Which drug dosage must be tapered off slowly to prevent acute adrenal insufficiency?

The correct answer identifies cortisone, which is a glucocorticoid medication that can suppress the hypothalamic-pituitary-adrenal (HPA) axis when taken for extended periods. When someone is on exogenous corticosteroids like cortisone, the body reduces its own cortisol production as a response to the external supply. If the medication is stopped abruptly after a prolonged period of use, the body may not be able to produce sufficient cortisol to meet physiological needs, leading to acute adrenal insufficiency.

Tapering off the medication allows the HPA axis time to recover and gradually increase its cortisol production, minimizing the risk of adrenal crisis. This is also true for other glucocorticoids, but the question specifically highlights cortisone as the focal point of tapering to prevent adrenal insufficiency, which is pivotal in understanding the management of steroid therapy.

Other options such as dexamethasone, hydrocortisone, and prednisone also require careful management and tapering but cortisone is often emphasized in the context of needing slow withdrawal to mitigate adrenal insufficiency specifically.