My patient on Steroids..

You are called for preoperative clearance of a patient who has taken 20 mg of prednisone daily for 2 weeks.

Should you be concerned about HPA axis suppression?

How long does it take prednisone to suppress the HPA axis?

Many sources cite that 3 weeks of daily therapy (of ≥20 mg) is needed to cause clinical blunting of the HPA axis. But the evidence base for this practice is unclear. Below we present 2 small studies of chemical – but not necessarily clinical – HPA suppression.

• In a small study of 10 healthy patients, Carella et al. found no HPA suppression 1 week after completing a 1 week course of prednisone (40 mg/three times daily for 3 days, then tapered over the next 4 days).

• In a small study of 9 COPD patients treated with 2 weeks of steroids, Schuetz et al. found HPA suppression up to 21 days after completing the course (40 mg of methylprednisolone, followed by an oral 13-day regime of 40 mg prednisone).

Schuetz P, Christ-Crain M, Schild U, et al. Effect of a 14-day course of systemic corticosteroids on the hypothalamic-pituitary-adrenal-axis in patients with acute exacerbation of chronic obstructive pulmonary disease. BMC Pulm Med. 8:1-1.
Carella MJ, Srivastava LS, Gossain VV, Rovner DR. Hypothalamic-pituitary-adrenal function one week after a short burst of steroid therapy. J. Clin. Endocrinol. Metab. 1993;76(5):1188-1191. Available at: http://www.ncbi.nlm.nih.gov/pubmed/8388401 [Accessed January 4, 2011].