Why is abrupt cessation of long-term high-dose corticosteroid therapy risky?

• A. It increases lymphocytes.
• B. It suppresses the hypothalamic-pituitary-adrenal axis.
• C. It increases cortisol production.
• D. It reduces immune function.

Answer: (B)

Abruptly stopping long‑term high‑dose corticosteroids is dangerous because these medications suppress the hypothalamic‑pituitary‑adrenal (HPA) axis. With chronic use, negative feedback reduces CRH, ACTH, and, over time, adrenocortical atrophy occurs. If the steroids are stopped suddenly, the adrenal glands may not be able to produce enough endogenous cortisol to meet the body's needs, especially during stress, illness, or injury. This can trigger adrenal insufficiency or an adrenal crisis, characterized by symptoms such as fatigue, weakness, low blood pressure, hypoglycemia, abdominal pain, and shock.

The important takeaway is that the risk is not about increasing cortisol or boosting immune function; it’s about the body's own cortisol production being suppressed and failing to respond when the external source is removed. This is why gradual tapering is essential to allow the HPA axis to recover and resume normal cortisol production.