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Should I Hold Off On The Prednisone Or Take Less And Try To Get An ACTH Test ?
Question: I am a 20 year old female. I was recently given the diagnosis of Secondary Adrenal Insufficiency. I never had any ACTH stimulation tests done. I went to the endo with symptoms of adrenal insufficiency. He put me on 4mg a day of dexamethasone and order a blood test.
2 weeks later, he tells me I have secondary adrenal insufficiency based solely on the blood test results. The lab showed my cortisl levels at .88 when the average is 6.7. He says something is wrong where the pituitary is concerned, but he doesnt need to do any more tests. He prescribed 15 mg daily of prednisone. I asked him if there were other choices as I am scared of the side effects and to confirm the dosage. He became angry and asked me if I want to die. NO I dont! but I also want the best care and the correct dosage. Should i hold off on the prednisone or take less and try to get an ACTH test so that I can learn the cause of SAI?
Everything I have researched seems to say that hydrocortisone is the preferred treatment and if prednisone is prescribed, it is usually HALF what my endo prescribed. I can’t see him for 6 weeks as he is traveling out of the country.
2 weeks later, he tells me I have secondary adrenal insufficiency based solely on the blood test results. The lab showed my cortisl levels at .88 when the average is 6.7. He says something is wrong where the pituitary is concerned, but he doesnt need to do any more tests. He prescribed 15 mg daily of prednisone. I asked him if there were other choices as I am scared of the side effects and to confirm the dosage. He became angry and asked me if I want to die. NO I dont! but I also want the best care and the correct dosage. Should i hold off on the prednisone or take less and try to get an ACTH test so that I can learn the cause of SAI?
Everything I have researched seems to say that hydrocortisone is the preferred treatment and if prednisone is prescribed, it is usually HALF what my endo prescribed. I can’t see him for 6 weeks as he is traveling out of the country.
Brief Answer:
See detail bellow
Detailed Answer:
Hello and thank you for your question. Hope I can be of help for you today. Adrenal insufficiency can be caused by secondary from interference with corticotropin(ACTH) secretion by the pituitary gland. The ACTH deficiency may be isolated or occur in conjunction with other pituitary hormone deficiencies. The diagnosis of adrenal insufficiency depends on having an appropriate level of clinical suspicion. Your doctor prescribed you prednisone because he might suspect you have adrenal insufficiency due to corticosteroid withdrawal. Do you have any history of taking steroids and stopping recently? Yes you may need to do an ACTH test if you are not having steroid withdrawal symptoms. You should continue prednisone and follow up the tapping dose with your doctor.
I hope that It can help you, and please let me know if you have any clarification or question about that, and I would be welcome to discuss it with you further. I hope you have good health.
Best regards,
Dr. Heang Chan Raksmey, General and Family Physician
See detail bellow
Detailed Answer:
Hello and thank you for your question. Hope I can be of help for you today. Adrenal insufficiency can be caused by secondary from interference with corticotropin(ACTH) secretion by the pituitary gland. The ACTH deficiency may be isolated or occur in conjunction with other pituitary hormone deficiencies. The diagnosis of adrenal insufficiency depends on having an appropriate level of clinical suspicion. Your doctor prescribed you prednisone because he might suspect you have adrenal insufficiency due to corticosteroid withdrawal. Do you have any history of taking steroids and stopping recently? Yes you may need to do an ACTH test if you are not having steroid withdrawal symptoms. You should continue prednisone and follow up the tapping dose with your doctor.
I hope that It can help you, and please let me know if you have any clarification or question about that, and I would be welcome to discuss it with you further. I hope you have good health.
Best regards,
Dr. Heang Chan Raksmey, General and Family Physician
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Thank you for your reply. I have NOT taken any steroids or any medications prior to seeing the endo. I only had symptoms. I was NOT being treated for ANY other medical conditions, disease or anything. I have ortho static hypotension, extreme fatigue, weight loss, no appetite, abdominal pain, joint pain, dizzyness, trouble concentrating, memory loss.
