Are there any obvious symptoms we will notice to suggest our Adrenal Glands are coming back to life?
I understand this could happen around 7.5mg of Pred and below. I am back to tapering from 4mg - 3.5mg and am not sure that my Glands have got the message !!!
not sure that my Glands have got the message !!!
What makes you say that?
Very rarely do people find they switch back on when reaching 7,5mg… although that is the figure often quoted, it cm be slightly or considerably lower - and it usually gradual.
There is no great big banner saying ‘we’re on again’ - but I did feel a bit more myself when I got to around 2.5mg Pred [sluggish adrenals has caused random bouts of fatigue for previous 8 or months] but whether that was totally adrenals, GCA going into remission or both I couldn’t say.
But even when they have woken up, it can take anything up to a year after finishing Pred for them to be tip-top!
You could ask for basic cortisol test from GP surgery to see if they are thinking about it!
Info from FAQs as well, if you haven’t read -
Not so much signs that they ARE, more if they are NOT! If they slowly start to take up the slack as the pred dose is reduced, you feel pretty OK-ish as you have all the time. If they are struggling, then you start to experience more fatigue and some odd effects such as dreams. Fatigue is probably the biggest factor. And there is no fixed point - 7.5mg is said to be a physiological dose and where the body MIGHT start to notice a lack of corticosteroid. But some feel effects at higher doses, some at lower and some none at all. And more recent research suggests the physiological dose is much lower, equivalent to as little as 2 or 3mg pred. You may feel OK day to day - but not under stress or with more activity or if unwell.
Meant to say - they aren't fitted with an on/off toggle switch. It is more like a dimmerswitch that slowly gets going - but gets stuck and wobbles from time to time.
I read that and i wasnt sure exactly what they mean by a physiological dose Is it an amount of steroid that could occur naturally? Not system swamped like with the high doses? Or an amount that could need topping up by adrenals? And does being at a physiological dose make side effects less likely? Im at 7mg so interested!
It is the dose that is about the same as the amount of corticosteroid the body requires to function properly - not could, but does occur naturally. It is essential to life and you would become very sick without it.
The natural steroid is cortisol. The correct amount allows your body to work properly. If something happens and either too much or too little is produced, you may become unwell. Too little is called Addison's disease, too much is called Cushings. There are various reasons why it might happen. And if it happens - there are side effects, the same as with pred for some people.
Hydrocortisone is the nearest to cortisol in having the same chemical structure. But even so, some people don't tolerate it well as a medication and develop side effects. It doesn't last long in the body and that is why it is used rather than pred to try to encourage normal adrenal function - it may or may not work. But pred works too when you use it carefully. But very little is guaranteed when the human body is in the mix!!!!
thank you! makes sense 🙂
Sadly there isn’t a convenient symptom to say the shop is open. Instead it’s the lack of feeling wiped out if you do anything other than lie still. Gradually, it takes more and more to cause fatigue. Why do you think yours are still napping?
I am on my third attempt at DL's tapering from 4.0 - 3.5 Pred, each time I have been here there has been some issue that has caused me to go back to 8mg, I am not sure if I am being over cautious and should stick it out if I feel a little bit worse. Hence my question.
Thank you DL and PMRpro for your answers, I have read the article and bought a dimmer switch 😉
Yes - but is it PMR/GCA related or adrenal related? It is more complicated at this level and sometimes it is difficult to decide which it is. By going back to 8mg you are throwing away any advance your adrenal function may have made and you start again. But when your body rebels at the same dose repeatedly - it is often a sign you have reached your lowest effective dose.
Ditto to PMRpro’s reply..
Looking back at previous posts, you seem to have been struggling to taper for the last 8 months.. which would indicate that you are trying [unsuccessfully] to get below the level your PMR actually needs, as stated by PMRpro.
Would suggest you hold fire at current dose for a couple of months and make sure that your PMR is fully controlled and also gives your adrenals a chance to get their act together.
Many find that reducing below 5mg is much more difficult than they had envisaged. You will get there, but honestly there is no rush…
thank you both, I never have been a good patient, and have been doing fairly physical work in garden for past 2 weeks plus played golf twice (badly)
When I fill my weekly pill box this Sunday it will be 4 mg Pred all week, I will forget tapering now until February, I have Christmas and New Year coming up followed by my annual trip to visit Son in Australia early January
Will revisit tapering when I get back.
Thanks again for your support and advice
How long have you been on the prednisolone as I have been on 5mg daily for 13 years and my doctor is talking about tapering me of an I'm really concerned
Why are you taking Pred? There is nothing on your bio to indicate what disease you have… assume as you have only taken 5mg daily then it’s not for PMR nor GCA as most on this forum are. RA maybe?
As for tapering off the drug, it really depends whether your underlying illness is still active or not? If it is, is the intention to replace with something else?
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