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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
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.
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And that raises other questions.
1. If the natural cortisol level is highest early in the morning and cortisol is supposed to help with PMR pain, why is that the time that PMR pain is often worst?
2. Why are we told the best time is morning dosing when that extends the peak cortisol level well beyond the natural mid morning reduction? Does extending the peak cortisol time more effectively control inflammation, or...?
3. Since everyone's cortisol fluctuations are different, why do some doctors continue to push the one-size-fits-all regimen of one dose in the morning only, especially when altering that regimen would result in less pain and inflammation for some people?
I'm not expecting you to answer the questions, just posing them.