Cortisol test for Adrenals

[Jane185]

Hi there

I have had PMR since 2016 and have gradually decreased my prednisone to 4.5 mgs. I have been on that for about 2 months.

Dr has agreed to order a 9 am cortisol test for me because I read on here it was easier/better than a synacthen test. I gather from Dr Google that I do not take my usual morning dose of Prednisone? But I did see in another paper that children being tested are supposed to miss two days. So is one day correct? And am I supposed to fast until the test is completed?

Also, another complicating factor is that I am on a once per week ovestin cream. Will this affect the test if I am being tested for whether my adrenals are working or not?

Thanks for your help.

[SheffieldJane]

having had 3 tests ( 2 morning cortisol and one Synacthen Test) the cortisol test seemed to indicate that a further test was needed ( Synacthen). I didn’t take my Pred dose until after the test was completed, just one day for both. My Endocrinologist did get exercised about Oestrogen cream and I was advised to leave it off. This was all some time ago so my memory maybe hazy. Ensure your own medics advise you. Perhaps give the Endo team a ring. In my experience they were all nurses, so ensure that they are not withdrawing their labour ( U.K. only).

[Jane185 in reply to SheffieldJane]

Can I ask what you meant by " my endocrinologist did get exercised about..."? Well the problem was that I asked my Dr for this test and she didn't say much about it, probably thinking/assuming I knew more than I actually did. So do I have to go off the Ovestin for 6 weeks before I can take the test? Oh, and is it a fasting test? I am in NZ and it is difficult to get in to see any specialists. I am off on holiday soon and wanted to know if I am in any danger of adrenal insufficiency, so, for instance, not going "bush" in Australia, where I might not be able to get immediate help.

[SheffieldJane in reply to Jane185]

He just meant for the accuracy of the tests on my Adrenal function. I wasn’t given a period of time to stop using hormone cream for. My Adrenals recovered their function when I eventually lowered my dose to 3 mgs. Academic because I then developed GCA.

There is a danger of an Adrenal crisis when we are on the low doses of Pred ( under 7 mgs). I was given a hydrocortisone injection kit for emergencies and I always take extra Pred on holiday. I honestly wouldn’t do anything risky or alone at this stage. Not being your doctor I can’t guess at the level of risk. You need proper answers to your understandable concerns. I hope PMRPro notices this, she is very knowledgeable on a more professional level. I have seen a primary care doctor privately in Australia - when I visit family, could that be an answer?

[PMRpro Ambassador]

The 24 hours before the blood is taken is usually enough. You aren't going to get a fantastically accurate result at this stage anyway - but it is a very good guide about how things are going.

PV oestrogen therapy does appear to raise the cortisol level - but I'm not sure that is going to make any overall difference - if you are on it long term then it will have a consistent effect and if your cortisol level is raised because of the cream that is possibly a good thing. It will show the adrenal glands are producing cortisol if nothing else!

[Jane185 in reply to PMRpro]

Thank you Ladies!