Short Synacthen test

[Wheelygood99]

I have been referred to have an urgent short Synacthen test. 18 March 2pm. The endocrine nurse who phoned me to book the appointment wants me to not take my prednisolone on the 18th and the 17th. Said I could take my dose straight after the test. I'm worried about how I will be with no pred for about 56 hours! I'm currently on 4.5mg. Is it really necessary to stop pred for that long before the test?The referral was made by my diabetic consultant (I have Type 1) who did a cortisol test in December with a result of 170 nmol/l . Your advice please.

[DorsetLady PMRGCAuk volunteer]

Usual advice is no Pred for 24 hours before test -so I’d double check and say you are worried about going so long without it and are risking a flare up..

[Wheelygood99 in reply to DorsetLady]

I did express concern at the time so she double checked with someone else and confirmed to not take pred the day before as well. I've looked online at other NHS documents and it says only stop it 24 hours before hand so I think I will phone them back. Thanks

[DorsetLady PMRGCAuk volunteer in reply to Wheelygood99]

It may depend why you are on Pred -if it’s for acute issues it probably okay but not with PMR. Try explaining the problems it could cause, they may not realise..

[PMRpro Ambassador]

Er - well of COURSE your basal cortisol is at a low level since you are still at a pred dose that is plenty to suppress cortisol production. I really would have thought a diabetes consultant would know better since they are usually endocrinologists too.

The time soon adds up doesn't it!!! You will take pred as normal on the morning of the 16th, none on the 17th and take it late on the 18th. Under the circumstances it is very poor they are doing it in the afternoon - they are normally done at 9am as standard. And many doctors only stop the pred dose the 24 hours before - this was discussed recently and we couldn't find any hospital info sheets that said to hold pred for more than the day before, morning tests and immediate taking of pred were then fine.

Like DL - I'd check and point out the problem. And ask why there is any point at this current dose.

[PMRpro Ambassador in reply to PMRpro]

Here is the link to the last time it was discussed. I'd really want to know why 48 hours when the majority of NHS patient info is no pred for 24 hours.

healthunlocked.com/pmrgcauk...

[Wheelygood99 in reply to PMRpro]

The nurse said because it was an urgent request the first appointment they could offer was 2pm. If I wanted to wait for a 9am test it would be into April. They do know I have PMR. She asked if I could manage not taking the pred on the day before as well but as I've never tried it, who knows? She also said the normal dose should be less than 5mg which it is.Not sure what can be done anyway if the results show low cortisol production. Can anything be done? Other than tapering off pred?

[PMRpro Ambassador in reply to Wheelygood99]

Exactly - which I can only assume the doctor who requested it is not entirely clear about!!