Adrenal Function

[Gunflash]

Good morning all, May I please ask our experts at what dosage the ‘adrenal function’ begins to kick in again? I have reduced from 15mg down by sensible tapering over 15 months to 1mg and wondering if my immune system will, at some time, get fully functional again. Thanks and best wishes to all of you who offer such sensible advice on this blog, it is such a huge benefit to those of us who had such little experience of this condition when being diagnosed with it.

[SnazzyD]

Hello, the only way of knowing if you are fully functioning in the adrenal department is to happily deal with all the challenges of daily life and the odd crisis. You can have Cortisol tests and a Synacthen test which give you a good guide but as to whether you have a reliable system, is seeing how it goes. So, if you’re on the low side, you may have times in the day when you feel the tank is empty or shakey, emotional or weak and it isn’t low blood sugar. When I got past that stage I felt fine if the day was average but if it wasn’t I’d be hit with the above symptoms. You might be ok with that but then have a big accident and the body doesn’t cope then, which is why you should always carry a steroid card or alert jewellery even a year after you’ve stopped Pred. When these stages of recovery occur is very much down to the person so nobody can say it’ll be all ok by 3mg or 1mg or zero. As for the immune system which is not your adrenal system, there isn’t really an easy answer for that either. Even a normal person without medication or medical history can have a weak immune system. It’s very individual but over 15mg is often the cut off for saying someone is in the weaker zone. Again, it’s variable. When I was on over 20mg I nursed the household through proper flu and was ill for only 2 days myself. At 10mg I got everything going. Your immunosuppression on 1mg will be thought to be minimal and then it’s down to your personal make up.

[Gunflash in reply to SnazzyD]

Thanks Snazzy, very helpful.

[SheffieldJane]

I think it may take a full year to become fully functional after finishing Pred. Are you experiencing symptoms ? I would also observe the sick day rules. See pinned posts. If you are worried you could request a Synacthen test to see how your adrenal system is getting on.

[PMRpro Ambassador]

Adrenal function and immune respose are two separate factors although the adrenal function does have a role to play, And adrenal function doesn't "kick in" - it is a much slower process that wakes up slowly as the pred dose is reduced, not a sudden "oh, I'm only getting x gm pred, time to get going".

[Gunflash in reply to PMRpro]

Thanks PMRpro.

[piglette]

Mine started to have problems at about 6mg and on 5mg I was totally incapable of moving I was so tired. I went back to 6mg for quite a while which helped. I did not want to go much higher as I felt as soon as I reduced the old adrenals would start complaining again!