A patient has been on daily, high-dose glucocorticoid therapy for the treatment of rheumatoid arthritis. His prescription runs out before his next appointment with his physician. Because he is asymptomatic, he thinks it is all right to withhold the medication for 3 days. What is likely to happen to this patient? (Select All that Apply)

A. Nothing it is appropriate to stop the medication for 3 days: Abrupt discontinuation of long-term, high-dose glucocorticoids suppresses the hypothalamic–pituitary–adrenal (HPA) axis. The body is unable to rapidly resume endogenous cortisol production. Even a short interruption can lead to serious physiological consequences. B. He will go into thyroid storm: Thyroid storm is associated with uncontrolled hyperthyroidism and is unrelated to glucocorticoid withdrawal. There is no mechanism linking sudden cessation of steroids to acute thyroid hormone excess. C. Nasojejunal tube: Placement of a nasojejunal tube is a medical intervention, not a physiological consequence of stopping glucocorticoids. It has no relevance to steroid withdrawal or adrenal function. D. He will go into adrenal crisis: Chronic glucocorticoid therapy suppresses endogenous cortisol production by the adrenal glands. Sudden withdrawal can result in acute adrenal insufficiency, leading to hypotension, hypoglycemia, weakness, and shock. This is a medical emergency requiring prompt treatment. E. His autoimmune disease will go into remission: Glucocorticoids suppress inflammation and immune activity; stopping them abruptly increases the risk of disease flare rather than remission. Rheumatoid arthritis symptoms often worsen when anti-inflammatory therapy is withdrawn. Remission would not be expected in this context.