Which clinical scenario places a client at risk for adrenal insufficiency due to corticosteroid therapy?

• A. GI bleeding symptoms such as hematemesis and melena.
• B. Gallbladder disease symptoms such as RUQ pain and clay stools.
• C. Asthma symptoms with wheezing and shortness of breath.
• D. Edema with weight gain and JVD.

Answer: (C)

Exogenous corticosteroids can suppress the hypothalamic-pituitary-adrenal (HPA) axis when used long term. This means the body reduces its own cortisol production, so if the steroids are tapered too quickly or if the patient faces major stress (illness, surgery) the body may not mount an adequate cortisol response, leading to adrenal insufficiency or crisis. In asthma management, patients who require ongoing corticosteroids—whether inhaled for maintenance or systemic for severe episodes—have the potential for this suppression over time.

So, a client with asthma symptoms who is receiving corticosteroid therapy is at risk because of the possibility of HPA-axis suppression with prolonged use. The other scenarios describe GI or biliary issues or fluid overload, which do not reflect exposure to corticosteroids and thus do not indicate adrenal suppression risk. If corticosteroids are being used long term, clinicians monitor for signs of insufficiency and plan gradual tapering with appropriate stress-dose coverage if needed.