What occurs if prednisone is stopped suddenly after high-dose treatment?

When high-dose prednisone treatment is abruptly discontinued, the body can experience adrenal insufficiency due to the suppression of the hypothalamic-pituitary-adrenal (HPA) axis. Prednisone, a glucocorticoid, acts to mimic cortisol, which normally helps regulate various functions including metabolism, immune response, and stress reaction. During high-dose treatment, the body’s own cortisol production diminishes since the external supply of steroid leads to a feedback inhibition of the HPA axis.

If prednisone is stopped suddenly, the adrenal glands may not resume their normal function immediately, leading to inadequate cortisol levels to meet the body's physiological needs. This results in symptoms associated with adrenal insufficiency, such as fatigue, weakness, hypotension, and in severe cases, adrenal crisis, which can be life-threatening. Therefore, tapering the dose of prednisone gradually is crucial to allow the adrenal glands time to recover and to prevent these complications.

Other choices do not reflect the effects of sudden withdrawal of steroids. An increase in energy levels is unlikely during adrenal insufficiency, improvement in growth rates is not a direct consequence of stopping glucocorticoids, and the risk of infection would typically be increased rather than reduced as corticosteroids suppress the immune system.