<prompt> Which one of the following is true of adrenal suppression due to steroid therapy -It is not associated with atrophy of the adrenal glandsIt does not occur in patients receiving inhaled steroidsIt should be expected in anyone receiving 5 mg, prednisolone dailyFollowing cessation, the stress response normalizes after 8 weeks  <response>: Ans. is c i.e., It should be expected in anyone receiving 5mg, prednisone daily o Any patient who has received 20-25 mgday hydrocoisone or equivalent for longer than 2-3 weeks should be put on a scheme of gradual withdrawl because of suppression of hypothalamic - pitutary-adrenal axis. o 20 mg hydrocoisone is equivalent to 5 mg of Prednisolone. So 5 mg prednisolone or 20-25 mg hydrocoisone causes hypothalmo-pitutary-adrenal axis suppression. About others options o There is atrophy of adrenal coex o Inhaled steroids can also cause adrenal suppression - Goodman Gilman o Many patients recover from several weeks to months, however, in some indils the time to recovery can be one year or longer -- Goodman Gilman . Measures that minimize hypothalamo - pittutary - adrenal axis suppression. Use shoer acting steroids hydrocoisone, prednisolone at the lowest possible dose. Use for shoest period of time. Give the entire daily dose at one time in the morning. Switch to alternate-day-therapy if possible. If possible use local preparations with poor systemic availability beclomethasone, triamcinalone, fluticasone. 