RESULTS OF SHORT SYNACHTEN TEST

[hwigston]

Can anyone tell me what the results of the test mean please. My cortisol levels were 143 before synacthen test half an hour later it was 411 and a further half hour was 476. I have received a letter from the hospital to see a consultant Endocrinologist. I can't see my GP until 12 May. Rheumatologist requested test because I have been unable to go below 8 mg of pred.

[mickt]

Hi ,I had synachten test ,it revealed I had addisons disease.I hope your test result is good,if you have adddisons it means the cortex part of your kidney does not produce cortisol ,a substance which give us our get up and go if you like.Im sure a more medically correct will be explained by posters on this site.I have to take hydrocortisone and fludrocortisone steroid daily to manage Addisons.

[hwigston in reply to mickt]

Hi I don't know what the symptoms of Addisons are, but I am always exhausted, little appetite and feeling nauseous.

[mickt]

Sorry to say I was the same ,fatigue mainly with me tho.I was getting tired at work and doing ordinary things that shouldn't tire .Don't worry its manageable with drugs ive stated,I don't know enough medically to say you have addisons but could be a possibility by how you are feeling .Good luck.

[hwigston in reply to mickt]

Many thanks for your reply. I will post my result when I have it.

[Celtic PMRGCAuk volunteer]

Hello hwigston

Although I haven't experienced this test, I suspect it has been carried out to check that your adrenal glands are producing their natural steroids (cortisol). When we take artificial steroids such as Prednisolone our natural cortisol production can be suppressed and in a few cases fails to get up to speed again.

Your results, showing increasing levels of cortisol throughout the test, hopefully means that all is well with your adrenal glands.

[PMRpro Ambassador]

The test is done to see if the feedback system which controls the adrenal glands is working properly.

In Dundee a normal response is said to be:

• Basal cortisol in the reference range

• Cortisol increase above basal >=170 nmol/l

• Peak cortisol > 530 nmol/l

I say "in Dundee" - different labs have different figures so where you had yours done may be slightly different. However, your basal cortisol level (the first one) is at the low end of normal, your response was normal (the amount it went up) and if the third is the peak it is a bit low.

The rheumy asked for it because he wonders if your adrenal glands aren't working properly and that is why you can't get below 8mg. This test shows they are working - whether they are working as well as they could I don't know and that may be why the endocrinologist wants to see you.

There are many rheumys who expect PMR patients to simply be able to reduce steadily to zero pred in a certain time - it doesn't work like that unfortunately. I don't know how long you have been on pred or how many "flares" you have had - but the most common reason for a flare is reducing too far or too fast. No reduction should be more than 10% of the current dose - many patients can't even manage that overnight but succeed by spreading it over a longer time. I never got below 9mg without a return of symptoms - until I started using the very slow reduction scheme I have posted several times on here already and have now got to 5mg. Quite a few people have used it or something very similar successfully after repeated failures. A consultant in the north east is also using a similar reduction scheme for his patients and is delighted to find it works for everyone!

It is difficult to tell if the pain you have is PMR flaring up or the lowering of the steroid dose suddenly causing "steroid withdrawal syndrome" because the pain is similar. Keeping the reduction tiny reduces that confusion because the return of pain is likely to be that the dose is too low to control the inflammation caused by the underlying autoimmune disorder - because as long as that is active the symptoms will come back. The pred has no effect on the autoimmune disorder - it only controls the symptoms of the damage the autoimmune illness is causing.

[ignatz in reply to PMRpro]

A brilliant explanation by PMRproAmbassador! Many thanks.😀

[mickt]

Celtic thanks for correcting ,Adrenal glands I should have said not kidneys.The cortec produces cortisol I think that's right,i should know ive got the addisons haha.

[mickt]

cortex even

[Celtic PMRGCAuk volunteer]

Hi Mick - it isn't surprising that it confuses us all when the adrenal cortex is part of the adrenal gland which sits just above the kidney......I just looked that up and now that's my little supply of grey cells spent for the day!!!

[Hidden]

I am puzzled as your Rheumatologist ordered a test whilst you are still on 8mg, but the good news is that your adrenal glands are working, albeit perhaps not fully functional but working. That is probably why the Endocrinologist want to see you himself.

I was given the synacthen test when I had been off pred for a while. Result fully functional. I saw the Endocrinologist first and he took a full history before ordering the test. I then had the test and the result was forwarded to me and my GP, so I don't have to see the Endocrinologist again.

[csy50]

Eileen - is your slow reduction method (which I am following at the moment) the same as Ragnar's or a variation?

Chris

[PMRpro Ambassador in reply to csy50]

It's just a variation - Ragnar did his when he got down to below 5mg and couldn't get below 3mg. A member of the northeast support group has worked out a reduction scheme too, the one that is being used by a consultant there, and it is based on Ragnar's method. All of them spread the drop over a longer period but how you count it is up to you. I post mine because I have it on the computer and it is easy to cut and paste it! I did it this way because I have a calendar for my anti-coagulant tablets as I don't take the same dose every day - it was easy to choose a day for the new dose and then count the days to the next one. Some people do 1 day new dose the first week, 2 the second and so on - but then you have to mess about deciding which days and so on - with this you just reduce the days between to get down to alternate days and then increase to get to all new and I found it easy to count out. You can stop anywhere - and you have reduced some and, to quote the ad "every little helps"!

[csy50]

Thank you Eileen - I thought your way of decreasing the days to the next lower dose was the easiest to calculate and I write it on the calendar each week. Still a long way to go!