Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Aug;48(4):116-121.
doi: 10.18773/austprescr.2025.037.

Practical guidance for stopping glucocorticoids

Faran Khalili  1   2 , Morton G Burt  1   2
Affiliations
Review

Practical guidance for stopping glucocorticoids

Faran Khalili et al. Aust Prescr. 2025 Aug.

Abstract

Glucocorticoids can be stopped abruptly, without tapering, in patients prescribed them for less than 3 to 4 weeks. Prolonged glucocorticoid use (more than 3 to 4 weeks) can cause hypothalamic-pituitary-adrenal (HPA) axis suppression, necessitating gradual stopping (tapering) to prevent the consequences of adrenal insufficiency. For some patients on prolonged glucocorticoids, the dosage can be tapered and stopped without testing serum cortisol concentrations. For some patients on prolonged glucocorticoids, morning serum cortisol testing can be used to assess HPA axis recovery and guide glucocorticoid cessation. Further testing of the HPA axis, with an adrenocorticotrophic hormone stimulation test, and referral to endocrinology services may be required in patients with repeated low cortisol concentrations despite a prolonged period at a physiological glucocorticoid dose.

Keywords: HPA axis; adrenal insufficiency; drug tapering; glucocorticoid withdrawal syndrome; glucocorticoids.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest: Faran Khalili has received honoraria from Boehringer, Novo Nordisk and AstraZeneca for lectures on sodium-glucose co-transporter 2 inhibitors in diabetes and glucagon-like peptide-1 agonist therapy for weight management. Morton Burt has no conflicts to declare.

Figures

Figure 1
Figure 1
Hypothalamic–pituitary–adrenal (HPA) axis
Figure 2
Figure 2
Stopping glucocorticoids when no longer therapeutically required
See this image and copyright information in PMC

References

    1. Nicolaides NC, Pavlaki AN, Maria Alexandra MA, Chrousos GP. Glucocorticoid Therapy and Adrenal Suppression. In: Feingold KR, Anawalt B, Blackman MR, Boyce A, Chrousos G, Corpas E, et al. Endotext. South Dartmouth (MA); 2000. https://www.ncbi.nlm.nih.gov/pubmed/25905379 - PubMed
    1. Alexandraki KI, Kaltsas GA, Chrousos GP. Adrenal Suppression. In: Feingold KR, Anawalt B, Blackman MR, Boyce A, Chrousos G, Corpas E, et al. Endotext. South Dartmouth (MA); 2000. https://www.ncbi.nlm.nih.gov/pubmed/25905276
    1. Drouin J, Trifiro MA, Plante RK, Nemer M, Eriksson P, Wrange O. Glucocorticoid receptor binding to a specific DNA sequence is required for hormone-dependent repression of pro-opiomelanocortin gene transcription. Mol Cell Biol 1989;9:5305-14. 10.1128/mcb.9.12.5305-5314.1989 - DOI - PMC - PubMed
    1. Glucocorticoid induced adrenal insufficiency. BMJ 2021;374:n1936. 10.1136/bmj.n1936 - DOI - PubMed
    1. Beuschlein F, Else T, Bancos I, Hahner S, Hamidi O, van Hulsteijn L, et al. European Society of Endocrinology and Endocrine Society Joint Clinical Guideline: Diagnosis and Therapy of Glucocorticoid-induced Adrenal Insufficiency. J Clin Endocrinol Metab 2024;109:1657-83. 10.1210/clinem/dgae250 - DOI - PMC - PubMed

LinkOut - more resources