Why must patients taper off corticosteroids?

Patients must taper off corticosteroids primarily to prevent adrenal insufficiency. Corticosteroids, such as prednisone, can suppress the hypothalamic-pituitary-adrenal (HPA) axis when taken in high doses or for extended periods. This suppression leads to a decreased production of adrenal hormones, particularly cortisol, because the body becomes reliant on the external source of steroids.

When corticosteroids are suddenly discontinued, the adrenal glands may not respond quickly enough to meet the body's physiological needs, resulting in inadequate cortisol levels. This condition, known as adrenal insufficiency, can lead to symptoms such as fatigue, weakness, nausea, vomiting, and in severe cases, it can be life-threatening. Therefore, tapering the medication allows the adrenal glands to gradually resume their normal function and hormone production, ensuring a safe transition off the medication without experiencing adrenal crisis.