💊 Glucocorticoid Stress Dosing & Taper
Glucocorticoid stress dosing by surgical magnitude, adrenal crisis management and long-term tapering, per the Endocrine Society and Woodcock 2020. Browser-side.
Prednisone > 20 mg/day for ≥ 3 weeks implies HPA suppression.
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When to use
Decide who needs stress-dose steroids, how much to give for a given surgery, and how to taper chronic steroids.
How it works
Minor: usual dose ± hydrocortisone 25 mg. Moderate: 50–75 mg/day. Major: 100 mg + 200 mg/24h. Crisis: hydrocortisone 100 mg IV then 200 mg/24h.
Key points
- Prednisone > 20 mg/day for ≥ 3 weeks implies HPA suppression.
- Hydrocortisone is preferred for its mineralocorticoid activity.
- Adrenal crisis: hydrocortisone + isotonic fluids + treat the trigger.
- HPA recovery after a taper can take weeks to months.
References
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| View | Who needs stress dosing |
|---|
→Key pointWho needs stress dosing (HPA suppression risk)
- Low risk (usually none)：Prednisone < 5 mg/day, or any dose < 3 weeks → HPA usually intact (unless crisis features)
- Uncertain：Prednisone 5–20 mg/day ≥ 3 weeks → treat as possibly suppressed or test the HPA axis
- High risk (needs stress dose)：Prednisone > 20 mg/day ≥ 3 weeks, or Cushingoid appearance → assume HPA suppression
| View | Long-term taper |
|---|
→Key pointLong-term steroid taper
- Needs taper：> 3 weeks of supraphysiologic dosing (HPA suppression) needs a gradual taper; < 3 weeks can be stopped directly
- Method：Reduce relatively quickly to physiologic dose (prednisone ~5 mg / hydrocortisone 15–20 mg), then taper slowly
- Recovery：HPA recovery can take weeks to months; supplement during stress in the interim
Frequently asked questions
- What is Glucocorticoid Stress Dosing & Taper?
- Glucocorticoid stress dosing by surgical magnitude, adrenal crisis management and long-term tapering, per the Endocrine Society and Woodcock 2020. Browser-side.
- How is Glucocorticoid Stress Dosing & Taper calculated? What is the core formula?
- Minor: usual dose ± hydrocortisone 25 mg. Moderate: 50–75 mg/day. Major: 100 mg + 200 mg/24h. Crisis: hydrocortisone 100 mg IV then 200 mg/24h.
- When is Glucocorticoid Stress Dosing & Taper used?
- Decide who needs stress-dose steroids, how much to give for a given surgery, and how to taper chronic steroids.
- What are the key clinical points for Glucocorticoid Stress Dosing & Taper?
- Prednisone > 20 mg/day for ≥ 3 weeks implies HPA suppression. Hydrocortisone is preferred for its mineralocorticoid activity. Adrenal crisis: hydrocortisone + isotonic fluids + treat the trigger. HPA recovery after a taper can take weeks to months.
- What are the limits and cautions when using Glucocorticoid Stress Dosing & Taper?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- How is Glucocorticoid Stress Dosing & Taper calculated in practice? Can you show a worked example?
- Inputs: View Who needs stress dosing → Result: Key point Who needs stress dosing (HPA suppression risk)（Low risk (usually none): Prednisone < 5 mg/day, or any dose < 3 weeks → HPA usually intact (unless crisis features), Uncertain: Prednisone 5–20 mg/day ≥ 3 weeks → treat as possibly suppressed or test the HPA axis, High risk (needs stress dose): Prednisone > 20 mg/day ≥ 3 weeks, or Cushingoid appearance → assume HPA suppression） Inputs: View Long-term taper → Result: Key point Long-term steroid taper（Needs taper: > 3 weeks of supraphysiologic dosing (HPA suppression) needs a gradual taper; < 3 weeks can be stopped directly, Method: Reduce relatively quickly to physiologic dose (prednisone ~5 mg / hydrocortisone 15–20 mg), then taper slowly, Recovery: HPA recovery can take weeks to months; supplement during stress in the interim）