Adrenals working?

[Pinkpepper]

I have reduced from 2mg to 1.5mg but still have sweats to head and neck. Could it be my adrenal glands are not working and how can I find out pleas

[SheffieldJane]

Request a Synacthen test via your GP. A simple blood test that measures the capacity of your Adrenal glands to produce Cortisol. I was referred to the Endocrinology Department at my local hospital. I ended up seeing an Endocrinologist as my results were not good initially. I can talk you through the test etc later if need be.Not sure that the sweating would necessarily indicate an adrenal problem but you certainly are dependent on your body’s ability to produce its own cortisol on your low dose. Anything below around 7 mgs of Pred and you may notice the symptoms of your own adrenals beginning to kick in.

Tiny doses of Pred are amazingly effective so you will feel these tiny drops.

[Pinkpepper in reply to SheffieldJane]

Thank you so much for your advice much appreciated.

[PMRpro Ambassador]

The synacthen test is the "gold standard" to show if they are able to produce cortisol - but it doesn't mean they are producing it reliably when needed as there are a lot of factors involved in the process. That can take up to a year to settle down after stopping pred entirely.

The synacthen test is done in a hospital setting so it may be a bit difficult to get an appointment. A good start would be to ask the GP to do a basal cortisol test on a morning blood sample, 9am-ish but it can be later without affecting the result. If the cortisol level is under 100 you probably are still suffering with adrenal insufficiency. If it is above 400 you are almost certainly fine.

[Pinkpepper in reply to PMRpro]

Thanks as always for your valuable advice x

[Viv54 in reply to PMRpro]

Here we are again the elusive Basal Cortisol test, that no one in my whole practice has ever heard of !!

[PMRpro Ambassador in reply to Viv54]

Tell them to do a bit of reading:

pubmed.ncbi.nlm.nih.gov/286...

ncbi.nlm.nih.gov/pmc/articl...

No-one is saying it is perfect - but it stops them making the silly excuse they can'tget a synacthen test done, they can reassure you with a single simple sample of blood. Though even that seems to be beyond their abilities at present.

[Viv54 in reply to PMRpro]

Thanks yes it does, i will take this next time I go.!

[Pinkpepper in reply to PMRpro]

Amazingly they’ve actually booked me a synacthen test next Monday

[PMRpro Ambassador in reply to Pinkpepper]

Golly! Must be bored! Or a spare appointment going begging.

[Pinkpepper in reply to PMRpro]

To sure they know what it is mind!

[arvine in reply to PMRpro]

my rheumy has sent requisiton to bood lab ,and told me for a cortisol test, I am in process of tapering from 5 mg to 4 mg pred, but as Ive said before, started at 40 will be on pred 5yrs now, thing in, she was very vague, just said have to be at lab before 10 am, Im going to try call her again, get more instructions, but is this something I have to fast for, and not take my morning prednisone,?

[Pinkpepper in reply to arvine]

I’ve been told mine is a non fasting blood test

[PMRpro Ambassador in reply to arvine]

If it is just a blood sample for cortisol, it is non-fasting but probably better without your morning dose of pred. If it is a synacthen test (which is normally started at 9am and takes just over half an hour for the basic version and 2 hours for the longer one, then you must not take any pred in the previous 24 hours.

Do you have a copy of the requisition slip?

[Pinkpepper in reply to PMRpro]

Think it’s just a Cortisol test as they’ve only allowed the normal 10 minute slot. Booked for 9.40 so I’ll hold off my pred dose until I get home. Many thanks.

[Pinkpepper]

Blimey not much chance of my surgery knowing then, they're useless!

[PMRpro Ambassador in reply to Pinkpepper]

You can be part of their CPD (continuing professional development)!! See the links just above ...

[Viv54]

This is a horrible symptom , im convinced its linked to Pred, i have had full blown sweats since day 1, but have found the lower i go its more of a clammy feeling rather than a sweat .

[Pinkpepper]

Thanks for your advice, much appreciated.

[AdoptMeow]

Often it is difficult to figure out what are PMR symptoms and what are prednisone side effects. Since PMR/GCA is a form of vasculitis, the excessive perspiration with exertion or sudden warmth can be caused by microvessel vasculitis when the body is slower to adjust to surface temperature.I've been curious myself about the head sweats because they just started this summer. My PMR started May 2018 but has been really worse this year. I had reduced to 6 mg and have just been returned to 30 mg. Will see how that impacts the sweats.

From what others have shared, the sweats could just be a sign that staying at 2 mg is necessary to control the inflammation.

[Pinkpepper in reply to AdoptMeow]

Thank you xx