I know that the doctor prescribe prednisone for suspected adrenal insufficiency. My concern is that I dont know WHY I have secondary. I have not been on any medications or steroids of any kind. The endo says there is something wrong with my pituitary gland. He said maybe something is pressing on it. But he doesnt want to run any other test. He only did one blood test to check my cortisol levels which were extremely low.
My questions are: Shouldnt I find out WHAT is causing the adrenal insufficiency? Will taking prednisone interfere with any additional testing to confirm and/or discover WHY the pituitary gland isnt working right? Also, isnt hydrocortisone the current preferred treatment? And isnt 15 mg a day high? (it appears to be DOUBLE what is usually prescribed for SAI). PLEASE address my questions. I am very familiar with what adrenal insufficiency IS and how its treated. My concerns are that I am not getting the best care. PLEASE answer the questions I have asked. Thank you.
I know that the doctor prescribe prednisone for suspected adrenal insufficiency. My concern is that I dont know WHY I have secondary. I have not been on any medications or steroids of any kind. The endo says there is something wrong with my pituitary gland. He said maybe something is pressing on it. But he doesnt want to run any other test. He only did one blood test to check my cortisol levels which were extremely low.
My questions are: Shouldnt I find out WHAT is causing the adrenal insufficiency? Will taking prednisone interfere with any additional testing to confirm and/or discover WHY the pituitary gland isnt working right? Also, isnt hydrocortisone the current preferred treatment? And isnt 15 mg a day high? (it appears to be DOUBLE what is usually prescribed for SAI). PLEASE address my questions. I am very familiar with what adrenal insufficiency IS and how its treated. My concerns are that I am not getting the best care. PLEASE answer the questions I have asked. Thank you.
Brief Answer:
See detail bellow
Detailed Answer:
Hello,
Thank you again for your question.1) Because you did not take any prednisolone or aldosterone or progesterone high dose drug before, you need to do more tests to find out what is the cause of adrenal insufficiency.
2) Prednisone will interfere at ACTH level. There are many reasons for adrenal insufficiency such as critical disease, traumatic brain, high dose progesterone, prednisone withdrawal or aldosterone medicine, mass or lesion in the pituitary gland that can cause cortisone low.
3) Hydrocortisone is used when you have adrenal crisis symptoms such as shock, low blood pressure, life threatening etc. or major procedures such as surgery.
4) Prednisone 15mg is a low dose for treatment of adrenal insufficiency. Usually we start the similar dose that you take in the past or with 1mg/kg per day and then tapper it slowly.
Adrenal insufficiency symptom weight loss, lost appetite, fatigue etc.
Wish you and you have good health. Let me know if I can assist you further.
Best regards,
Dr. Heang Chan Raksmey, General and Family Physician
See detail bellow
Detailed Answer:
Hello,
Thank you again for your question.1) Because you did not take any prednisolone or aldosterone or progesterone high dose drug before, you need to do more tests to find out what is the cause of adrenal insufficiency.
2) Prednisone will interfere at ACTH level. There are many reasons for adrenal insufficiency such as critical disease, traumatic brain, high dose progesterone, prednisone withdrawal or aldosterone medicine, mass or lesion in the pituitary gland that can cause cortisone low.
3) Hydrocortisone is used when you have adrenal crisis symptoms such as shock, low blood pressure, life threatening etc. or major procedures such as surgery.
4) Prednisone 15mg is a low dose for treatment of adrenal insufficiency. Usually we start the similar dose that you take in the past or with 1mg/kg per day and then tapper it slowly.
Adrenal insufficiency symptom weight loss, lost appetite, fatigue etc.
Wish you and you have good health. Let me know if I can assist you further.
Best regards,
Dr. Heang Chan Raksmey, General and Family Physician
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Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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