The need for biochemical testing for adrenal insufficiency and has anybody had liraglutide injections ?

[ThunderB]

After my last post I went to see my GP to ask him if I needed a synacthen test to assess my ability to produce natural cortisol as I have tapered to 3mg of prednisolone daily. He took a random blood cortisol test which showed a result of 146nmol/L and as a result referred me to an endocrinologist. I had a Zoom consultation with the Endocrinologist who said that the 146 nmol/L cortisol reading was not particularly contributory and he did not think it made a big difference generally to monitor the routine reduction in prednisolone. He told me that the role of biochemical testing would come into play if I developed “significant symptoms suggestive of adrenal insufficiency” as I tapered the dose. He thought that unlikely to occur at the current rate and that a synacthen test was unnecessary noting that generally the pace of rheumatological and endocrine tapering more or less coincide. Does this accord with other members experience of cortisol testing?

Of further interest, the endocrinologist was more concerned about my weight gain (+21kg) on prednisolone and glycaemic control, which has been unpredictable and high as a consequence of the prednisolone and he prescribed liraglutide daily injections. He says these will have the advantages of provoking insulin release to improve my diabetes control but will also contribute to weight loss. Upon googling liraglutide I discover this is marketed as the ‘skinny jab’ healthierweight.co.uk/facts.... Have any of the forum members any experience of this product and similar significant weight gain over 12 months? I have already lost 7kg since January as I continue to taper but was wondering how long it might take to get rid of the prednisolone weight gain?

[PMRpro Ambassador]

The endo's comment seems fair enough but if you DO develop any symptoms then pursue the synacthen test again. One lady on the forum felt absolutely fine at 2mg but her rheumy ordered a synacthen test which established she has no reserve adrenal function at all - which poses a problem in the event of an emergency situation. Feeling OK is not always a reliable guide so familiarise yourself with the signs of adrenal insufficiency and if you suddenly feel ill with anything that could be an adrenal crisis don't hesitate to call the emergency services as it can be a very serious event if not treated quickly.

This forum makes a big thing of cutting carbs when on pred - it works to reduce weight gain for most people and also reduces the risk of developing pred-induced diabetes. If you have already lost 7kg since January I'd suggest that sticking another medication in the mix is a tad superfluous at present!! People do sometimes gain massive amounts of weight when on pred - especially when no-one tells them that it is a risk that can be mitigated by diet - they assume it is inevitable and don't realise that nutrition can be key.

Strange - steroid induced diabetes is not necessarily a problem with insulin - it is due to the liver releasing spikes of glucose from the body stores in the muscles. That triggers release of insulin but often MORE insulin than required because the spike is just that and not followed by the carbs the body expects in a meal. Excess insulin remains and then sends any available carbs into fat stores in the usually expected places seen in Cushings. As you reduce pred, this effect reduces.

[ThunderB in reply to PMRpro]

Thanks for this. Answer to “strange” might be that I had onset of T2D in 2017 before PMR diagnosis in early 2020 but with low carb diet and exercise I had got glucose and weight under control in 2019 and diabetes was in full remission with no metformin. PMR / pred brought it all back in 2020 so I think therefore that I must be short of natural insulin? Yes, my Dr did tell me that Pred weight gain was inevitable and that Pred was sometimes prescribed to make certain underweight patients gain weight. I now realise that with strict low carb diet it is possible to control matters.

Your comments on watching out for signs of adrenal insufficiency are duly noted.

[SnazzyD]

Hello, It might well come back at the same speed as reduction but I expect that depends on how fast you drop. No testing on my adrenal function was done until I was down to 4mg. It doesn’t tell you if your adrenal glands will function every time reliably though. That can take time. I didn’t feel great for quite a long time and occasionally I felt I was having a bit of an adrenal crisis when I had shock eg a bad fall or being in a lot of pain. At 4mg my test was ok, just. At 1mg it was pretty good but still I had the wobbles at times. Keep an eye on it and be aware of signs of adrenal insufficiency that can creep up slowlypituitary.org/knowledge-bas...

Re insulin and weight - in order not to put on weight and keep my sugars normal I had to cut out practically all carbs. What about asking to try that as a trial before adding another drug in?