Synthacen test

[SilverCruiser]

Hi everyone,

Just a quick question. When can you have a synthacen test and do you ask for one or are you recommended to have one?

Am down to 3.5mg using the slow taper method but feeling achy, lethargic and weary. Is this just part of the tapering process or a sign adrenals not yet kicking in?

Thanks for your time.

[DorsetLady PMRGCAuk volunteer]

Hi,

Could be either, or more likely a combination of both.

You need to ask your GP - or Rheumy if you see one regularly - to request a test.

It won’t tell you if the adrenals are actually working, only if they are capable of doing so.

[SilverCruiser in reply to DorsetLady]

Hi Dorset Lady,

Its your slow taper method that has got me this far, so many thanks for that!

Will ask GP about having a test, you also answered an unasked question- " who do I ask". Thanks again, Linda.

[DorsetLady PMRGCAuk volunteer in reply to SilverCruiser]

I felt like you between the doses of 6mg down to 3mg despite the slow taper. But once I got to 3mg the fatigue suddenly disappeared - so don’t give up hope!

I didn’t bother with a test.

[jinasc in reply to DorsetLady]

That is odd Freya my first test they told me the were working but not fully functional

The second one, up and running and fully functional.

[DorsetLady PMRGCAuk volunteer in reply to jinasc]

Okay.

This is what it says on one forum - Synacthen Test protocol

The synacthen test evaluates the ability of the adrenal cortex to produce cortisol after stimulation by synthetic ACTH...

Just quoting what herself always says!

[jinasc in reply to DorsetLady]

Wow...................I aaaam still living and learning. I loved my Greek Endocrinologist who spent 45 minutes each time I saw him................he wanted to know the who, why, where and when of both GCA and the charity.

[PMRpro Ambassador in reply to DorsetLady]

Yes - but that doesn't mean they are doing so!!! it is a very complex feedback system!

[Marilyn1959]

When I asked my Rheumy about test he said local hospital has policy that they won't do test until patient is on 3mgs or less. So maybe it depends on your local hospital policy?

[Pollyanna16]

In my experience.... I asked my rheumatologist for one when I had got down to 2.5/3 & she was keen to get me onto Methotrexate. It took several weeks, well almost 5 months as had to change to hydrocortisone first then have a blood test to see what the levels might be & then the synacthen test finally showed a very low level of adrenal activity. I have been on pred since 2011. Eventually saw my Endrocrinologist who advised never to drop below 3.5 & go up to 5mg for the time being. But, to answer your question! It seems clear that the test is rarely offered & if I hadn’t pushed for it .....?

[SilverCruiser in reply to Pollyanna16]

HI Pollyanna16,

Thanks for getting back to me. It all seems a bit of an effort! Maybe I should persevere a bit longer and see how things go (I am a bit impatient!).

[Pollyanna16 in reply to SilverCruiser]

I was pleased to finally have an answer for the exhaustion though. Plus

The 1st blood test they forgot to tell me not to take hydrocortisone that morning & so it gave a false reading. Things seemed to drift rather. Hopefully your hospital will be more efficient! The synacthen test itself was no drama, just a couple of hours around 9 am & I didn’t have any side effects other than rather tired afterwards.

[SilverCruiser in reply to Pollyanna16]

Sorry not to thank you for your reply sooner but my server has been down so haven't been receiving e-mails!

[Pollyanna16 in reply to SilverCruiser]

No problem! Hope you get an answer soon. Take care x

[PMRpro Ambassador in reply to SilverCruiser]

Depends on the doc. Some rheumies do it automatically.

[Hidden in reply to PMRpro]

The rheumy I see tests at 3 to 5 depending on how you feel when you get to 5 I presume). But the test is automatic by 3mg.

[PMRpro Ambassador in reply to Hidden]

So it should be