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taper decision - stay at 1MG or keep going lower
Polymyalgia Rheumatica (PMR) | Last Active: Apr 15 5:58pm | Replies (11)Comment receiving replies
That's the big question - how do you know if your adrenals are back to "normal" ? My rheumatologist told me that a test for cortisol levels while taking prednisone will not yield accurate results.
Replies to "That's the big question - how do you know if your adrenals are back to "normal"..."
Decreasing symptoms of adrenal insufficiency mostly ... that is the problem when you are still on prednisone. Any amount of prednisone will cause an inaccurate cortisol reading. My endocrinologist said a prednisone dose of less than 3 mg should allow my adrenals to recover somewhat.
After I was able to stay on 3 mg of prednisone for an "extended period of time" an 8 a.m. cortisol level was checked. I couldn't take prednisone for 48 hours in order to get a more accurate 8 a.m. cortisol level. My endocrinologist was very interested in how I felt when I held my prednisone dose for 48 hours prior to doing this lab test.
When my morning cortisol level came back within range -- my endocrinologist still wasn't sure what would happen if I stopped prednisone. She just told me to stop prednisone and let her know if anything happened. It was more like a "leap of faith." My understanding was that I could take Prednisone again for any reason "if I felt the need."
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My ophthalmologist said I had a need for 60 mg of Prednisone within days of me stopping Prednisone the first time. It was another problem that had nothing to do with PMR or my adrenals. I had a flare of panuveitis but most people don't have to worry about that. I had a prior history of uveitis but the way it flared surprised everyone.
https://rarediseases.info.nih.gov/diseases/8577/panuveitis
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I think you can assume your adrenals are working if you are reducing prednisone and you're not having any of the following symptoms of secondary adrenal insufficiency (from Google):
"Key Symptoms of Secondary Adrenal Insufficiency:
Fatigue: A persistent feeling of tiredness and lack of energy is a prominent symptom.
Muscle Weakness: Difficulty performing daily tasks due to weakness in the muscles.
Weight Loss: Unintentional loss of weight.
Gastrointestinal Issues: Nausea, vomiting, and diarrhea can occur.
Low Blood Sugar (Hypoglycemia): Can cause sweating, shakiness, and confusion.
Mood and Mental Changes: Irritability, depression, and mood changes are possible.
Changes in Appetite: Loss of appetite or cravings.
Low Blood Pressure (Hypotension): Can lead to dizziness or lightheadedness, especially when standing.
Abdominal Pain: Pain in the stomach area.
Dizziness or Fainting: May occur due to low blood pressure.
Less Common Symptoms:
Loss of sex drive (in women): Decreased libido.
Decreased pubic and axillary hair (in women): Due to the lack of androgens.
Hyponatremia: Low sodium levels in the blood. "
The weight loss symptom is interesting to me. I've just lost a little weight unintentionally, but I think it's from tapering prednisone, and not from adrenal insufficiency.