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

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?

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?

 First of all, I want to give a disclaimer that I cannot give medical advice. Your doctor is your best source of information. This is based on the incredibly small amount of information you’ve shared with me, I’ll give you the scientific information. You have 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) Hypothalamic Pituitary Adrenal Axis.

Adrenal Insufficiency while on High Doses of Prednisolone?

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.

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. This is because you are not making adrenal hormones and every single person is adrenal insufficient while taking prednisone.

This is why you if keep taking prednisone you must not stop taking it without tapering. That is the whole principle behind it. That’s the whole point. 

Prednisone Withdrawal Symptoms

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 symptoms.

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 want to know more about prednisone withdrawal symptoms, check out this video and article about Prednisone Withdrawal.

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. Your body isn’t making any because you’re taking the prednisolone, prednisone, dexamethasone, methylprednisolone or any other steroid. 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 a lot.

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Dr. Megan Milne, PharmD, BCACP

Dr. Megan Milne, PharmD, BCACP, is an award-winning clinical pharmacist board certified in the types of conditions people take prednisone for. Dr. Megan had to take prednisone herself for an autoimmune condition so understands what it feels like to suffer prednisone side effects and made it her mission to counteract them as the Prednisone Pharmacist.

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