J Endocrinol Metab

Journal of Endocrinology and Metabolism, ISSN 1923-2861 print, 1923-287X online, Open Access

Article copyright, the authors; Journal compilation copyright, J Endocrinol Metab and Elmer Press Inc

Journal website https://jem.elmerpub.com

Original Article

Volume 16, Number 5, October 2026, pages 228-237

Evaluation of Hypothalamic–Pituitary–Adrenal Axis After Short Course of Systemic Steroids

↓ Figure 3. Receiver operating characteristic curve of HPA axis suppression and 8 am cortisol after 3 days of treatment completion (AUC 0.630). HPA: hypothalamic–pituitary–adrenal; AUC: area under the curve.

↓ **Table 1.** Status of HPA Axis During the Study Period
Time after steroid discontinuation	Number tested	HPA axis suppression	HPA axis recovery
HPA: hypothalamic–pituitary–adrenal.
Day 3	121	57 (47.1%)	64 (52.9%)
Day 10	57	18 (31.6%)	39 (68.4%)
Day 17	18	4 (22.2%)	14 (77.8%)
Day 24	4	1 (25.0%)	3 (75.0%)
Day 31	1	0	1 (100%)

↓ Table 1. Status of HPA Axis During the Study Period

Time after steroid discontinuation

Number tested

HPA axis suppression

HPA axis recovery

HPA: hypothalamic–pituitary–adrenal.

Day 3

121

57 (47.1%)

64 (52.9%)

Day 10

18 (31.6%)

39 (68.4%)

Day 17

4 (22.2%)

14 (77.8%)

Day 24

1 (25.0%)

3 (75.0%)

Day 31

1 (100%)

↓ **Table 2.** Comparison of Baseline Parameters of Study Subjects With and Without HPA Axis Suppression (n = 121)
Parameter	Patients with HPA axis suppression (N = 57) (mean ± SD)	Patients with no HPA axis suppression (N = 64) (mean ± SD)	P value
*Significant P value. HPA: hypothalamic–pituitary–adrenal; BMI: body mass index; SD: standard deviation.
Age (years)	41.3 ± 14.72	48.42 ± 13.78	0.007*
Height (cm)	161.35 ± 6.93	159.06 ± 7.28	0.090
Weight (kg)	65.46 ± 10.22	62.81 ± 10.2	0.145
BMI (kg/m²)	25.09 ± 3.15	24.83 ± 3.71	0.583
Sodium (mEq/L)	138.02 ± 3.92	137.45 ± 4.14	0.554
Potassium (mEq/L)	4.08 ± 0.38	4.08 ± 0.38	0.958
Urea (mg/dL)	22.32 ± 6.16	24.28 ± 12.05	0.975
Creatinine (mg/dL)	0.86 ± 0.23	0.91 ± 0.32	0.451
Fasting glucose (mg/dL)	118.88 ± 36.75	128.27 ± 58.98	0.502
Baseline cortisol (µg/dL)	10.43 ± 2.74	11.74 ± 2.93	0.014*
Cumulative steroid dose (mg)	550.18 ± 896.47	1,133.28 ± 1,586.12	0.005*
Total steroid duration (days)	14.23 ± 7.86	17.53 ± 10.58	0.101
Tapering of steroid done	21 (36.84)	40 (62.5)	0.006*

↓ Table 2. Comparison of Baseline Parameters of Study Subjects With and Without HPA Axis Suppression (n = 121)

Parameter

Patients with HPA axis suppression (N = 57) (mean ± SD)

Patients with no HPA axis suppression (N = 64) (mean ± SD)

P value

*Significant P value. HPA: hypothalamic–pituitary–adrenal; BMI: body mass index; SD: standard deviation.

Age (years)

41.3 ± 14.72

48.42 ± 13.78

0.007*

Height (cm)

161.35 ± 6.93

159.06 ± 7.28

0.090

Weight (kg)

65.46 ± 10.22

62.81 ± 10.2

0.145

BMI (kg/m²)

25.09 ± 3.15

24.83 ± 3.71

0.583

Sodium (mEq/L)

138.02 ± 3.92

137.45 ± 4.14

0.554

Potassium (mEq/L)

4.08 ± 0.38

0.958

Urea (mg/dL)

22.32 ± 6.16

24.28 ± 12.05

0.975

Creatinine (mg/dL)

0.86 ± 0.23

0.91 ± 0.32

0.451

Fasting glucose (mg/dL)

118.88 ± 36.75

128.27 ± 58.98

0.502

Baseline cortisol (µg/dL)

10.43 ± 2.74

11.74 ± 2.93

0.014*

Cumulative steroid dose (mg)

