QUESTION: Safest/easiest way to wean off 2.5 years prednisone therapy? HPI: Mid-september, 2008, 68 y/o married medical doctor on a routine cardiac follow-up, was determined to have an elevated serum calcium. Follow up studies over 4-6 weeks revealed slowly rising CA levels. Despite lab & scan workup, no evidence of parathyroidism. By Dec 4, 2008, serum calcium was 15 and patient had lost 60 lbs due to loss of appetite & inactivity as well as having mental changes. Hospitalized & treated with intravenous fluids & diuretics. On Dec 6, patient under general anesthesia underwent an iliac crest bone marrow biopsy, left axillary biopsy, and since the presumed diagnosis at this point was non-hodgins lymphoma, had a port-a-cath inserted in the right chest wall. Post operatively patient was placed on prednisone and discharged on Dec 7, 2008. Within 2 weeks the biopsy returned after having been reviewed by multiple pathologist at several institutions and showed Sarcoidosis of the Bone Marrow wilthout pulmonary complication. Subsequently on prednisone therapy, the serum calcium fell to normal but attempts made to wean off of prednisone have failed multiple times. He developed signs of osteoporosis of the femoral necks and prednisone myopathy, particularly in the shoulders and hips so it was decided to try to stop the prednisone. He has been on 5 mg of prednisone every other day for the past 3 months and is severely symptomatic with arthralgias and myalgias, joint stiffness, headaches, neck pain,nausea, anorexia, and total body misery. These symptoms have not improved since the prednisone was reduced on 03/24/2011 to 5 mg alternate days. Prednisone withdrawal has also induced mild congestive heart failure, requiring the addition of O2 to nightime C-Pap. What do you recommend to jump-start the adrenal gland or adrenal/pituitary axis?