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Conflict with Rheumatologist over taking Prednisone for PMR in AM/PM
Polymyalgia Rheumatica (PMR) | Last Active: Jul 29 2:54pm | Replies (29)Comment receiving replies
I take most of the dose in the morning and a smaller part of it, 2mg, early evening which definitely helps reduce morning aches. I'd previously thought that the morning dose was to more closely mimic the body's natural cortisol production throughout the day. Plenty of websites had said so, and the rationale for morning dosing was to reduce the chances of our adrenal glands not kicking back into production as we reduce and finish prednisone.
Now I'm confused. The image attached is natural cortisone production, with the peak being around 5am to 9am with a quick decline in level for the rest of the day. We do the opposite with a morning dose, taking the big prednisone dose as natural cortisol would be dropping fast. So you raise a good question. This is one of those times I wish we had doctor experienced with prednisone to answer our questions.
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Those nice smooth curves don't show what actually happens to cortisol levels. When the "average levels" are graphed, the graph doesn't represent what actually happens. My understanding is cortisol levels fluctuate throughout the day depending on what happens during the day.
The whole point being --- a daily dose of Prednisone is never going to duplicate what the HPA axis does and how cortisol levels are regulated by the body. Prednisone only puts a wrench into the entire mechanism.
Figure #1 in the following link illustrates the problem with averages.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3475279/
"The peaks of cortisol at noon and around 18:00 represent meal-induced cortisol stimulation."
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Everyone will have a different curve because we are all individuals.
No two days are the same so the curve on one day won't be the same on another day.
My endocrinologist says checking single cortisol levels doesn't show the bigger picture. This is one reason why adrenal insufficiency is so difficult to diagnose and treat.