Can I have adrenal insufficiency whilst taking 13mg pred?

[Paininthenck]

I am on 13mg pred having been told to increase from 7mg by my GP as I am experiencing a flare. He advised 10mg but I did not improve so increased by 1mg a week so far and still much pain, fatigue and generally feeling rough. But I also feel weird, most of the time, so fatigued, spaced out, brain fog, panicky, stressed and unable to hold my thoughts. Feel like this most days and extremely bad in the mornings. From others descriptions my symptoms appear more in line with lack of cortisol but is that possible whilst on a dose of 13 mg pred? Hope I have explained that properly. Just keen to know if any others can relate to this at this dose?

[SheffieldJane]

It is unlikely that you are experiencing Adrenal insufficiency at 13 mgs of Prednisalone. It is more likely that you are swamped with it. However, not in the way natural cortisol would be produced ie in response to stimuli such as stress, excitement or fear. Rather all at once giving rise to jumpy, anxious feelings. Pred does make you feel kind of weird and spacey with what we call “Pred head” forgetful and muddle headed. I think you get kind of used to it over time, I did anyway. You are getting used to a high dose that is almost double what you were on. At 7 mgs you may well have started to signal to your body that you needed more cortisol. Then suddenly there was plenty. What symptoms did you have early in your flare before you increased? You seem to be experiencing the side effects of Pred now apart from the pain you mention. Fatigue comes hand in hand with autoimmune diseases and it is very debilitating. I think Pred contributes to it. I don’t think the fatigue you feel at very low doses is necessarily worse but you can feel the adrenals trying to work and then be exhausted. Lovely little bursts of energy. That I was surprised to experience because this is my second time tapering down. I hope you get back on track soon - yo yo- ( won’t let me put in an…). Is pretty grim and confusing.

[Paininthenck in reply to SheffieldJane]

Thank you everyone for getting back to me. I think I am just struggling to accept that this is an ongoing issue, there’s no quick fix and I just have to learn to deal with it. When I was first diagnosed I was put on 15mg prednisolone and felt amazing. I was ok until I got down to about 8mg and then started to get pain in my ankles, feet, hips, knees that would wake me up constantly. It just got worse but I didn’t connect to a flare as I hadn’t realised that was part of the ongoing challenge until I joined the forum a couple of weeks ago. Now I have read many posts/FAQs I understand much more and it’s pretty frustrating or all of us isn’t it!! I really do appreciate all your responses, looks like we’re all in for the long haul 🤦‍♀️

[SheffieldJane in reply to Paininthenck]

Maybe 8 mgs was your perfect dose for now. It is ok to pause a taper for a bit if you feel the old symptoms creeping back. I stayed at 7 mgs for a year. I was embarrassed seeing my Rheumatologist and saying I was still at 7 mgs. She was understanding though and it turned out that GCA/LVV was brewing.

[Nextoneplease]

Hi 😊

SheffieldJane has given you a very complete answer but I just wanted to add that I’m on 12.5mg and I too feel weird, anxious, spaced out and above all fatigued….especially mentally and emotionally 😟 Like you, mornings are the worst. I think it has to do with the dose of pred and the regular changes thereof - I had the opposite feeling of being ‘high’ and full of energy when I was on 40mg! False friend that was!

This illness and it’s treatment are a rollercoaster, and rarely in a good way, it seems…..

All the best to you xx

[SnazzyD]

Pred made me feel that way most of the time especially above 10mg. 7mg felt bad because it was tipping into the not enough cortisol territory when adrenal function needed to start but wasn’t inclined to do so because the dose was still a bit high. The only way to get out of that zone was to continue to reduce slowly. For me personally flipping between 13 & 7 the two would have been grim. However, if you are having a flare with pain, needs must. If your autoimmune activity has gone up you won’t feel great either so it’s a real mixing pot of confused symptoms.

[DorsetLady PMRGCAuk volunteer]

As others have said, highly unlikely.

Here are a couple of posts that might help you get your head around things ,first on adrenals and second on flares -

healthunlocked.com/pmrgcauk...

healthunlocked.com/pmrgcauk...

Your panicky feelings can be due to the Pred, have you had them all the way through? If so, perhaps you should talk to GP about them, or try some relaxation techniques- they can be very unsettling, but there is help out there.

Do hope you soon feel a bit better.

[PMRpro Ambassador]

With a flare at 7mg, we would have suggested adding 5mg immediately for a week to 10 days - and then you can drop straight back to just above where the flare happened without an extended period at a higher dose. Creeping up like that rarely works well and makes it all last longer ...