cortisol test

[Ana-16]

I’ve been on prednisone for three years and have gradually reduced amount so I’m now taking one mg every four days. I’ve had little or no input from gp or rheumatologist but have managed by following advice from amazing people here. I finally got to see a rheumatologist last month and she agreed I could have a cortisol test to check adrenal gland function. My gp surgery does not do the test so I will be going to another clinic. They open for tests at 8.30. I haven’t been told if this is a fasting test or if I should not take prednisone on that day. I would be grateful for any advice.

Many thanks

[SheffieldJane]

If you can’t get in touch with the people doing the test for advice. I would be inclined not to take Pred on the day of the test and not eat. This would be less likely to ruin the test. If I remember correctly, this is what I did for my Synacthen Test.

[Ana-16 in reply to SheffieldJane]

Thank you.

[DorsetLady PMRGCAuk volunteer]

You don’t need to fast for the am cortisol rest, but you do need to ensure you haven’t taken Pred for previous 24 hours.

Might be sensible to contact clinic just to check on other medication you might be taking.

[Ana-16 in reply to DorsetLady]

Contact the clinic!! That would be wishful thinking. I will just not take anything for the previous 24 hours. There won’t be any issue with missing a dose of the other meds I’m on. Thanks for the advice

[DorsetLady PMRGCAuk volunteer in reply to Ana-16]

Yes well… wishful thinking on my part… should know better !🤦🏻‍♀️

[Ana-16 in reply to DorsetLady]

Yes. It’s not been great though my gp is lovely. Just that I’ve been left alone to manage everything for almost a year. Without this forum I would have been lost.

[tangocharlie in reply to DorsetLady]

I think you do have to fast, I was told to anyway? And I took my Pred after the test

[Ana-16 in reply to tangocharlie]

Will do. Thank you

[Zebedee44 in reply to tangocharlie]

No you don’t need to fast. My synacthen test was booked for 10am and I was still drinking the coffee I bought from the hospital cafe when I arrived at the unit. No problem. Just don’t take the pred fro 24 hours prior.

[Ana-16 in reply to Zebedee44]

Many thanks for the info. Best wishes

[tangocharlie in reply to Zebedee44]

Youre proably right but 9am cortisol test is different to the synacthen test so best to check with the surgery

[Lydia08 in reply to tangocharlie]

My doctor was quite specific about fasting to the point of saying that if I didn’t or forgot to that the test would have to be redone.

[Ana-16 in reply to Lydia08]

Oh dear that is confusing. Some seem to insist on fasting and some think it’s unnecessary. Checked with dr Google as the advice there is that fasting is not necessary

[PMRpro Ambassador in reply to Ana-16]

The safe option is to assume you should go fasting! I can't see how having breakfast would affect a basal cortisol test though!

[Ana-16 in reply to PMRpro]

Yes I think I will err on the side of caution and fast. Thanks to everyone who took the trouble to respond.

[PMRpro Ambassador]

You should not take any pred in the 24 hours before the blood sample is taken. So you take pred in the morning the day before and none until after the blood sample is taken.

Is this just for a basal cortisol or will it be a proper synacthen test which takes an hour or so?

[Ana-16 in reply to PMRpro]

Thank you. Just basal cortisol as far as I know.

[PMRpro Ambassador in reply to Ana-16]

Bit pathetic of your GP then - it only requires a simple blood sample taken at a relatively specific time. Or maybe it is the delivery system ...

[Ana-16 in reply to PMRpro]

😢

[Bcol in reply to Ana-16]

Mine was done at GP's both times, no Pred for the 24 hours before and test before 09:00.

[tangocharlie in reply to PMRpro]

a simple blood test, usually pre 9 am, I had mine done at my GPs, though it might have been at the direction of the endocrinologist at the time I can't remember now, was many years ago

[Luciejane]

Hi Ana I've had the Synacthen test twice in the last few months and you don't have to fast but you mustn't take any steroids for 24 hours beforehand. As you only take 1mg every 4 days you can arrange your test for a day you don't take it. If you don't have adrenal insufficiency symptoms it's likely that you are ok. Good luck

[Ana-16 in reply to Luciejane]

Thank you. That’s helpful. Best wishes

[Meezamom]

I had the test in July and the department told me to not take Pred for two days before, I didn't need to fast though. I ended up getting a horrible flare afterwards, which thanks to Dorset Lady and other lovely experts on here, I managed and am back down to 4mg, just above what I was on (3/3.5mg). The test was successful, but now I am under pressure to keep on reducing to zero. I feel like they treat it as an addiction we need to be weaned off, but the pains I had with the flare made me realise that I still actively have PMR and I will now reduce at my own speed, or not at all, if it is controlling the PMR and reducing causes pain.

I hope your test is successful and with you at 1mg every 4 days, you stand much less chance of getting a flare - good luck!!

[Zebedee44 in reply to Meezamom]

That was pretty bad advice and It’s no real surprise that you had a flare if you stopped your pred for two days prior to the test.

[Lydia08]

I just took the test last week. They told me to eat nothing after midnight before the test and I could take my morning meds as usual. I elected not to take them until after the test.

[Vawils]

Think you already got the right answer that you should not take prednisone the morning of test and 24 hours before. I am curious as to why your rheumatologist wants you to have the test. Were you having symptoms again since you were at a low dose? I was down to 2 mg prednisone per day and had a significant flare and my rheumatologist refused a cortisol test I requested since she felt it would not show anything that we didn't already know since my flare showed that my adrenals weren't producing enough and the answer to that is more prednisone which I increased. I would have preferred the test to get a more definite answer.Good luck with the test.

[DorsetLady PMRGCAuk volunteer in reply to Vawils]

Low adrenals don’t cause a flare of your illness -that is caused by too low a dose of Pred. Which was rectified by increasing it.

Symptoms of low adrenal activity may be similar to some symptoms of a flare -but the cause is different.

In your post a couple of months ago I did explain and sent info on adrenals.

[Vawils in reply to DorsetLady]

I was only repeating why my rheumatologist said I didn't need that test, in her opinion- "that testing of the adrenal axis (cortisol) will likely show suppression and the treatment of adrenal insufficiency is steroids, which I am on already, so she suggested to save time/money to differ the cortisol testing with no further tapering for now and staying on 2 - 3 mg/day of prednisone."

I did appreciate the information you sent on adrenals and would have preferred to get the cortisol test to better understand where I stand.

[DorsetLady PMRGCAuk volunteer in reply to Vawils]

Perhaps she didn’t explain her idea properly- but it’s an odd comment for her to make… and yes you do want to know where you stand. If you aren’t having any particular issues would say they are working- but unfortunately you don’t know how well… but a cortisol won’t tell you that either.. just if they are capable of working.

[Ana-16 in reply to DorsetLady]

Oh dear. I thought that the test would tell me if my adrenal glands are actually working not just capable of working.

[DorsetLady PMRGCAuk volunteer in reply to Ana-16]

Well it’s an indication that there is function -so it is worth having. But as I said not how well…

[Ana-16 in reply to DorsetLady]

Thank you for clarifying. Have a good evening

[Ana-16 in reply to Vawils]

Just to check function of adrenal glands

[PMRpro Ambassador in reply to Vawils]

A flare has nothing to do with whether your adrenal glands are producing enough cortisol - where on earth did she get that idea?