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
julian. dan38655
Posted
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.
dan38655 julian.
Posted
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?
constance.de dan38655
Posted
dan38655 constance.de
Posted
misdiagnose dan38655
Posted
dan38655 misdiagnose
Posted
Vaso-constriction can lead to cold fingers when the weather isn't balmy, but I didn't consider how it would affect PMR(?).
misdiagnose dan38655
Posted
EileenH misdiagnose
Posted
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.
EileenH dan38655
Posted
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.
dan38655 EileenH
Posted
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?
EileenH dan38655
Posted
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.