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With chronic glucocorticoid, recovery of HPA axis might take longer.

The hypothalamic-pituitary-adrenal (HPA) axis can be suppressed after a single dose of steroid, but typically recovers quickly.

In addition to being used as a replacement therapy for adrenal insufficiency, glucocorticoids have been widely used for their anti-inflammatory and pharmacological effects in a variety of medical conditions. However, missing the diagnosis could lead to detrimental consequences. The mortality and morbidity associated with secondary adrenal insufficiency depends on the underlying etiology. This may occur due to a variety of reasons including hypothalamic defects, hypopituitarism, defects in synthesis and processing of ACTH and chronic glucocorticoid use. Secondary adrenal insufficiency can result from inadequate stimulation of the adrenal glands due to either insufficiency or inadequate secretion of adrenocorticotropic hormone (ACTH).

Keywords: Adrenal insufficiency glucocorticoid use stimulation test adrenocorticotropic hormone (ACTH) Understanding the effect of exogenous glucocorticoids on the hypothalamic pituitary adrenal axis, recovery of the axis, and tests used to assess the recovery, are crucial to avoid prescribing unnecessary steroid replacement or missing a critical diagnosis with detrimental consequences. Typically, the hypothalamic pituitary adrenal axis recovers after cessation of glucocorticoids, but the timing of recovery can be variable and can take anywhere from 6–12 months. This may lead to secondary adrenal insufficiency. However, chronic glucocorticoid use may lead to suppression of the hypothalamic pituitary adrenal axis through negative feedback. Glucocorticoids were introduced in the 1950s, and have been used for their anti-inflammatory and other pharmacological effects, and also as replacement therapy for adrenal insufficiency. This can be caused by hypopituitarism, central nervous system injury (tumors, radiation, and surgery) or long-term glucocorticoid therapy.