Update

[maria40]

I posted last week about feeling truly awful after the combination of a fall and reducing prednisolone. I've since taken my pred dose back up to 9.5mg (from 8.5) and, after five days begin to feel much better. I now wonder whether, when I see my GP on Tuesday, I should ask him for a synacthen text as PMRpro suggested I might have hit my level at 8.5mg. Would I have to go back down to that level to have the test or would it be possible to tell at 9.5 what was happening? Hope someone can help me with this.

[DorsetLady PMRGCAuk volunteer]

Hi Maria,

Not sure there is a specific dose you need to be at - but sure if there is, someone will confirm idc.

Docs may not consider it necessary as yet because you haven't got to the 7mg point which is considered to be the nearest to natural production of cortisol.

But no harm in asking the question.

[SheffieldJane]

I don't think they will do the Synacthen test yet. The Pred you are on is still doing most of the work of your Adrenal glands. Good to know you are feeling better on the higher dose of Pred. My Rheumie wouldn't test me until I was down to 4 or 5 mgs. I am afraid that we can still feel pretty blerg with plenty of cortisol especially after the shock of a fall.

[PMRpro Ambassador]

What sort of feeling awful? PMR unwell or increasing fatigue? There are 2 different aspects - the level of pred that manages the PMR is one. The other is are your adrenal glands functioning well enough. They probably WON'T start to function until 5mg or lower - for anyone. They have to have a need to fulfil - to make up a shortfall of steroid in the body. In the meantime, any shock or stress will shake you. I don't really think this blip means you need a synacthen test yet - your pred dose is still abit high.

[maria40]

Lethargic, stiff and dizzy though dizziness apart (and I am primarily seeing GP about BP) I am feeling somewhat better at 9.5mg. I raised this again because you mentioned the possibility that I might not - at 8.5mg - be absorbing all the prednisolone I take, especially as all tablets are enteric coated.

[Amkoffee]

What is synacthen?

[PMRpro Ambassador in reply to Amkoffee]

The synacthen test is to assess adrenal function under stress, it shows if the adrenal glands are able to produce cortisol at all. Another name is an ACTH stimulation test. They measure cortisol levels before and after an injection that should stimulate the adrenal glands to produce cortisol.