According to the rule of twos, how far back should you inquire about steroid use?

• A. 1 month
• B. 6 months
• C. 1 year
• D. 2 years

Answer: (D)

The rule of twos is a guideline used in the assessment of patients who may have been exposed to corticosteroids, particularly when evaluating for potential adrenal insufficiency or other side effects associated with steroid use. This rule suggests that you should inquire about any steroid use within the past two years. The rationale behind this timeframe is that it helps to capture the period during which the patient might have been significantly affected by the suppressed adrenal response due to steroid therapy.

Steroid use for prolonged periods, especially over a significant threshold (commonly considered to be 20mg of prednisone or its equivalent for more than three weeks), can impact the hypothalamic-pituitary-adrenal (HPA) axis. As a result, a two-year history provides a comprehensive view of any relevant steroid exposure that could influence current health status.

While shorter timeframes such as one month, six months, or one year may capture some cases, they do not encompass the full potential impact that two years of steroid therapy can have on a patient’s endocrinological system. Thus, inquiring about steroid use over the two-year span aligns best with understanding the possible repercussions and ensuring appropriate management of the patient's condition.