March 20, 1981

Adrenal Corticosteroid Therapy

Author Affiliations

National Asthma Center
National Jewish Hospital & Research Center Denver

JAMA. 1981;245(11):1118. doi:10.1001/jama.1981.03310360010003

To the Editor.—  We are concerned that the conclusions of Klinefelter et al, in their article entitled "Single Daily Dose Prednisone Therapy" (1979;241:2721-2723), tend to minimize the degree of adrenal suppression in their patients and could lead to a false sense of security about the adrenal status of patients receiving this form of therapy. The possible need for supplemental steroids during stress is mentioned only in the abstract and not in the body of the article, where the authors state that the majority of their patients had normal adrenal function, a conclusion not substantiated by their data.The authors use the adrenocorticotropic (ACTH)-stimulation test to evaluate the function of the hypothalamic-pituitary-adrenal (HPA) axis. The test result was considered normal if there was at least a 7-μg/dL rise in plasma cortisol levels. This criterion is not adequate for a conclusion that adrenal function is normal. Barnes et al1 required an