Plasma “cortisol” response to Synacthen in patients on long-term small-dose prednisone therapy.

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Abstract
Thirty-nine patients on prolonged low doses of steroids were studied by the Synacthen test for evidence of adrenal suppression. Four had unequivocally abnormal tests. No abnormality occurred before the end of 1 year, but thereafter there was no relationship between total dose, total time, and onset of suppression. Nineteen of the patients were re-tested after an interval of 1 year to assess the effects of altered or continued steroid therapy. The dose level of 5 mg/day prednisolone is not free of the danger of adrenal suppression. The variation in individual sensitivity is so great that predictions cannot be made, and each patient must be treated separately. Adrenal function proceeds as might be expected from a simple dose-response relationship when studied over a period of time, but individual variability is evident.