Virus or adrenal insufficency?

[maxismall]

Hi. Been using Dorset Lady taper - 4.5mg to 4mg started 28 Aug. Up until now been doing well - no flares despite accident in March which put me in hospital for 11 days. No weight gain, kept active. This week aches , extra fatigue, fever( alternating between sweating & shivering with cold), slight nausea, extra fatigue , low mood. No chest or nose symptoms & covid test negative. Symptoms improve 2 hours after pred. Have asked GP if she would kindly consider adding cortisol test to my normal bloods next week. When results come back what happens next please? If cortisol levels low what have I proved , if anything? Is it just a question of going back up to 4.5mg for a bit ( I had only had 3 spaced out days at 4mg)? Many thanks.

[PMRpro Ambassador]

You'll have proven nothing unless it confirms what my suspicion would be: adrenals lagging behind and insufficiency. The fact you feel better 2 hours after taking pred fits perfectly with that too. What it will do is provide you with a baseline so you can see if things are improving over time in the future.

4,5mg should be enough to tickle the adrenals into producing their own cortisol and there is nothing else you can do except wait for them to wake up. But it is also enough to provide the amount of corticosteroid you need for day to day functioning, It MIGHT work if you do week one a few times, week 2 a few times so it takes longer for you to get to week 3 and the system has had a bit longer to adjust to the change.

[maxismall in reply to PMRpro]

Cheers. I like the sound of doing week one etc a few times. I feel better after pred but not able to function to even 50% of normal activities. The shivering responds positively to paracetamol. So I will go back to 4.5mg for a while & depending on cortisol result ( if GP does it) will think again. Thanks for your invaluable support.