Endocrine Abstracts

Background: Long-term glucocorticoid therapy can lead to adrenal suppression, making steroid tapering difficult and increasing the risk of adrenal insufficiency. A cautious and individualized approach is often required, particularly in patients who have previously failed standard tapering regimens.

Case Presentation: We describe a 45-year-old female with Still’s disease in remission who had been on long-term prednisolone therapy for over 13 years. The patient was hesitant to attempt further steroid reduction after unsuccessful tapering attempts, confirmed by a short synacthen test (SST) in December 2024 showing adrenal suppression (baseline cortisol 160 nmol/l; 30-minute cortisol 232 nmol/l). She also expressed concern about experiencing fatigue or instability, as her role as a counsellor requires full mental alertness and emotional stability. An individualized tapering plan using Meeran’s protocol was implemented to allow gradual adrenal recovery. Over two months, she successfully reduced her dose from 3 mg daily to 2 mg on alternate days and 1 mg on the off days. The patient tolerated this regimen well, reporting no symptoms of adrenal insufficiency or postural hypotension. Blood pressure remained within normal limits. A follow-up SST showed marked improvement (baseline cortisol 340 nmol/l; 30-minute cortisol 593 nmol/l). She remains clinically stable, adheres to sick day rules, and continues regular endocrine follow-up.

Conclusion: This case illustrates the value of a slow, patient-centred steroid tapering approach supported by clear education and multidisciplinary monitoring. The successful use of Meeran’s protocol demonstrates that individualized tapering regimens can safely restore adrenal function and improve patient confidence during long-term glucocorticoid withdrawal.