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Testing for Cortisol levels during taper of prednisone
Polymyalgia Rheumatica (PMR) | Last Active: 2 days ago | Replies (28)Comment receiving replies
@dadcue I wasn’t told anything about timing for the cortisol test. I did some research the day before and realized I should do an AM one so I could compare to the afternoon one. I fasted and didn’t do my prednisone dose or my inhaler before the test. But based on all the info above, neither test really told me much. I do have fatigue and it now looks like Hashimotos thyroid so we were trying to find all the things prednisone has done in my body so I can try to minimize the impact. Not easy!
And coming down on prednisone after so long is hard so trying to tease out “is this adrenal issues or withdrawal or asthma flare or am I just having a bad day?” is also not easy!!
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@lluth412
Timing is crucial ... I think between 8 and 10 a.m. for a morning cortisol level. There are many other factors to consider for an accurate interpretation. I'm not sure that fasting is that important but perhaps. The following link is about cortisol levels for people who aren't on Prednisone.
https://www.webmd.com/a-to-z-guides/cortisol-test
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Cortisol levels for people on prednisone and trying to taper off is totally different. If the test isn't done correctly the results are meaningless. I think that is another reason why cortisol levels aren't done very often. Doctors that aren't endocrinologists have no clue how the test is done or how to interpret the results.
The following is some guidance that was recently published jointly by European and American endocrinologists. Even this seems vague to me.
https://www.endocrine.org/clinical-practice-guidelines/glucocorticoid-induced-adrenal-insufficiency.
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You can click on various sections under recommendations for more details.
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Otherwise the prednisone pharmacist has a video.
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I can appreciate you having additional problems with your thyroid, asthma and other things. Those things make it even more complicated. My problem was only because I was on Prednisone for a long time.
An a.m. cortisol level is just a screening test. If needed, an endocrinologist can do a Synacthen test and other extensive testing which gets even more complicated.