I am reducing my prednisolone which have bee... - Vasculitis UK
I am reducing my prednisolone which have been on for 3years,how do I know my adrenal glands will work,am also on methotrexate too?
This isn't really a concern until you are below about 10mg. If you reduce the pred slowly enough your adrenal glands will be able to start up again (if they are and they usually do). It isn't the adrenals themselves that pose the problem, it is the complex feedback setup that governs them that has to settle down. There are symptoms of them not working properly and you should be warned about these signs - as long as you don't ignore them it isn't a problem.
Some doctors won't do a synacthen test to see if they are working until after you are fully off pred - which, frankly, is a bit late! Others have worked out how to do it while you are still on pred and I know several people who've had it done and got a reasonable result.
Some doctors encourage patients to stick at 5mg for a few months to let the body catch up - it all depends. But in many illnesses the MTX is to allow a lower dose of pred to achieve the same result - it isn't always aiming to get the patient off pred altogether so that means you will be on a low dose anyway and that is often enough to avoid any problems.
Thankyou for your reply it was most helpful. Can you tell me what symptoms I should be looking for if adrenal glands are not working.Have not had synacthen test doctor doesn't think it's needed!
The format of this forum is so irritating! I posted this for someone else but unless you come back and read the entire thread every few days you miss such a lot! Here you are
Here's a link for an adrenal crisis
but this is the sort of thing you might experience if you suddenly stopped taking your pred - as long as you reduce VERY slowly it shouldn't happen. It could happen if you had a d&v bug and couldn't keep your pills down for a few days or if you had an accident and were unconscious and couldn't tell anyone - hence the recommendation to carry a steroid card or wear a medicalert bracelet.
Hi PMRpro,
Could I ask you a couple of questions please (you seem to be very well informed!)?
What are the signs your adrenals (or the complex feedback system) aren't working properly?
Also, what is considered a "low" dose ( i.e. a dose low enough to keep symptoms at bay but not high enough to cause damage if taken long term).
Thanks.
Here's a link for an adrenal crisis
nhs.uk/conditions/addisons-...
but this is the sort of thing you might experience if you suddenly stopped taking your pred - as long as you reduce VERY slowly it shouldn't happen. It could happen if you had a d&v bug and couldn't keep your pills down for a few days or if you had an accident and were unconscious and couldn't tell anyone - hence the recommendation to carry a steroid card or wear a medicalert bracelet.
A low dose is below about 7.5mg - it can still cause some problems, it depends on the person but that is what the body produces itself every day. Above that there is an excess and it is the excess that causes the problems.
It isn't actually possible to give an OK/not OK dose, it is the total amount of pred you take over a long period of time that is important. If your adrenal glands aren't functioning at all you can take some pred every day for the rest of your life with almost no side effects. But when you are on a high dose for a moderate amount of time or a moderate dose for a long time the effects can mount up. Everyone is different, some people have few problems with even a 10mg dose, others have problems with just a few mg. And some people need 10mg to keep the symptoms at bay, others are fine on 2mg. It depends on the underlying autoimmune disorder and how active it is - more activity needs more control. Sorry, but we're people not machines and as a result are all different. If only your average doc could get the hang of that!
These links may help too.. cortisone-info.com/Side-Eff... there is a page on the Vasculitis UK website which discusses all aspects of taking Cortisones. vasculitis.org.uk/news/cort... cortisone-info.com/ 
