As I am down to 51/2 mg red, I began to wonder if I was regaining any Adrenal function.

I was going to ask my Rheumy to order a test and decided to research the test name and procedure. This led me to a reference of the NADF which is the National Adrenal Diseases Foundation here in the US. The part of their extensive material available that i landed on was an article by the director about secondary adrenal insufficiency. I hope the content of a few parts of it that I quote here will bw worth your time. To simplify, before quoting, the references to ACTH which is produced in the pituitary are key to the process. This hormone controls the prodution of cortisol by the adrenals. the following extractions were the most pertinent to me.

"The most common cause of suppression of ACTH is the use of glucocorticoid medications to treat a large variety of illnesses. Glucocorticoids are steroid hormones that act like cortisol. They include cortisone, hydrocortisone, prednisone, prednisilone, dexamethasone, as well as intravenous, intramuscular, inhaled and topical "streroids". All of these medications have an effect on ACTH because the pituitary is producing this hormone in response to the body's need for cortisol.When the cells in the pituitary recognize any of these drugs, they sense that there is cortisone present and therefore produce less ACTH. This ACTH suppression from glucocorticoid medication can be very temorary, prolonged or permanent depending on the dose, potency and length of use of the medication. For example, a few days of prednisone will not produce a significant problem, but several weeks of prednisone at a dose of 10 mg will diminish the cortisol level and the ability to fight a stressful situation. Recovery of the pituitary-adrenal response after use of a suppresive dose for more than one month will take about one month. Generally, this one for one recovery time is typical up to about 9 to 12 months, when recovery will often take up to a year or may not occur at all."

"Once glucocorticoids have been tapered to below 5mg of prednisone, dosing for stress such as illness or surgery is still needed until there is full recovery of adrenal reserve, typically using a guide of one  month for each month that steroids had been used. The most difficult issue is that symptoms of adrenal insufficiency will be present during the tapering phase, because low levels of cortisol are the only trigger to the pituitary to stimulate the return of ACTH production and the restoration of normal pituitary-adrenal responsivness. The longer high dose steroids were given for a disease like asthma, rheumatoid arthritis, polymyalgia rheumatica or inflammatory bowel disease, the more likely that individual will suffer from adrenal insufficiency symptoms on withdrawal of the steroids. In addition, tapering off the steroids may cause a relapse of the disease that had been treated, causing a combination of disease symptoms overlapping with adrenal insufficiency symptoms. That is why it is very common for steroid tapers to be aborted, with a temporary return to therapeutic doses of glucccorticoids, followed by a slow attempt at tapering if the primary disease is in remission."

I hope this is of some interest as it involves all of us. My take is that for most of us, we will be taking some pred for the rest of our lives. I'm sure some of you allready have made this aasumption. The main point is that our GP's or Rheumy's are bent on going to 0 pred when they must know the information I have just quoted.

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