Short Synacthen Test for AI

[Ghoulette]

Hi folks.

So, having been weaned off prednisolone and put onto 20mg hydrocortisone, I have a short synacthen blood test scheduled for 20th July to check adrenal function.

I have been told by endo that i need to stop all steroids (except hydrocortisone) for 1 week prior to the test. So I will be unable to have my Fostair 200/6 and mometasone nasal spray. I am also on Spiriva Respimat 2 puffs morning, as well as ipratropium (Atrovent) and salbutamol via nebuliser 3-4 times daily (as well as other asthma meds). I have been told that these are ok to continue.

Has anyone else had this and managed without their steroid inhalers for a whole week beforehand? They did say that I wasn't to make myself ill, and if i need to take my fostair, I should and they will rearrange the blood test. But if I can't manage it the first attempt, I'm not sure what difference rearranging it will make 🤔

Has anyone had this and either:

A) managed to withhold all week?

B) had to take Fostair but managed to either rearrange or still have the blood test anyway?

Thanks for any advice ☺

Michelle x

[Huchin95]

Hi,I have AI through long term use of prednisone and was diagnosed after having a short synacthen test. The first attempt at a test, I was told to withhold all inhalers too but ended up unwell with my asthma flaring and an admission. The next time they just said not to take the inhalers on the morning of the test but to take them along to the hospital with the hydro and take them straight after the test was completed. You could call and explain that you’re a bit anxious about not taking your asthma meds and see what they say…? I don’t know the exact break down of times but I thought 24 hours without inhaled steroids was enough… someone else might know more about this!

Good luck!

[Ghoulette in reply to Huchin95]

Thank you for replying. I think they're hoping I don't have AI (2½ of daily high dose preds).

Bizarrely, I have an endo appointment with a consultant on the 6th July, so I'll ask him what the absolute minimum is for withholding inhalers. I could very well manage ok for a week if I'm using my spiriva and Atrovent abd salbutamol nebs. I guess I just need to try it and see x

[Lysistrata Administrator Community Ambassador]

Ok that's quite weird - a week?! I have had I think 5 synacthen tests now (they were checking to see if my adrenals would recover which they now have, after 4 years).

I was initially told 48 hours for Fostair, 24 for hydro and 24 for fluticasone nasal spray. This is now 72 hours for the nasal spray, for the last couple, and after I had an admission for asthma shortly after one test, my endo nurse said I should just do 24 hours off Fostair and that would be fine (I am on max dose of it btw). So I've done 24-36 hours off Fostair, 72 off Avamys spray and 24 off hydro and it's been completely fine ie they were able to tell that my adrenals were not working and then last time that they now are.

I don't want to contradict your endo but a week seems excessive, and i feel like they're not thinking about your asthma - if you already need several nebs a day, removing ICS-LABA for a week might not be ideal (I use nebs at home, but I don't need them all the time and needing several a day usually means things are not going well - this is *on* all meds). And my experience with synacthen tests suggests it can be done on less - they never, ever mentioned needing to be off the inhaler for a week, and were very aware that stopping asthma meds could be an issue.

I wonder if you could try this helpline, which has an endo nurse, and see what they think -could give you some information to take back to endo? pituitary.org.uk/support-fo...

You could also ask the AUK nurses about the stopping Fostair thing, as that may be something else you can take back to the endo team (AUK helpline - 0300 2225800 M-F 9-5;AUK WhatsApp - 07378 606728). I tend to find that many cons are not very knowledgeable outside their own speciality, so he may need a bit of a kick...I mean prompt, to realise that it's not great for asthma to be off for that time, and he needs to find a balance instead of pushing it to get the best test results in an ideal world.

This post I wrote could also be helpful about AI and synacthen test:

healthunlocked.com/asthmauk...

[Ghoulette in reply to Lysistrata]

Thank you so much, that's all really helpful. I had a telephone consult with my asthma consultant last week and told him what they said. He asked me how i felt about it, and I said the only thing I could do is try. I am seeing an endo consultant for the first time on 6th July so I will go armed with information and confirm with him/her too.

I'm glad your AI has resolved 🥰

Thank you again x

[Lysistrata Administrator Community Ambassador in reply to Ghoulette]

Good luck! Hope it works out for you (and that you don't have AI, though if you do I am proof it can resolve sometimes when it's steroid-induced).

[hilary39]

This sounds dangerous. Can you check your endo's advice with your GP or pulmonologist?

[Ghoulette in reply to hilary39]

My asthma consultant checked hiw I felt about it and I said I would try, but he said said to make myself ill. I will check with the endo consultant on Tuesday x

Thank you x

[Hidden]

Hi - when I was tested I just had to stop my hydrocortisone for 24 hours - it only stays in your system for 4-6 hours and I was told I must not stop my inhalers (on high dose) because of the risk of asthma flare! they can adjust for your inhalers if they’re aware. I would ring the Endocrinology department at the hospital and explain

[Ghoulette in reply to Hidden]

Thank you for replying. I'm due to see the endo consultant for the first time on Tuesday so I will ask him/her then x