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Post Prednisone Adrenal Insufficiency

Posted by petermccarville @petermccarville, May 4 8:12am

I am quite sure I have Post Prednisone Adrenal Insufficiency, also known as Tertiary Adrenal Insufficiency (TAI). My symptoms tend to be fatigue and whole body aches/pains after I "overdo" my activities such as manual labor (digging, lifting, etc while working on my property). After a couple of days of rest (less or no labor) I am back to normal. It is like I have half the abilities (energy stores) that I used to have (pre PMR). No reserves. Another example is jet lag. A recent trip (April) to and from Austria really hammered me. I had body aches, stomach pains, digestive issues, and fatigue as symptoms of my jet lag. 5-7 days later I was "normal". Really an amazing/unpleasant experience. Back in October I went to Austria and was on about 6-7 mg of pred. Jet lag was not an issue at all in both directions. If it is true that I have TAI, how long until I might be "back to my old normal" ? Any thoughts? The adrenals are acting but just not producing as much as I need to reduce the pains that come with activity, it seems. I was on pred for 10 months (starting in April /May of 2025) now off for 2-3 months, started at 15 mg, had an excellent taper and experience on pred with little to no side effects from pred. Thoughts?

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jennyjune | @jennyjune | May 5 7:55pm

Wow, that is an amazing tapering, I’m struggling a little bit, stress along the way interfered a bit with mine but back on track now. I actually read up on the adrenal while on prednisone, and yes they basically turn off so to speak, so when you stop your meds they have to learn to work again, thus could take a little while, a good adrenal supplement would probably help. I’m back up to 5mg of prednisone was down to 3mg and am now taking bioceuticals Adrenoplex to give my adrenals a helping hand.

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caroljeand | @caroljeand | May 6 7:43am
In reply to @petermccarville "@caroljeand . Thanks for your interesting take on the fatigue issues that you have, post steroid..." + (show)
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@caroljeand . Thanks for your interesting take on the fatigue issues that you have, post steroid taper. I am not sure that I agree that these are still PMR symptoms that I have. I never really had fatigue with PMR . I also think that since I do not have the classic bilateral hip and shoulder pain, fatigue only after I complete a task of heavy work our something physical, and labs that are perfectly fine (no inflammation markers), and I do not have daily pain when just hanging out ...I can safely say that I do not have PMR anymore. My issue is overdoing and recovery. If I do not tax myself physically with a 8 hour day of digging holes for tree planting for example, then I do not have pain nor a hard time recovering from it. But when I do a day or two or three in a row like that (exercise, labor, etc) then I seem to get into a recovery deficit. My body aches and I am dead tired. But, I do recover eventually to a pain free state in a couple of days. I like to think I am in remission or "cured" but just suffering from the side effects of prednisone. Maybe this is just semantics?!

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@petermccarville
I don’t know how old you are but it sounds like you are much more active than most people who don’t have a history of PMR. I know when I first had PMR symptoms I could be active without any problems then the next day I suffered. I was on prednisone at the time so I don’t think the issue of fatigue was related to my adrenals.

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csimmonds | @csimmonds | May 7 9:30am

I can relate to the experience. Since it is spring I have done yardwork. I can rake, dig weeds, move planters, etc. and feel ok. The next day is a different story. It takes a couple of days to recover. I am tapering off prednisone and don't know how to balance activity and tapering.

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bubbiebirder | @bubbiebirder | May 7 3:58pm

Thanks for this discussion - it's very helpful. I was diagnosed in February 2026, have been on prednisone for 8 weeks (highest dose 20 mg a day), currently just tapered to 10 mg. (Am also on Tyenne (tocilizumab) injections), and this current dosage is the first time I have felt general achiness (flulike). I'm 76, and I had some L shoulder impingement signs before being diagnosed with PMR - PT suggests the prednisone has masked those symptoms and they may recur once my dose is lower.

Here is what the PT I am seeing advised me to do about exercise and tapers. He said that the prednisone can mask symptoms of muscle or ligament strain, and that for 72 hours before and 72 hours after the taper, I should not increase (numbers of reps on the light weights I am doing, increase swimming or walking distance, yard work etc. ), and that after the first 72 hours of the taper, I can carefully increase.

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