Received shot of methotextrate today, 2mgs for the week. Have been feeling better. Doctor is ok with my taking 3mgs per day of medrol.
Did some research and found this study on recovering adrenal function. This testing seems to show positive results. If I am reading it correctly, it can take from one to three years to recover adrenal function after a "normal" course of prednisone or methylprednisone for GCA (and PMR, (which is obviously different for each person) I believe they included in this study). Sounds very positive. Sending the link. This pp seemed appropriate.
"...Time until adrenal function recovered
Seventy-four (49%) non-responders to the first ACTH stimulation test were re-evaluated annually until they had fully recovered. The patients’ outcomes are shown in Figure 1. Nineteen patients were lost to follow-up during the study, four patients voluntarily stopped the hormone substitution, two patients died (unrelated to GCA) and one patient relapsed. (graph on site)
Among the non-responders when first tested, 30/57 (53%) had not recovered normal adrenal function after 1 year. After 2 years (at test 3), 15 of these patients had still not recovered. By year three (at test 4), 4 patients were responders whereas 7 were not. Among patients with a negative first ACTH test, recovery of adrenal function occurred in a mean time of 14 months; the maximal time until recovery was 51 months, and this patient needed five tests. Until 36 months, 41/48 (85%) patients, who were non-responders at the first ACTH test, had recovered. Regarding the entire study population, seven patients (5%) never responded to ACTH stimulation and were finally categorized as having definitive adrenal insufficiency. Only, three of these patients received a metyrapone test, which confirmed this status...."
Wanted to include this, which also contains good information, I believe:
None of our patients had an adrenal crisis. However, our patients were given hormone substitution and were strictly followed up.
". . . Although the risk of developing such a severe complication has been known since the 1950s, its real frequency remains controversial [11,12]. One could explain the very low frequency of adrenal crisis by its central origin: the glucocorticoid-induced negative feedback to the hypothalamic and pituitary glands may result in an adrenal crisis, but usually only if there is acute physiological stress (e.g. surgical or infectious stress). Thus, given the rarity of an adrenal crisis, systematic ACTH testing does not seem to be justified. However, symptoms of slow adrenal insufficiency (e.g. weakness, fatigue, myalgia, arthralgia, depression) should not be minimized. Thus, detecting slow adrenal insufficiency may be critical because of its considerable impact on quality of life and the potential risk of disability.
Our study confirmed that total dose and duration of GC were predictive factors [8,11,13]. We determined the thresholds of 6 and 12 months of therapy, which may help physicians to evaluate an increased risk of adrenal insufficiency. . . ."
Sounds good. wishing all good health
all my best, Whittlesey
heavy snow in NYC -- but ok, today