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) 1â€“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.