I have suffered from PMR for the last 3 years 10 months. I am now down to 2 mg of Pred, 1 at 3am ish and 1after breakfast. I recently asked my GP for a blood test for my Adrenalin levels as I didn’t feel a return of Adrenalin even though I am on a very low dose of steroids. It took 3 months to get the results only to be told they had not tested for Adrenalin as no tests were available on the NHS for such a test. I followed this up with requesting a telephone conversation with a GP( not my own who was on holiday) The GP who rang me was pompous, badly informed of my condition and very condescending. When I asked for my Adrenalin to be tested he queried why I should need this, I explained patiently about my PMR and the length I’d been on steroids etc. He then said, very condescendingly, “ So if you met a wild animal in the street you wouldn’t run away?” I was begining to lose my patience and told him I’d never met a wild animal in the street so I didn’t know. He then went on about Adrenalin and all the negative effects but I challenged him and said what about all the highs it gives people that I’ve also been missing. He argued there weren’t any! So I gave him the example of a pop singer/ actor coming off stage after a really successful performance, what was pulsing through their veins? He didn’t answer, he said if I really wanted to pursue this he would talk to a rheumatologist, I said please do.
Nothing for a month, now I get a message from the surgery, after consultation with the hospital they are offering me a cortisone blood test. I must make an early morning appointment having taken no steroids for 24 hours.
Should I accept this with open arms? Will this give me a view of my Adrenalin levels.
Thank - you in advance for any advice.
Written by
GrannyJane
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I would say yes as this is the standard test to assess whether your adrenal glands are functioning having been closed down by long term steroid use. Puzzled by the request for adrenalin test? There will be a better and more thorough explanation from others but this does seem fairly straightforward. There are articles on here explaining adrenal insufficiency, symptoms etc.. in Frequently asked questions. Good luck with it all and hope those adrenals are doing their stuff.
It isn't an adrenaline test you need but a synacthen test. That is a test done in a hospital clinic where they take a sample of blood for basal cortisol and then give you an injection of synthetic ACTH which should stimulate your adrenal glands to produce more cortisol, The difference in the two readings shows how well your adrenal glands are performing.
However, having a basal cortisol test is a good start - it will identify whether you are adrenally insufficienct or in normal range and if you are in the middle, a synacthen test will provide more information.
Basal cortisol is the cortisol level in a sample taken in the morning between 9am and 1pm - exact time isn't too important but you must not have taken pred in the previous 24 hours - you can take it immediately after the blood sample is taken.
If the basal cortisol is under100, that is adrenal insufficiency. It it is over about 400, that is normal. In between is equivocal but actually provides information about how your adrenal function is returning, Being to the lower end of that range shows they are struggling a bit still, towards the higher end is a good sign.
But even if they are low, it doesn't mean they won't continue to recover. It can take a long time.
I think they may have been muddled by the fact you asked for an adrenaline test. In fact this test measures the levels of catecholamines in the blood. As PMRPro says what you want is a synacthen test to measure your adrenals.
Yes, take the test offered because although the adrenal glands produce adrenaline they also produce cortisol which is the one that is greatly affected by Pred. You need a test for cortisol not adrenaline as PMRPro explains. It can be confusing because of the name adrenal gland and that we talk about energy levels which does sound like it should be about adrenaline.
Thank-you everyone for your replies. A particular thank-you to PMRpro whose wise advice and information is always so valuable. Yes I should have asked for a Synacthen test but I’d forgotten it was called that. Anyway I now understand it all a lot more and will be better equipped when I get the results to understand where I am.
i am also reducing my pred. I have been on the steroid for 10 years! My rhumatologist has asked me to reduce then i will be having a blood test for cordisol. I will try to get down to 3 from 10. I am not sure what addisons disease is?
It is the name for the illness when your adrenal glands aren't working, it is also called primary adrenal insufficiency. There are various reasons for you having low cortisol in Addison's and they are all what are called pathological, due to something in the body not being right.
We have SECONDARY adrenal insufficiency - it is because we have another condition which is treated with pred and the low cortisol is secondary to that. It is because we are taking pred to manage our PMR/GCA and that tells the body it doesn't need to make any more corticosteroid in the form of cortisol because there is plenty present in the body.
Hi. I’ve just read your post and you’ve inadvertently answered my questions about the cortisol test. It seems it is a fasting test and no steroids for previous 24 hours. Without this forum I would not have known about adrenal glands or cortisol tests or requirements for the test to give valid result.
Corticosteroids, such as prednisolone, are a synthetic alternative to the natural hormone cortisol, which is produced by the adrenal glands. When the body detects lots of prednisolone in the blood, it turns down the production of natural cortisol accordingly. High doses can shut down the production of cortisol completely and, if this condition lasts for an extended period, the adrenal glands can be slow to restart when they should.
Note, this is by no means the only function of the adrenal glands. They are part of a regulatory system called the hypothalamic-pituitary-adrenal axis.
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