Paper II
2023 March (Supplementary) (2010 Scheme)

Question

Tapering dose of Glucocorticoids after prolonged therapy rather than stopping it abruptly

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Answer

Prolonged exogenous glucocorticoid therapy suppresses the hypothalamic-pituitary-adrenal (HPA) axis through negative feedback, causing the adrenal cortex to atrophy and lose its normal capacity to produce endogenous cortisol. If the drug is stopped abruptly, the suppressed adrenal glands cannot immediately resume adequate cortisol production, precipitating an acute adrenal (Addisonian) crisis — hypotension, shock, hypoglycemia, which can be life-threatening. Tapering the dose gradually allows the HPA axis time to recover its own responsiveness and endogenous cortisol production before exogenous supply is fully withdrawn.

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