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First meeting with endocrinologist
Polymyalgia Rheumatica (PMR) | Last Active: 11 hours ago | Replies (12)Comment receiving replies
I saw an endocrinologist as well as a rheumatologist because I was also diagnosed with Hashimotos about the same time as PMR. The Endo told me he couldn't check my adrenals (cortisol) until I was tapered off the prednisone. Makes sense as cortisol is supressed while on Prednisone as I understand it. I was curious if my adrenals kicked back in after tapering off the prednisone. Fortunatley mine seemed to be functioning fine
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@joyl263
There is some debate about needing to to be completely off Prednisone in order to have a morning cortisol level checked. My endocrinologist said being on 3 mg or less of Prednisone for an "extended period of time" was a low enough dose to "screen" for a return of my adrenal function. I also had to be able to not take any Prednisone for 48 hours prior to checking my cortisol level.
My endocrinologist "expected" a low cortisol level because I was on Prednisone for 12 years. However, she also thought 3 mg of Prednisone or less would be a low enough dose to see if my adrenals had started to produce any cortisol again. While complete cessation of steroids is ideal, tapering to a low dose (≤ 3 mg prednisone) and holding it for 24–48 hours is a standard protocol to screen for adrenal functioning while minimizing the risk of an adrenal crisis.
There isn't any consensus of opinion about the proper way to discontinue Prednisone after long term use.
https://bmjopen.bmj.com/content/15/12/e107269
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At least it is recognized that the normalization of the HPA axis and the ability of the adrenals to produce cortisol again is a significant barrier to tapering off Prednisone. It seems that it is easier to say the patient had a flare of their disease instead of a low cortisol level causing symptoms. The function of cortisol in the body is to "regulate inflammation" so it is no wonder we flare. However, the reported symptoms could either be a disease flare or they could be interpreted as attributable to adrenal insufficiency. Symptoms can also be a combination of disease flare and adrenal insufficiency.
It was also interesting when my endocrinologist said 3 mg of Prednisone was a very low dose. When my cortisol level was "adequate" and I didn't need Prednisone any longer to control PMR then I could simply stop taking Prednisone. In other words ... as long as PMR was controlled AND my cortisol level was normal then I could discontinue Prednisone without doing a prolonged taper. My symptoms of adrenal insufficiency were also evaluated before I discontinued Prednisone.