550.18 ± 896.47

1,133.28 ± 1,586.12

0.005*

Total steroid duration (days)

14.23 ± 7.86

17.53 ± 10.58

0.101

Tapering of steroid done

21 (36.84)

40 (62.5)

0.006*

↓ **Table 3.** Predictors for HPA Axis Suppression on Day 3 After Completion of Steroid Therapy
Parameters	Adjusted OR	P value	95% CI (lower–upper)
*Significant P value. HPA: hypothalamic–pituitary–adrenal; OR: odds ratio; CI: confidence interval.
Age (years)	0.963	0.015*	0.934–0.993
Baseline cortisol (µg/dL)	0.832	0.013*	0.719–0.962
Tapering done	0.448	0.072	0.187–1.075
Treatment duration (days)	0.982	0.441	0.937–1.029
Cumulative glucocorticoid dose (mg)	0.806	0.029	0.664–0.978

↓ Table 3. Predictors for HPA Axis Suppression on Day 3 After Completion of Steroid Therapy

Parameters

Adjusted OR

P value

95% CI (lower–upper)

*Significant P value. HPA: hypothalamic–pituitary–adrenal; OR: odds ratio; CI: confidence interval.

Age (years)

0.963

0.015*

0.934–0.993

Baseline cortisol (µg/dL)

0.832

0.013*

0.719–0.962

Tapering done

0.448

0.072

0.187–1.075

Treatment duration (days)

0.982

0.441

0.937–1.029

Cumulative glucocorticoid dose (mg)

0.806

0.029

0.664–0.978

↓ **Table 4.** Comparison of Baseline Parameters of Study Subjects With and Without HPA Axis Suppression (N = 57) on Day 10 After Completion of Steroid
Parameter	Patients with HPA axis suppression (N = 18) (mean ± SD)	Patients with HPA axis recovery (N = 39) (mean ± SD)	P value
*Significant P value. HPA: hypothalamic–pituitary–adrenal; SD: standard deviation; BMI: body mass index.
Age (years)	39.83 ± 14.79	41.97 ± 14.83	0.525
Height (cm)	161.33 ± 6.71	161.36 ± 7.11	0.973
Weight (kg)	66.11 ± 10.47	65.15 ± 10.22	0.718
BMI (kg/m²)	25.35 ± 3.32	24.96 ± 3.11	0.565
Sodium (mEq/L)	138.33 ± 3.38	137.87 ± 4.18	0.563
Potassium (mEq/L)	4.11 ± 0.39	4.07 ± 0.38	0.763
Urea (mg/dL)	22.11 ± 6.13	22.41 ± 6.25	0.770
Creatinine (mg/dL)	0.86 ± 0.24	0.86 ± 0.23	0.770
Fasting glucose (mg/dL)	124.61 ± 28.07	116.23 ± 40.19	0.097
Baseline cortisol (µg/dL)	11.52 ± 2.62	9.93 ± 2.68	0.045*
Cumulative dose (mg)	523.89 ± 435.59	562.31 ± 1,048.33	0.240
Total steroid duration (days)	21 ± 7.71	11.1 ± 5.73	< 0.001*

↓ Table 4. Comparison of Baseline Parameters of Study Subjects With and Without HPA Axis Suppression (N = 57) on Day 10 After Completion of Steroid

Parameter

Patients with HPA axis suppression (N = 18) (mean ± SD)

Patients with HPA axis recovery (N = 39) (mean ± SD)

P value

*Significant P value. HPA: hypothalamic–pituitary–adrenal; SD: standard deviation; BMI: body mass index.

Age (years)

39.83 ± 14.79

41.97 ± 14.83

0.525

Height (cm)

161.33 ± 6.71

161.36 ± 7.11

0.973

Weight (kg)

66.11 ± 10.47

65.15 ± 10.22

0.718

BMI (kg/m²)

25.35 ± 3.32

24.96 ± 3.11

0.565

Sodium (mEq/L)

138.33 ± 3.38

137.87 ± 4.18

0.563

Potassium (mEq/L)

4.11 ± 0.39

4.07 ± 0.38

0.763

Urea (mg/dL)

22.11 ± 6.13

22.41 ± 6.25

0.770

Creatinine (mg/dL)

0.86 ± 0.24

0.86 ± 0.23

0.770

Fasting glucose (mg/dL)

124.61 ± 28.07

116.23 ± 40.19

0.097

Baseline cortisol (µg/dL)

11.52 ± 2.62

9.93 ± 2.68

0.045*

Cumulative dose (mg)

523.89 ± 435.59

562.31 ± 1,048.33

0.240

Total steroid duration (days)

21 ± 7.71

11.1 ± 5.73

< 0.001*