How long
after discontinuation of steroids should a patient be considered adrenally
suppressed and treated accordingly?
The duration and dose of steroid therapy
determine the duration and degree of suppression that results. Short courses of
high doses of prednisone, such as may be administered to treat poison ivy
(e.g., prednisone 50 mg per day for 5 days), have been shown to cause abnormal
response to ACTH stimulation testing for up to 5 days. Recovery after prolonged
exposure to oral steroids is highly variable, but may take as long as 1 year.
Exposure to lower doses of steroids from inhalers and enemas results in an
unknown degree of adrenal suppression. In the absence of ACTH testing, the
underlying principles this author adheres to are as follows: (1) only the most
major of surgi-cal procedures require doses of hydrocortisone in the 200 mg per
day range for 2 or more days; (2) 1–2 day courses of intermediate-dose steroids
carry very little risk; (3)a common anti-nausea prophylactic dose of
dexa-methasone (e.g., 8 mg IV) alone will more than suffice to treat adrenal
suppression in almost all commonly per-formed surgeries including hernia
repair, cholecystectomy, lumpectomy, and hysterectomy.
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