27th May 2025

Management

Management of SAI is the same as PAI with respect to acute crisis and in the context of intercurrent illness. There are also recommendations for tapering of glucocorticoids based on the length of treatment. The consensus is that if the duration is <1 week, glucocorticoids can be stopped without need to taper. For a duration of 1 to 3 weeks, tapering should be considered if the dose exceeds 7.5 mg prednisolone per day (or equivalent). For long-term regimens exceeding 3 weeks, it is recommended to taper by 2.5 mg prednisolone every 3 to 4 days until a physiological dose is reached. Once a dose of 2.5 mg prednisolone is reached, morning cortisol levels can be checked, and if normal, glucocorticoids can be stopped.