connection between Prednisone and adrenals.

Rhea, i am wondering about that too.  I am also at seven and a half one day and seven the next.    Is this the time to ask for a  test ...is that the synathen test.  Or acth?

 

Yes, that is correct. Body normally makes 5-8mg of cortisol, so when you start reducing below that level, it is much harder because adrenals have to wake up and start making cortisol to supplement smaller dose of pred. It is also harder to reduce below 7mg because one has to be careful not to reduce more then 10% of the dose, which means 1mg step in reduction is too high. Usually people use 0.5mg steps  at low doses.

Yes, and yes. 

But there is no real need to ask for a synacthen (ACTH stimulation) test UNLESS you start to find it difficult to reduce further because of increasing fatigue and a feeling unwell that isn't PMR-type symptoms. As long as you are reducing slowly without problems you can take it that you are likely to be functioning OK. Possibly at somewhere about 5mg or lower it COULD be done but all it tells you is whether your adrenal glands are CAPABLE of producing cortisol, not whether they are doing so, there are several factors and organs involved. In some ways like your car won't start with an empty battery or fuel tank - but even if the tank is full and the battery is fully charged, it still won't start if the fuel pipe is blocked or the starter motor is damaged.

There is also the point that if you have got to 7mg you are bound to be closer to the dose you are looking for: "the lowest dose that manages the symptoms as well as the starting dose" and the amount you are reducing by becomes proportionally greater with each drop so  your body notices more.

Eileen, I just love the way you explain things, for simpletons like me its great, Thank You. Long may you reign. Just for info ive been on the dsns reducing .5mg over approx. 4week period since I was on 10mg for me its working, yes a few niggles but I suppose we have to expect it with old age!