Adrenal Gland production

[Creamtea]

Morning

At what dose of prednisolone does the adrenal gland start producing cortisol and is there a test to tell whether the glands are working.

[Hidden]

Afternoon, I think according to my Rheumy that we have to be on quite a low dose to be tested. I'm currently on 10 mg until the end of November. Then i will take 10mg one day and 9mg the next for a month. Then 9mg one day and 8 the next for the following month, so on and so on. I'm not due to see my Rheumy until June next year when hopefully I'll have managed to be on a very low dose. But won't hold my breath on that after reading so many posts where people have flare up and have to increase again....but must remain positive. If you google your question you may find out.

[PMRpro Ambassador]

Below about 8mg pred daily dose but it varies from person to person. There is little point testing until you are down below 5mg, preferably 3mg.

There isn't really a test that shows the adrenal glands are working - just one that shows if they are capable of producing cortisol which isn't the same thing at all! The system is quite complex and needs a lot of components to get their act together and in balance which is why it tends to take a while to get going. If one bit doesn't work, neither does the cortisol production - just as your car won't start if either the fuel tank is empty or the battery is flat. It all has to be working.

[DorsetLady PMRGCAuk volunteer]

This might help -

Quick explanation-

Once you have been on steroids for more than 3 weeks and at a dose higher than 7.5mg (which is roughly equivalent to the normal cortisol production by your Adrenals (does vary between 5-10mg) known as the physiological level) they temporary stop working because the artificial cortisol in your body (Pred) means they don’t have to.

When we get low levels (around 7.5mg) we need to reduce very slowly to nudge the adrenals into working again.

For the majority of people they do start working again - although it’s not like switching a light on - one day they’re asleep next day they’re awake! It takes a little while to recover all function. But there is a test (Synacthen test) to check if they are capable of working - not if they actually, just if they are capable of functioning. GPs won’t usually refer you for test until you reach 5mg maybe 3mg and if you are having problems (fatigue, nausea etc).

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Cortisol and pred are not the same. The body normally makes about 30mg of cortisol per day though measurements of 300mg have been measured in patients undergoing surgery. 30mg of cortisol is approximately equivalent to 7.5mg of Pred