiency: Check morning cortisol levels; levels below 270 nmol/L (approximately 10 μg/dL) suggest possible adrenal insufficiency 6

2. Temporary reinstitution of glucocorticoids: If symptoms are significant, restart prednisone at 5-10 mg daily and taper more gradually over 2-4 weeks 4, 1

3. Stress dosing education: Teach patients to increase their dose during illness or stress (e.g., double or triple their maintenance dose) 4

4. Monitoring: Follow patients closely during the tapering period for recurrence of withdrawal symptoms 1

Prevention Strategies

For future steroid courses:

• For courses lasting more than 14 days, implement a more gradual taper 1
• Consider alternate-day therapy when possible to reduce HPA axis suppression 5
• Avoid abrupt discontinuation of steroids after any course lasting more than a week 5
• Use the lowest effective dose for the shortest duration possible 5

Important Caveats

• Symptoms of adrenal withdrawal can mimic the underlying condition being treated, making diagnosis challenging 7
• Adrenal recovery can take months after prolonged steroid use, but typically occurs within weeks after short-term therapy 3
• Patients with previous exposure to glucocorticoids may have increased risk of adrenal insufficiency with subsequent courses 2

Remember that while this prednisone taper is relatively short, it still carries a risk of causing temporary adrenal insufficiency, and patients should be monitored for withdrawal symptoms.