Who is at risk and needs stress dose steroids?

Patients taking 20 mg/day or greater of prednisone for more than 3 weeks are at increased risk of adrenal insufficiency and need stress dose steroids. This is due to the effects of glucocorticoids on the hypothalamic-pituitary-adrenal (HPA) axis. Prolonged use of high-dose glucocorticoids can suppress the natural production of cortisol, making the body unable to mount an adequate response to physical stress, such as surgery or illness.

In individuals who have been on high doses of glucocorticoids for an extended period, the adrenal glands may become less responsive, and during times of stress, such as surgery or severe infection, these patients can experience adrenal crisis without supplemental glucocorticoids. Therefore, for patients on 20 mg/day or more of prednisone for more than 3 weeks, it is critical to administer stress doses of steroids to ensure they maintain sufficient cortisol levels to handle the stress.

Patients taking lower doses of prednisone or those on glucocorticoids for a shorter duration typically do not experience the same level of suppression of the HPA axis and are less likely to require stress doses of steroids, making option B the most appropriate consideration in this scenario.