Can I Test for Adrenal Insufficiency while on High Doses of Prednisolone?

Can you test for adrenal insufficiency while on high doses of prednisone? 

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Can I Test for Adrenal Insufficiency while on High Doses of Prednisolone?

Transcription autogenerated from the video above so some errors are possible.

I got a question from a prednisone warrior asking;

Can I please ask your advice as I feel awful and I think I’m getting adrenal insufficiency, I’ve been reduced down to 15mg of Pred now, but when I asked my Endocrinologist if I could be tested for it, he said that it’s impossible to test for adrenal insufficiency while on high doses of Prednisolone. Do you know if this is correct, please?

Disclaimer from your Prednisone Pharmacist

 First of all, I wanna give the disclaimer, I am Dr. Megan, the Prednisone pharmacist, but I cannot give medical advice. Your doctor is your best source of information. Based on the incredibly small amount of information you’ve shared with me, I’ll give you the scientific information. But you’ve got to apply this to your own personal situation with medical advice from an actual doctor.

The real question is;

Can you test for adrenal insufficiency while on high doses of prednisone? 

The HPA Axis

I have to agree with your endocrinologist that it is in fact impossible to test for adrenal insufficiency. And that is because of the HPA axis. HPA stands for Hypothalamic Pituitary Adrenal Axis.

This system works just fine when we’re not taking prednisone. The part of your brain that sends signals using CRH to your pituitary and another part in your brain using ACTH to your adrenal cortex. This is all complex and it’s this beautiful dance is what allows us to release glucocorticoids like prednisone or a naturally occurring cortisol.

I don’t want you to really worry about this. The important part to know is when you take prednisone, you are cutting off the arrow between ACTH and Adrenal Cortex. It is turned off completely that there is no signal coming to the adrenal cortex to make prednisone equivalent to cortisol. It’s just not happening because there’s so much of cortisol being represented in the brain that it’s like, “oh, I don’t need to make any, there’s plenty of stuff floating around.”

Who is considered Adrenal Insufficient?

The system shuts down because it’s listening, waiting for a drop in the cortisol levels to start making more cortisol. Every single person who is taking prednisone more than 2 ½ milligrams a day has adrenal insufficiency. Because you are not making adrenal hormones and every single person is adrenal insufficient while taking prednisone.

This is why you keep taking prednisone and you don’t stop taking it without tapering. That is the whole principle behind it. That’s the whole point. 

Prednisone Withdrawal Syndrome

Along with that, the real issue you are having is you feel awful, and thinking that you’re getting adrenal insufficiency. Adrenal insufficiency isn’t really the word, it’s probably you’re going through prednisone withdrawal syndrome.

What you’re calling adrenal insufficiency is really a mismatch in the amount of cortisol replacement that you’re giving your body and the amount of cortisol your body’s expecting. The reason is you’re probably tapering too fast. 

You need to go back to whatever the lowest dose of the drug was, where you felt fine. Whether that was your disease was under control or you didn’t feel awful.

If you wanna know more about prednisone withdrawal syndrome, I have a whole in-depth article about it on my blog. Prednisone withdrawal is not adrenal insufficiency, but every single person who’s on prednisone has adrenal insufficiency. 

When can you test for Adrenal Insufficiency?

The test can’t actually work until at least two weeks after your last dose of prednisone. It might show something, but it’s not a full and complete picture.

 So no, an endocrinologist is going to offer to test you while you’re taking high doses of Prednisolone. There’s no point because the HPA circle isn’t working. 

The actual test is the amount of ACTH your body is making. And your body isn’t making any because you’re taking the Prednisolone or Prednisone or any other steroid. They all do the exact same thing, whether it’s dexamethasone, methylprednisolone, or whatever. If you’re taking it by mouth, it’s turning off this axis. So there’s just no point in testing. 

Read my blog all about prednisone withdrawal syndrome and if it works with your doctor, go back on the lowest dose that you didn’t feel awful alot. That’s how you can get back. Signing off with Dr. Megan, your Prednisone pharmacist.

For further reading:

• Prednisone Withdrawal as Dangerous as the Treatment?
• Recovering from Prednisone: When Will Your Adrenal System Return?
• Adrenal Support for Prednisone Tapering
• How to Taper Prednisone – Printable Taper Chart