when and why does adrenal insufficiency occur?

[PMRinAVL]

I am trying to figure out by reading through lots of posts when and why adrenal insufficiency occurs or not. It all seems very confusing. Is every individual different? Is there an average time frame or dosage factor? I have had diagnosed PMR for almost one year now, I am currently on 12.5 mg of Prednisone and initially had an 8 month taper from 10 mg to 3mg but then had a recurrence and went back up. What should I expect in regards to adrenal insufficiency?

[DorsetLady PMRGCAuk volunteer]

Have a read through this post- has further links which should give you a better idea - but if still have questions after reading through come back -

healthunlocked.com/pmrgcauk...

[PMRinAVL in reply to DorsetLady]

thank you sooo much for this info!

[SnazzyD]

Hello, definitely read the links on DorsetLady’s reply. There’s just too much to write to explain it all; it’s a simple question but a lot of answer! The frustrating thing is that nobody can predict how you’ll be, so nobody can advise you exactly what will happen, so you need to be ready. If you understand the theory it really helps make sense of what you’re feeling; is it flare? Is it adrenal insufficiency?. You don’t need to worry about it until you are below about 7mg give or take so you’ve got time to become the expert! One thing I would say that your reduction to 3mg was quite speedy compared to what most here can cope with, so it isn’t surprising you had a flare. Perhaps you can negotiate a slower taper as soon as you start to feel you’re not winning or preferably before that. A year is still early in the scheme of things, though many docs believe it takes 2 years. Once below 10mg I reduced at 0.5mg per month to start and below 7mg every 6-14 weeks. The lower I got the slower I got.

[PMRinAVL in reply to SnazzyD]

thank you!

[PMRpro Ambassador]

As soon as you are on above about 8mg pred for a couple of months your adrenal function is blunted. The higher the dose, the sooner it happens and the longer it goes on, the longer it will take to recover. Recovery seems to be an individual thing - but it isn't fully recovered for possibly a year after stopping pred altogether although some achieve normal function when down to 2-3mg pred but it is a gradual process from about 8mg producing top up cortisol.

So for you - currently your adrenal function will be very blunted, there will be no cortisol being secreted because of the level of pred dose and it is possible you have a very poor response to stress and illness.

That was a low starting dose and a very speedy taper to too low a dose - you aren't heading for zero, you are looking for the lowest effective dose for YOU.