Corticosteroids: adrenal suppression: practice question

A Pharmacology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pharmacology · Corticosteroids: adrenal suppression

Sample item

A 50-year-old man treated with prednisolone 30 mg daily for pemphigus for three months stops it abruptly. He develops fatigue, nausea, blood pressure 88/54 mmHg and sodium 128 mmol/L with normal potassium. What is the mechanism?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Suppression of the hypothalamic-pituitary-adrenal axis with adrenal cortical atrophy

Prolonged exogenous glucocorticoids suppress CRH and ACTH, and the adrenal cortex atrophies, so abrupt withdrawal leaves cortisol deficiency. The renin-angiotensin-aldosterone axis is intact, so potassium is typically normal, unlike primary adrenal failure. Doses should be tapered after prolonged use, and stress doses covered during illness or surgery.

Option by option

  • A. Isolated loss of aldosterone synthesis

    Aldosterone is controlled by angiotensin II and remains functional, so potassium is normal.

  • B. Autoimmune destruction of the adrenal cortex

    Autoimmune Addison disease would usually raise potassium and cause pigmentation.

  • C. A pituitary adenoma causing loss of ACTH

    There is no pituitary lesion in this scenario; the suppression is pharmacological.

  • D. Suppression of the hypothalamic-pituitary-adrenal axis with adrenal cortical atrophy (correct)

    Correct. Negative-feedback suppression causes secondary adrenal insufficiency after stopping steroids.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is D, Suppression of the hypothalamic-pituitary-adrenal axis with adrenal cortical atrophy. Prolonged exogenous glucocorticoids suppress CRH and ACTH, and the adrenal cortex atrophies, so abrupt withdrawal leaves cortisol deficiency.

Why is "Isolated loss of aldosterone synthesis" not the answer?

Aldosterone is controlled by angiotensin II and remains functional, so potassium is normal.

Why is "Autoimmune destruction of the adrenal cortex" not the answer?

Autoimmune Addison disease would usually raise potassium and cause pigmentation.

Why is "A pituitary adenoma causing loss of ACTH" not the answer?

There is no pituitary lesion in this scenario; the suppression is pharmacological.

What concept does this question test?

It tests Corticosteroids: adrenal suppression in Pharmacology. The renin-angiotensin-aldosterone axis is intact, so potassium is typically normal, unlike primary adrenal failure. Doses should be tapered after prolonged use, and stress doses covered during illness or surgery.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Corticosteroids: adrenal suppression?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.