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Several weeks of exogenous glucocorticoid therapy are typically required for development of adrenal insufficiency (Salvatori, 2005; Chrousos, 2015). Longer-acting glucocorticoids, and higher doses of systemic glucocorticoids (vs topical or inhaled formulations) have been associated with a higher risk of developing adrenal suppression. There are no current evidence-based guidelines regarding the optimal method for discontinuing glucocorticoid therapy, although gradual tapering of dosages over a period of weeks to months, prior to complete discontinuation, is recommended to allow time for recovery of the hypothalamic-pituitary-adrenal axis (Liu et al, 2013).

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