Pituitary–Adrenal Function during Corticosteroid Therapy: Learning to Live with Uncertainty

THIS issue of the Journal contains a report by Schlaghecke et al. on the responsiveness of the hypothalamic—pituitary—adrenocortical (HPA) axis in patients treated daily with corticosteroids. 1 The authors demonstrate that testing with corticotropin-releasing hormone (CRH) is nearly as useful as the insulin hypoglycemia test in assessing the function of the HPA axis in patients undergoing long-term corticosteroid therapy. 1 They also demonstrate something more important: the incorrectness of our long-held assumption that a large daily dose of corticosteroid and prolonged treatment correlate dependably with HPA suppression. 1 Happily, the study by Schlaghecke et al. is free of many of the defects that . . .