Adrenal deficiency symptoms

[Italybound62]

hello. Is it okay to have mild adrenal deficiency symptoms when reducing steroids ? Is this just something we all need to go through and wait for it to pass?

or do we need to avoid it by upping steroids? (I hope not)

[PMRpro Ambassador]

What do you mean by "mild AI symptoms"? What dose of pred are you at currently?

[piglette]

I got hit quite hard by the adrenals complaining on reducing the steroid dose. Ideally you should just stop reducing if you have problems, not increase. In my case I gave in and went from 5 to 6mg as I was turning into a zombie. You do not treat the problem as you would PMR pain.

[Italybound62]

sorry I should have provided that.

I’m moving from 3mg to 2.5mg.

Normal symptoms of Headaches, and fatigue Plus some muscle body aches

Although I am now realizing that what I experienced a few weeks ago was not a stomach virus or food poisoning. I think it may have been borderline adrenal crisis (I was tapering to 3mg)

Extreme nausea with severe vomiting for over 6 hours. Uncontrollable body shaking and feeling freezing cold in a warm house. I almost went to hospital until my husband comforted me through it middle of the night

Luckily not like that this time and that’s why I say ‘mild’.

Just wondering if we should push through it with headaches and some aches. Aches are not everyday. I know fatigue is normal

[PMRpro Ambassador in reply to Italybound62]

I would suggest you stick at 3mg for a month or two before starting the next drop. The HPA axis (hypothalamus, pituitary, adrenal set-up) that governs it all has to adjust its settings as the pred dose falls and it doesn't manage to do that overnight, it can take weeks to settle down. If you INCREASE the dose of pred all you are doing is postponing the evil day, you have to get through it at some point and the most comfortable way is to taper VERY VERY slowly, with small steps and at long intervals.

Yes - that would be typical of a threatening adrenal crisis and even if it was a bug/food poisoning the stress on your body would have normally been met with a spike of cortisol from the adrenal glands to help the body cope but your adrenals just couldn't oblige. This is the sort of event the sick day rules are designed to mitigate. Not sure how it works in the USA but the emergency services paramedic crews in the UK carry the necessary kits for a hydrocortisone injection to avert the crisis. Here where I live, the ambulance crews can't do it but the Notarzt (emergency critical care doctor) would be sent as well and they would deal with it. If you are not actively vomiting but feel awful then the usual advice would be to take 10mg pred immediately and seek medical care. You really should have gone to hospital, untreated you could have had an adrenal crisis and that can be life-threatening.

[Italybound62 in reply to PMRpro]

Ah okay. Thank you for that explanation of how to handle the adrenals . Makes sense now.

[Jbobby in reply to Italybound62]

Oddly enough what you describe is exactly what happened to me earlier this week - vomiting etc ( I posted about it at the time). I’m now wondering if what I was going through was borderline adrenal crisis. I took 10mg as recommended - which helped instantly - but only for one or two days and then back down to 7.5mg. Not sure I’ve done right as am again feeling stiffness pain in back neck and legs until my e/c Pred kicks in during afternoon. Anyway as far as you’re concerned - and given my recent gastric episode - I wd stick to very very slow reduction as PMRpro suggests.

[PMRnewbie2017]

In the early days I experienced the effects of mild AI on two separate occasions about a year apart when at 2.5mg. From 3mg I reduced more slowly and by 0.25mg. Fiddly yes, but no more AI symptoms. A couple of years ago i had a basal cortisol test, purely out of curiosity. I was taking 1.5mg and it gave a huge result which shocked me. Since then I've flared and am still at 4.5mg but feel reassured that my adrenal cortex should still be capable of working.

[Italybound62]

Thanks for all the comments.

Has anyone saught help of an Endocrinologist to prescribe hydro prednisone to help with AI and tapering? My Rheumatologist told me 2 months ago to see an Endocrinologist for this purpose but I am reluctant to switch to hydro prednisone. Worried about getting hooked on another steroid or that it will cause PMR flare due to not being as efficient. ( could be my ignorance) But now that I am noticing some AI maybe it is a good idea.

[PMRpro Ambassador in reply to Italybound62]

It is hydrocortisone (HC), not prednisone.

It is all very well switching to hydrocortisone BUT it only works to encourage return of adrenal function IF the underlying disorder for which you need the pred in the first place is no longer active. HC doesn't have anything like the antiinflammatory effect of pred and also lasts a much shorter time in the body. An endocrinologist can and probably will prescribe HC but they are only considering the endocrinological aspect and not that the patient may still require management of the disease they are taking pred to manage. It is an option if the PMR is burned out and in remission but only then.

[Italybound62]

thank you for explaining that. Sounds like a patient may require both drugs in some cases.

[PMRpro Ambassador in reply to Italybound62]

Not really because they are both steroids - pred does the job in both requirements. So if you were to use BOTH you would have more steroid rather than less and the only thing that encourages the adrenal glands to wake up is a LACK of steroid in the body.