Would you consider reducing physiological replacement doses of steroids for secondary adrenal insufficiency in patients who develop steroid induced complications such as avascular necrosis of the joints?

That depends on what you mean by "physiological replacement dose". I usually tell patients to use the lowest dose that keeps them feeling well, and sometimes they are able to reduce the dose on less stressful days, such as weekends. Most patients function well with less than 20 mg of hydrocortisone equivalent per day. Some patients with secondary AI function well with only an early AM dose. If secondary AI is partial, some patients only take steroids when they are stressed or sick.