Once again, I have a theory. Assuming that the vast majority (90% ?) of BLA patients had "florid" Cushing's (as opposed to cyclic) prior to BLA, then we could assume that any cortisol produced post BLA would be in a normal pattern as well. Based on this assumption, all it would take would be a decreased dose of steroid to solve any problem.
In the cyclic patient population we are seeing a higher number of patients experiencing problems with cortisol production post BLA. Here, my assumption would be that the naturally produced cortisol levels are again fluctuating like they were prior to BLA. With this cyclic production, cortisol supplements can not be accurately determined and once again patients find themselves in limbo.