A 30-year-old woman receiving high-dose prednisolone for 2 weeks undergoes a routine differential leukocyte count. Which single finding is most characteristic of sustained glucocorticoid exposure?

• A Lymphocytosis with atypical lymphocytes
• B Peripheral eosinophilia above 15 percent
• C Monocytosis exceeding 20 percent
• D Eosinophils markedly reduced or absent ✓

Explanation

Glucocorticoids redistribute and destroy eosinophils and lymphocytes, producing eosinopenia and lymphopenia, while demargination of neutrophils produces neutrophilia. This pattern underlies the historical use of the eosinophil count as an index of adrenal cortical function. Eosinophilia, monocytosis, and lymphocytosis all run opposite to the direction in which cortisol drives the differential count, so they are physiologically inconsistent with sustained steroid therapy.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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