Prednisolone v hydrocortisone

[Johnone1940]

A short while ago I posted regarding my problems reducing my pred dose. I had an appointment with a consultant” endo “ who referred me for a synacthen test the results of which I posted on here . At the time he said that depending on the result of the test he would recommend either that I stay on pred for life or he would transfer me on to hydrocortisone with a slow reduction program in order to attempt to awake my adrenals up. The choice would be mine. I am due for a follow up appointment shortly, when I will be asked to make my decision . Has anyone had a similar experience re hydrocortisone in its use to awaken the adrenal glands also how successful is the therapy, or should I go my own way and continue with my attempts to reduce the preds. ? I have been on 3 1/2 mg of preds now for about 3 months after being on 3 mg for six months when the fatigue/ tiredness set in . I then upped the dose to 5mg and then slowly reduced to the 3 1/2 . Any advice will the considered and appreciated. Cheers John. P S when I get on the lower doses I reduce by 1/2 mg on alternate days giving a 1/4 mg daily reduction over the month.

[PMRpro Ambassador]

Remember you don't just have the problem of wakening the adrenal function - you probably also need to manage the PMR inflammation too. HC isn't as strongly antiinflammatory as pred and it is also excreted from the body much more quickly. The effect of those two factors is that the PMR may not be managed well if it is still active and you may get a return of symptoms.

Do you know the result of the synacthen test? Has he made his recommendation for you to think about?

[tangocharlie]

I was switched from Pred to HC about 4 years ago when I had adrenal problems when going below 5mg Pred. In may case the problems was not just that the adrenals were sluggish but also that the PMR was still there. Conseqeuntly although the HC got the adrenals moving again, although very slowly, meanwhile the PMR flared up again and to cut a very long story short I had a big relapse. So I guess it partly depends on whether your PMR has actually gone. But how do you know whether it has? I guess you know from listening to your body whether it feels like it is still there,but it's complicated as withdrawal pains, PMR stiffness and pain and adrenal problems can all feel very similar. If the 9am cortisol tests and synacthen tests show the adrenals are functioning better but you still feel bad there is possibly still an element of PMR going on which needs treating Tricky!

[lizg0017]

Thanks posting your question. I’m in the same boat. I was at 6mg Pred for a year and almost felt normal. Then my endocrinologist wanted me at 4mg in order to evaluate my adrenals. So in October, I tapered from 6mg down to 4mg as of Jan 17. I was feeling bad at 4mg. Called doc. She said let’s make the switch to hydrocortisone 10mg twice a day. I started it on Sunday. I feel horrible. I’m supposed to see my endocrinologist this coming Friday but they’re predicting a snow storm so I may need to postpone. I haven’t felt this bad since onset in 2018. I’m from the states, Michigan. Best of luck to you.