Hydrocortisone

[kate1978]

Hydrocortisone

I recently had a shirt synatchen test and it came back with very low cortisone levels the doctor rang to tell me to change from 2mg of pred to 10mg in the morning and 2.5 mg in the afternoon Of hydrocortisone, I'm concerned as he was talking about what to do if I was sick or couldn't keep the tablets down, he said he had written to me, but I haven't received the letter, I'm also worried about weight loss and was having tests for this, but he told me to cancel the the appointment which was the next day to have an endoscopy with ultrasound

I did post this yesterday but I don't think I posted in the right place, I was diagnosed with PMR in 2013

[PMRpro Ambassador]

It was OK where you posted it - I saw it and answered it. But because of the way this forum works few others who know much about it will have seen it.

Not quite sure what else you are asking though?

[TheMoaningViolet in reply to PMRpro]

Hi, I can't see that post or your answer PMRpro? And, as always, I am very interested.

[PMRpro Ambassador in reply to TheMoaningViolet]

It was part of a a reply here

healthunlocked.com/pmrgcauk...

[kate1978 in reply to PMRpro]

I was wondering if it could be related to my weight loss and if hydrocortisone is better than pred

[PMRpro Ambassador in reply to kate1978]

I imagine that they are now assuming that the weight loss is due to your non-existent adrenal function. It is a typical symptom.

I explained the difference between the use of HC and pred for adrenal insufficiency in the other reply - it is horses for courses.

Hydrocortisone (HC) is the usual management for adrenal insufficiency as HC has the same structure as cortisol and has a shorter halflife in the body so that it can be used in a way that mimics natural cortisol production. Normally you have a larger amount produced in the early morning to prepare you for the day and another boost in the afternoon.

Using HC as 2 doses replicates that. It is also a corticosteroid and theoretically should be OK for your PMR as long as the dose is enough (in terms of numbers, the total HC dose should be 4x the pred).

It isn't that HC or pred is better - it is what it is being used for. With HC it is possible that your adrenal function may return in time, it may even on pred but would probably take longer. What neither I nor anyone else can say is whether the HC will be adequate for managing the PMR or whether you will get on well with HC. Some people do, some people don't. That is a suck it and see question.

[kate1978 in reply to PMRpro]

I have now received the letter from the consultant and it says my pre synatchen test was low at 120 and after the the the cortisol the level was 180 which he said was very low, would be interested to know what good levels are?

I am to start the hydrocortisone 10 mg in the morning and 5 mg in the afternoon

The endoscopy and ultrasound test which had to be cancelled for now was to see why I have lost so much weight

[PMRpro Ambassador in reply to kate1978]

A normal level of cortisol 30 minutes after the injection would be over 420 nmol/litre. So yes, 180 is pretty low.

The first thing you think of with sudden weight loss is a gastric problem - but obviously they think it was probably the adrenal insufficiency.

[kate1978 in reply to PMRpro]

Thank you for your reply

[tangocharlie in reply to PMRpro]

I remember the endocrinologist saying normal was somewhere between 400 and 500 , which is why I surprised when I was signed off once my level hit 140.

[kate1978 in reply to tangocharlie]

Are you back on pred now ?

[tangocharlie in reply to kate1978]

Yes I had to go back on after about 6-9 months off it, but I switched to Depo-medrone injections last last year rather than oral Pred.

[kate1978 in reply to tangocharlie]

Do the injections help? and where do you go the have them?

[PMRpro Ambassador in reply to tangocharlie]

Strange - who said it would get get to normal? Many a slip and all that ...

[tangocharlie in reply to PMRpro]

Both me and Dadcue, who both experienced sudden rapid weight loss, turned out to have adrenal problems so you might as well investigate that route before exploring other gastro reasons for weight loss I think. Other symptoms of adrenal problems can include vomiting and diarrhea.

[kate1978 in reply to tangocharlie]

Thanks for your reply, I haven't had diarrhoea, but I have been vomiting but not every day, maybe once a week to 10 days

It's possible that my low cortisone levels might be a contrituary factor

[tangocharlie in reply to kate1978]

They may well indeed. So are you on hydrocortisone now?

[kate1978 in reply to tangocharlie]

I started yesterday, 10mg in the morning and 5mg at 4pm I'm a bit nervous as the consultant said if I get a cold I must double up and if I get sickness and can't keep the tablets down I must ring 999

[PMRpro Ambassador in reply to kate1978]

Worry about it when it happens, not before - but be proactive and sensible and do make sure your family knows too and put a note on the fridge in case you are ill so a paramedic could see it and know.

[kate1978 in reply to PMRpro]

Good idea thanks

[tangocharlie in reply to kate1978]

I'm sure I was on 20, 10 in the morning then 5 in the afternoon and 5 in the evening

[kate1978 in reply to tangocharlie]

Yes it's 10 in the morning and 5 in the afternoon around 4pm

[tangocharlie]

Sounds plausible to me