Cortisol levels and PMR/prednisone

Posted , 7 users are following.

It is my understanding that the "stress" hormone cortisol regulates the body's immune response, preventing the sort of over-activity that is PMR.

 

That said, and knowing that prednisone mimic's cortisol's regulating effect (taking over this function in fact), what might we conclude about the the root causes of what would seem like a simple case of inadequate cortisol production?

Could it be that too much cortisol-producing stress causes the sort of glandular insufficiency that sometimes afflicts the adrenal glands (adrenaline) and pancreas (insulin)?

Having just learned that this cortisol is produced by the adrenals (in response to ACTH production by the pituitary), this has me wondering how much that a crtisol insufficiency (as associated with consumption of caffeine and sugar btw) is related to PMR?

I'm thinking that there is perhaps a 1:1 relationship here, and with the fatigue aspect of PMR being the adrenal side of it, and with the cortisol-producing function of the adrenals being the other side of it.

I plan some alteration of my caffene and sugar intakes, noting that my onset of PMR concided with what were (and are) lifetime highs of caffeine consumption for me, yet surely there are other things that can effect the adrenals in their production of both cortisol and adrenaline, and so also worthy of study.

And to think that, at one point, I was increasing my caffeine uptake in order to combat my feelings of fatigue!

Opinions, anyone?

4 likes, 11 replies

11 Replies

  • Posted

    I'm a bit sceptical.

    I suspect that if PMR were caused by insufficient cortisol we would be able to measure cortisol in blood and find it low, or measure ACTH in blood and find it high as the pituitary attempted to increase cortisol production by the adrenals.

    This doesn't seem to be the case.

    Rather we find that there is inflammation caused by the PMR which can fortunately be reduced by much higher than normal cortisol - we take pred.

    After diagnosis, during treatment, a side effect is that the pred suppresses the need for the adrenals to produce cortisol. We could probably measure ACTH in the blood and find it low.

    Basically, my limited understanding suggests that PMR is an auto immune disease which causes inflammation (of blood vessels and muscles), not a problem with the hypothalmic - pituitary - adrenal axis.

    This is very different to hypo thyroid (Hashimotos syndrome) where the thyroid gland has a problem so it doesn't produce sufficient thyroxine so the pituitary creates more TSH (Thyroid Stimulation Hormone) to compensate. We take synthetic thyroxine and the TSH returns to normal levels.

    • Posted

      Thanks Julian, for replying to my post.

      I really don't know what caused the sudden onset of PMR in my case, but I had noticed how much that a feeling of adrenal insufficiency has become the larger problem now that my worst symptoms and prednisone dosage have tapered down.

      So I'm hoping that I can now do something to relieve these fatigue symptoms, feeling intermittently weak, and needing to nap during the day. Maybe the daytime nap should simply become part of my routine?

    • Posted

      Yes, you're right, since I tried it today and was quite refreshed in just 30-40 minutes.
  • Posted

    There is so much misinformation around that one never knows what to believe and so little research about basic, necessary questions. I am asking around to find out about natural vaso dilators and I was told that coffee was one so I have increased my intake. It's such a contrary world!
    • Posted

      Caffeine is actually a vaso-constrictor, is that what you perhaps meant to say?

      Vaso-constriction can lead to cold fingers when the weather isn't balmy, but I didn't consider how it would affect PMR(?).

    • Posted

      It is very frustrating that I cannot privide links on this forum. If put into a search engine 'caffeine' and 'vasodilation' there are 166,000 options. The person who told me this actually was more interested in chocolate which is worth looking up.
    • Posted

      You can put links - the post will just be held for moderation until the link has been checked and approved. 

      If we're going to be totally accurate - caffeine causes a transitory vasoconstriction followed by vasodilation. It also depends on the tissue - caffeine leads to a reduction in cerebral blood flow for example - and it is also different depending on whether the subject is caffeine naive or habitually drinks coffee. 

       

  • Posted

    I think it has been looked at and concluded that whatever it is that causes PMR it isn't adrenal dysfunction. Julian's response is pretty much the same as I would have said.

    If it were merely lack of cortisol a low dose of pred alone would sort it out - more is required to combat the inflammation - and you would never get off the pred. Some people never do. Adrenal insufficiency is far more than just fatigue - it can cause some really severe problems that are not seen in PMR, even when PMR isn't managed with pred.

    • Posted

      Thanks, EileenH.

      Do you know of anyone who gets their PMR care directly from an endocrinologist instead of from a rheumatologist?

      Any difference in outcome if so?

    • Posted

      There is a lady in Canada who I think is under an endocrinologist but that is because she has other problems and felt an endo might be more helpful in dealing with both. It took her 3 attempts to find one who would listen and not immediately tell her she had to stop pred immediately.

      In the UK you are automatically sent to a rheumatologist, in some European countries you might be under a rheumatologist, an ophthalmologist or even a neurologist depending on the first symptoms to present - or maybe two out of the three. In the US it is probably most likely to be a rheumatologist because of the restrictions that the insurance companies put on who can do what. GCA may be seen by eye specialists if they present with visual symptoms - but even then they sometimes are sent back to a rheumatologist.

      An endocrinologist is not likely to be high on anyone's list of options: dealing with PMR and GCA on a day to day basis is not going to be part of their specialist training and they are almost certainly going to be fully occupied with "real" endocrinology. An endocrinologist might be brought in at a late stage of reducing the pred dose because some patients who have been on high doses for a long time DO demonstrate adrenal problems, mostly because their doctor is trying to get them to reduce too fast in the later stages, below about 10mg. This is not common however and in fact all that needs to be done is a synacthen test to assess their adrenal function. That can be requested by a GP in the UK although the results are interpreted by a specialist at the laboratory. The patient might then be referred to an endocrinologist but not necessarily. If you have adrenal insufficiency the treatment is very simple - a single daily dose of pred or hydrocortisone 2 or 3 times a day, a single daily dose always being preferable in terms of compliance. But I have come across endos who don't know what PMR/GCA is, never mind how to manage it.

      There isn't going to be much of a difference in outcome - PMR can't be cured and management is fairly basic really: manage the symptoms with as low a dose of pred as possible, always trying at intervals to reduce in small decrements to see if the patient can get lower, hopefully off pred altogether. GCA is a bit different but the same applies. If there are problems there are other options, albeit some disputed, for trying to reduce the pred dose but to date there is no other drug that is proven to work 100% besides pred. You can't experiment too much if a patient's sight is at risk, which is what it comes down to in GCA.

Report or request deletion

Thanks for your help!

We want the community to be a useful resource for our users but it is important to remember that the community are not moderated or reviewed by doctors and so you should not rely on opinions or advice given by other users in respect of any healthcare matters. Always speak to your doctor before acting and in cases of emergency seek appropriate medical assistance immediately. Use of the community is subject to our Terms of Use and Privacy Policy and steps will be taken to remove posts identified as being in breach of those terms.