Adrenal Corticosteroid Therapy-Reply

In Reply.— We are grateful to Drs Goldstein and Morris for emphasizing our point that patients receiving long-term steroid therapy should receive supplemental steroids during major stress. If they will reread the comment section, they will find this emphasized both there and in the abstract. We differ, however, with their conclusion that the low baseline values reflect significant suppression of the HPA axis. They state that 5 μg/dL is the lower limit of fasting-morning cortisol levels in normal subjects. Yet they believe that a value lower than 10 μg/dL in patients taking steroids must be regarded as evidence of partial adrenal suppression. It is difficult to understand why there should be this difference. If 5 μg/dL is considered the lower limit of normal, then only 25 of our 76 patients had baseline control cortisol levels lower than this. There are at least three reasons why "baseline" values vary, as follows: