I'm hoping someone in the know on adrenals could offer some advice. A couple of weeks ago I was very unwell with chest pains, shortness of breath especially on laying down, pressure on my breastbone, feeling rather feverish.
I was advised by GP to attend A&E who weren't sure what it was and suggested indigestion 🤦♀️ and advised Gaviscon. Even though my CRP level was raised. A couple of days later I was bent over with the pain and called 111 who,predictably sent out the paramedics. All ECG's were normal except for fast pulse. They advised getting bloods redone at A&E as the heart blood test was elevated.
So off I went, this time triage sent me to SDEC, same day emergency care, based on a ward where you can see a variety of specialists. Must say it was far more pleasant and efficient than A&E. They wanted me to see a cardiologist the next day for an echocardiogram, which showed I had extra fluid around my heart so they diagnosed pericarditis, inflammation of the bag of fluid the heart sits in. Could be viral or bacterial.
Due to an anaphylactic reaction several years ago I'm unable to take Ibuprofen which is the usual treatment for pericarditis, so they prescribed an antibiotic and 2 weeks of Prednisolone, 30mg a day. I've taken Prednisolone very occasionally before when my asthma has flared up, but never for more than 5 days and not since I've been hypo and on Levo. They also gave me Colchinine, used for gout as an anti inflammatory but I didnt take it.
I've now stopped the Prednisolone, no taper,but the last couple of days I've felt weak, shaky, trembling legs, abdominal pain, off balance/ dizzy and just not right. I'm wondering if the Prednisolone has affected my adrenals/ cortisol levels adversely? And is there anything I can do to help myself feel better?
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Sparklingsunshine
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You're probably best off contacting your GP or the doctor who prescribed you the meds to check if this is a normal reaction or if anything else could be going on. I'm not sure any member here would be qualified to give an accurate assessment.
poor you, this sounds rough. I hope you get the help you need. Definitely get back to cardiology /GP A&E and list those symptoms, sounds like you need more investigation 🌱
Did you stop the Prednisolone or was it the medic? sometimes it's best to taper the dose before stopping to give your body time to adjust, is it normal to stop completely on 30mg daily, I was on 60mg and tapered very slowly under specialist care for that reason. I may be wise to seek advice from your doctors about this given your symptoms. I hope you feel better soon.
Have you ever had your cortisol measured? I would suggest you ask the hospital you went to for a copy of the tests they did over the time you've had this chest pain. You should be able to find the records department on the hospital's website. You should also ask the wards and departments you were treated by if they have the records. I don't know how quickly they would be moved to the records department.
People who are given cortisol or cortisol substitutes in high doses can find that this can adversely affect the production of cortisol from their adrenal glands. I don't know how quickly this happens or what dose would cause problems. There is a danger that the adrenal glands will shut down or reduce their output and there is no guarantee that they will wake up again.
[This is completely the opposite of how the thyroid reacts to thyroid hormones - the thyroid does wake up eventually after being disused for a while due to people taking thyroid hormones in tablet/liquid/intravenous form and it will start producing thyroid hormones again.]
There are two standard ways of testing cortisol that I know of. There is the blood test usually used by doctors. It measures "Total Cortisol" plus "Free Cortisol". Then there is the saliva test which measures "Free Cortisol". Both tests are useful, but doctors only pay attention to the blood test, which has always puzzled me, because Free Cortisol is the active form of cortisol that can get into the cells. The saliva test is the only one that gives you information about how well your cortisol is being produced throughout the day because it is usually done with four samples throughout the day, whereas the blood test is a single sample which ideally should be done at the time of peak production of cortisol which is usually assumed to be roughly 9am.
The random cortisol blood test isn't terribly helpful since cortisol has a circadian rhythm and it depends on the time of day the blood is taken what the expected level of cortisol should be, and they use ridiculous reference ranges that usually cover 6am - 10am, then there is a gap then they have another reference range for 4pm - 8pm. I always wonder why they don't cover the period from 10am - 4pm.
There is also a 24-hour urine test, but I can't remember anyone ever getting it done and wouldn't know what results to expect or how reliable the test is.
Under the circumstances it would be worth you knowing the signs and symptoms of Addison's Disease.
Chest pain can be caused by very low iron. Low iron can also cause tachycardia (very fast heart rate)
Personal anecdote : I once had severe chest pain and went to hospital. The tests that were run included potassium which turned out to match the bottom of the range. I don't know what caused this to happen and it has never happened again that I know of.
I've also had chest pain from having extremely low iron.
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The problem with potassium is that both low and high levels can cause cardiac arrhythmias, and high levels are considered to be very dangerous, so don't make assumptions.
Quote from the high potassium link below :
Hyperkalemia means the concentration of potassium in the blood is too high. This occurs when the concentration of potassium is >5 mEq/L.[3][9] It can lead to cardiac arrhythmias and even death.[3] As such it is considered to be the most dangerous electrolyte disturbance
I think they tested my electrolytes which were in range though at that point I wasnt on the steroids. They did all the usual ones like FBC etc. The only two abnormal ones were elevated BNP but not elevated enough to denote a heart attack or heart failure and my CRP was 7.6. But as I have connective tissue disease (EDS) they didnt seem that bothered. I guess whatever they gave me worked as the chest pain and shortness of breath has completely gone 😄
Hi Sparklingsunshine, you have been taking a high dose of prednisolone (roughly more than 5 times what a person with autoimmune adrenal disease would take). It sounds like you are experiencing withdrawal symptoms by stopping prednisolone suddenly (cold turkey). Your doctor should have planned a taper off period where you reduced your dose gradually over a period of time, to allow your adrenals to 'rev' back up to the work of producing cortisol again. Might be best to get back in touch with GP. If you are still poorly after a well planned taper period they should investigate your adrenal function. Hope you get your sparkle back soon.
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