Question

A patient has been on daily, high-dose glucocorticoid therapy for the treatment of rheumatoid arthritis. His prescription runs out before his next appointment with his physician. Because he is asymptomatic, he thinks it is all right to withhold the medication for 3 days. What is likely to happen to this patient?

a. He will go into adrenal crisis.
b. He will go into thyroid storm.
c. His autoimmune disease will go into remission.
d. Nothing; it is appropriate to stop the medication for 3 days.

Answer 1

Abruptly stopping high-dose glucocorticoid therapy can lead to adrenal crisis due to the body's inability to quickly resume natural cortisol production. Long-term use suppresses adrenal function, and these medications should be tapered off under a doctor's guidance.

Step-by-step explanation:

If a patient who has been on daily, high-dose glucocorticoid therapy for rheumatoid arthritis suddenly stops taking the medication, it is likely they will go into adrenal crisis. Glucocorticoids, such as cortisol, are essential for many physiological processes and abruptly discontinuing them can result in insufficient cortisol production. This can cause severe symptoms due to the sudden drop in circulating cortisol levels necessary to regulate the body's metabolic functions.

Long-term glucocorticoid therapy suppresses the natural production of cortisol by the adrenal glands. If the medication is discontinued abruptly, the body may not be able to resume production quickly enough, leading to symptoms of adrenal insufficiency. These symptoms can include fatigue, dizziness, hypotension, and can escalate to a life-threatening condition known as an adrenal crisis. Therefore, glucocorticoid medications should always be tapered off under medical supervision, not stopped cold turkey.