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This prolonged suppression has been attributed primarily to delayed restoration of hypothalamic\u2013pituitary signaling based on indirect measures of central axis activity. To identify the rate-limiting site of hypothalamic\u2013pituitary\u2013adrenal (HPA) axis recovery, we evaluated the timing of functional and histologic recovery at each node of the axis following 8 weeks of dexamethasone (DEX) treatment in adult, male mice. Dexamethasone administration fully suppressed HPA axis activity. Unexpectedly, within 1 week of DEX withdrawal, hypothalamic Crh mRNA and plasma adrenocorticotropic hormone (ACTH) rebounded above control levels, whereas corticosterone (CORT) remained suppressed for an additional 7 weeks. Dexamethasone-treated adrenals were markedly atrophic and contained large clusters of lipid-filled macrophages. Even after adjusting for macrophage content, CORT secretion was disproportionately low relative to the remaining adrenocortical cell mass despite supraphysiologic ACTH stimulation. The adrenal is thus the principal site of postwithdrawal GIAI, involving adrenocortical cell loss and a superimposed defect in steroidogenesis. We next tested whether preserving adrenal trophic signaling during glucocorticoid exposure could prevent GIAI. Adrenal function recovered more slowly in mice treated with DEX and daily cosyntropin (a synthetic ACTH analog) compared to those treated with DEX alone. In contrast, mice with nonsuppressible endogenous ACTH due to targeted hypothalamic deletion of the glucocorticoid receptor maintained normal adrenal architecture and steroidogenic capacity despite prolonged DEX treatment. Pharmacologic treatments that mimic sustained trophic signaling to the adrenal during chronic glucocorticoid treatment may thus prevent GIAI.<\/jats:p>","DOI":"10.1210\/endocr\/bqag081","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T11:47:13Z","timestamp":1784202433000},"source":"Crossref","is-referenced-by-count":1,"title":["Adrenal rather than central dysfunction limits hypothalamic\u2013pituitary\u2013adrenal axis recovery after chronic glucocorticoid treatment in male mice"],"prefix":"10.1210","volume":"167","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3486-7254","authenticated-orcid":false,"given":"Lindsey S","family":"Gaston","sequence":"first","affiliation":[{"name":"Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School , Boston, MA 02115 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenna C","family":"Jorgensen","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School , Boston, MA 02115 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah R","family":"Friedman","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School , Boston, MA 02115 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc S","family":"Sherman","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School , Boston, MA 02114 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4983-5143","authenticated-orcid":false,"given":"Joseph 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