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Old 11-24-2013
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Drug Chronic glucocorticoid treatment

In uworld it is written that prednisolone chronic treatment decrease CRH, ACTH and also cortisol.
BUT why cortisol is decresing it should be increase as we are giving exogenous cortisol(i.e prednisolone)
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Old 11-24-2013
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I remember the qs. It is quite different because it talks about a pt under prednisolone that is doing a surgical procedure.

We know that in particular situation such as stress, surgical procedure, infection and so on there is an increase in cortisol release (endogenous). However the pt is under steroid so he can not have a normal cortisol stress-related release (the exogenous steroid inhibits via negative feedback both the hypothalamus and the pituitary) thus compared to a normal subject this pt will have a decrease in crh, acth and cortisol.

By the way during infection or surgical procedures, the steroid dosage in a pt under chronic trt should be increased to prevent this kind of situation.
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Endocrine-, Pharmacology-, Physiology-

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