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    Old 05-26-2008, 06:36 PM   #1
    Pam44
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    Adrenal Suppression

    Can a person have adrenal suppression from taking oral steriods or using asthma inhalers and recover after a time and be able to taper down off the cortef and eventually have a normal ACTH stim test? I've read several articles written by Dr. Krasner on the subject and it seems that is really very common and it might be a up to a year before the person can safely start weaning off the cortef. The person still needs extra cortef when sick and is treated like AI until which time they are able to go off cortef. In one article I read, it recommended taking the morning serum cortisol level 24 hours after taking the last dose of cortef occasionally to see if the adrenal function was returning. Wouldn't there still be some sort of HPA axis problem for this to happen after only one steriod injection or say one oral steriod treatment? Also is the CRH the best test to see if the problem is the hypothalamus or pituitary in secondary Addison's? If the problem is the hypothalamus is there anything more than can be done other than remain on steriods?

     
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    Old 05-27-2008, 09:56 AM   #2
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    Re: Adrenal Suppression

    I was taking advair (steroid inhaler) for asthma and then had to get two steroid injections in my spine. My doctor said the advair was keeping my adrenal glands from producing the right amount of cortisol. When I finally had spine surgery, my adrenal glands couldn't produce what I needed for surgery, and I went into adrenal crisis. Four months later after seeing many doctors for all kinds of crazy symptoms, my husband ran tests and diagnosed me with hypoadrenalism. I went see an endocrinologist, who ran tests and said I had secondary because of the steroids. My pituitary glands are not releasing ATCH which tells my adrenal glands to produce cortisol. Even when given ATCH, my adrenal glands hardly produced any. My pituitary gland was normal on an MRI.

    My endo said it will take a year of slowly tapering off of hydrocortisone to "jump start" my adrenal glands. I have to travel with an injection of steroids in case I ever get in a wreck or find myself in an adrenal crisis. After the year, he said my adrenal glands should be working fine, but I may never have the energy and stamina that I used to have. He said I will have to get used to a new "normal."

     
    Old 05-27-2008, 10:48 AM   #3
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    Re: Adrenal Suppression

    Quote:
    Originally Posted by nopearce View Post
    I was taking advair (steroid inhaler) for asthma and then had to get two steroid injections in my spine. My doctor said the advair was keeping my adrenal glands from producing the right amount of cortisol. When I finally had spine surgery, my adrenal glands couldn't produce what I needed for surgery, and I went into adrenal crisis. Four months later after seeing many doctors for all kinds of crazy symptoms, my husband ran tests and diagnosed me with hypoadrenalism. I went see an endocrinologist, who ran tests and said I had secondary because of the steroids. My pituitary glands are not releasing ATCH which tells my adrenal glands to produce cortisol. Even when given ATCH, my adrenal glands hardly produced any. My pituitary gland was normal on an MRI.

    My endo said it will take a year of slowly tapering off of hydrocortisone to "jump start" my adrenal glands. I have to travel with an injection of steroids in case I ever get in a wreck or find myself in an adrenal crisis. After the year, he said my adrenal glands should be working fine, but I may never have the energy and stamina that I used to have. He said I will have to get used to a new "normal."

     
    Old 05-27-2008, 10:53 AM   #4
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    Re: Adrenal Suppression

    How did you find an endo who knew your adrenals were only suppressed instead of AI for life? What tests do you have done to see if your adrenal function is returning to normal? From what I've read if the ACTH stim test is repeated very soon after weaning off cortef it will come back positive again. I was told it took several months before the ACTH test could be done and I was wondering if there are any tests that could be done to check adrenal function while on cortef.

     
    Old 05-27-2008, 05:10 PM   #5
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    Re: Adrenal Suppression

    Quote:
    Originally Posted by Pam44 View Post
    How did you find an endo who knew your adrenals were only suppressed instead of AI for life? What tests do you have done to see if your adrenal function is returning to normal? From what I've read if the ACTH stim test is repeated very soon after weaning off cortef it will come back positive again. I was told it took several months before the ACTH test could be done and I was wondering if there are any tests that could be done to check adrenal function while on cortef.
    I am going to two different ones. One endo told me he just knows. The other endo ran tests to make sure my adrenal and pituitary glands didn't have a tumor. I just lowered my hydrocortisone to 20 mg (10 mg in the morning, 5mg @ 12 noon, & 5 mg @ 4 pm. Next month we will change it from three times a day to twice a day. Then, he will do an ACTH test to see if I am producing more cortisol. If not, then we will have to wait a while to lower my hydrocortisone. My other doctor said he doesn't need to test because we will know if I am producing more cortisol by the way I feel. Both doctors say it will take a year to get my adrenal glands working.

    You might be able to do the morning cortisol and ACTH test to see if you are producing more. My first morning cortisol test was 1 and with the ACTH, it was 7.

    I have until next spring to get better. I am hoping it goes by quickly, because this is hard on my family. I can't work, because I get so tired just from doing "normal" activities like getting a few groceries with my boys doing most of the work. It takes me hours to recover from things like this.

     
    Old 06-03-2008, 07:08 PM   #6
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    Re: Adrenal Suppression

    I have tried 3 times to lower my hydrocortisone and the last time was HORRIBLE - I will never do it again. The doctor told me not to try it again! I'm on Advair 500/50, singular, and albutrol prn. I wish I could stop taking it but my doctor told me I'd never be off of it. I'm now on 10 mg a day and that's as low as I can go. I'm amazed reading some of the comments on the board that endo's are telling them they will be able to stop taking them. I wonder what I am doing wrong.

     
    Old 06-04-2008, 06:04 AM   #7
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    Re: Adrenal Suppression

    You are doing nothing wrong. Your adrenals have simply adjusted to the steroids. Some people are simply more sensitive to them.
    You perhaps could wean down - but it would have to be very slowly and carefully... and judging by your meds.... well, you need non-steroidal replacements to your puffs too. Advair has steroids in it. Interesting, looking at albuteral - it is called a beta-adrenergic stimulator and can lower potassium - I wonder why it has a word close to adrenal in it... but the lowering of potassium can be significant for someone with poor adrenal as my adrenals lose potassium as well as sodium against the rules... so it does happen.

    Since those are not pills... it would be a lot harder to wean as well.

    Hang in there.

     
    Old 06-04-2008, 07:22 AM   #8
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    Re: Adrenal Suppression

    I was on Advair, singular, and the puffer, but my doctor took me off of those right away when he found out my adrenals quit producing cortisol. So now I have to use a nasal wash that I bought from a health food store, breathing treatments that don't have steroids, and an occasional sudafed. This helps, but not as well as the steroids. I will never be able to take anything with steroids in it because my body is much too sensitive.

    One and a half weeks ago I had to lower my dose of hydrocortisone to 20 mg. I am still having a hard time adjusting. I feel so tired until after my afternoon dose has kicked in. I feel like I am walking around all day about to get a virus. When I am sitting, I am okay, but when I try to do things around the house, I get tired, dizzy, and a little nauseated. I can't exercise, because I start feeling bad, but I can swim a little, which is good because it is so hot right now in Louisiana.

     
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