Prednisone and adrenals

[dawnpice]

TEX,

You said in a response to my initial first post that prednisone can destroy the adrenals. How long would I have to be on before they start affecting the adrenals? Also they did a CT scan on me and found a tumor on my adrenal gland before I was on prednisone, so should I be concerned with the addition of a high dose of prednisone? I've been on it for 2 weeks now and last week the DR doubled my dosage taking me to 60mg a day. He doesn't want me to start tapering till we see significant results. SO I do not know how long I will be on it. The Endo DR says he wants to watch the tumor to see if it grows.

Thanks for any help, I do so appreciate it.

Dawn

[tex]

You said in a response to my initial first post that prednisone can destroy the adrenals. How long would I have to be on before they start affecting the adrenals?

Actually, it doesn't physically destroy the adrenals, it suppresses their cortisol output. That happens almost immediately, but their ability to function normally usually isn't affected unless a corticosteroid is used for at least several months, or years. IOW, after the corticosteroid is tapered and discontinued, the adrenals should return to their normal functional capacity. That's why it's necessary to taper the dose, before discontinuing it completely, and the longer a corticosteroid is used, the longer the dose must be tapered, in order to allow the adrenals to slowly regain their ability to produce normal amounts of cortisol. If a corticosteroid is used for years, though, the adrenals can permanently lose their ability to function properly.

Also they did a CT scan on me and found a tumor on my adrenal gland before I was on prednisone, so should I be concerned with the addition of a high dose of prednisone? I've been on it for 2 weeks now and last week the DR doubled my dosage taking me to 60mg a day. He doesn't want me to start tapering till we see significant results. SO I do not know how long I will be on it. The Endo DR says he wants to watch the tumor to see if it grows.

Depending on the location of the tumor, some of them can cause increased cortisol production. Most likely, your treatment won't make any difference on the tumor. I just don't understand why your GI doc would choose to use prednisone to treat MC, in the first place, when Entocort would be a much better choice, (it's just as effective, and it's generally safer, for anyone).

Surely, he doesn't plan for you to use prednisone for more than a few weeks, because if you were to use it for something like close to a year or more, it would take months of careful tapering of the dose, in order to wean off it, (to say nothing of all the Draconian side effects). IMO, doctors who prescribe prednisone to treat MC, for more than a week or two, probably don't have the foggiest idea how to treat the disease. I don't understand their logic, because when the prednisone is discontinued, the MC symptoms will relapse, anyway, every time. They're like Charlie Brown, though, and they keep thinking that sooner or later, the prednisone will "cure" the MC. Unfortunately, that ain't ever gonna happen.

Tex

[dawnpice]

Thanks for the reply Tex,

You are helping me a lot! Should I be looking for a new GI doctor or is there a different kind of doctor I need to be going to? Can you suggest any goods ones here in Indiana? I live about 30 minutes north of Indianapolis, in Sheridan. Im already having increased pain since the doubling of the prednisone and the "flush" seems to be getting worse and comes on much quicker and I cant sleep!!!
My family doctor is doing a HIDA scan this wednesday, b/c he feels that my gall bladder may be affected in all this.
Since I first posted on here I have cut gluten out of my diet, and dairy. Milk has always made my stomach hurt so the dairy wasn't that big of a deal to remove from my diet. So far I really don't see any change but I know it will take a while. The prednisone has slowed down my trips to the bathroom, but I don't want to start back 20 times a day once I am off of it again.
Just need a doctor that can help me to get through all of this. I think maybe also I need to find a good nutritionist to help me with changing my eating habits. I am still losing weight and Im not and never have been heavy.
Im sorry I am rambling, just frustrated at the moment..............I should be sleeping at 4am!!!

Thanks again, you are a blessing in my life right now.

Dawn

[tex]

Hi Dawn,

I hope you were able to get some sleep. Prednisone has a very good track record for being effective at "shocking" the immune system into submission, and it will usually bring quick remission of symptoms. I'm not sure what your previous dosage was, but 40 mg, for example, should have been sufficient to do the job. It sounds as though your doctor is frustrated by the fact that the treatment isn't working as effectively as he thinks it should, and so he thinks that he can "force" it to work, by increasing the dosage, and staying the course. While that may not be an ideal strategy, sometimes it works.

The body learns to accommodate glucocorticoids, (aka corticosteroids), and it slowly builds up a tolerance, over time. That's why people who use them for medium to long-term treatments find that they need to increase the dosage, as time passes, in order to get the same results that they previously got with a lower dose. This makes me wonder if maybe your adrenal tumor has been there for years, and it has been causing cortisol to be produced at elevated levels, all that time. IOW, that might have caused your body to develop a tolerance for glucocorticoids, suggesting that treatments with a corticosteroid might require higher dosage levels than normal. Actually, 60 mg is not a particularly high dose of prednisone. It's certainly not a low dose, either, but it's not unrealistically high, under such circumstances.

If it is helping to control your symptoms, then it's accomplishing the desired effect. Hyperactivity, and/or sleep issues are rather common with the corticosteroids. Hopefully, the side effects won't be totally intolerable. You alone will have to be the judge of whether or not the benefits are worth putting up with the side effects, because it's your body that is experiencing all this, and no one else can possibly understand your situation better than you.

I'm not aware of any doctors in your area who are up to speed on treating MC, unfortunately, so I don't know if it would do any good to switch, at this point. Without specific information, changing doctors is pretty much a matter of luck. A few more weeks or so of this treatment shouldn't put your adrenals at any significant risk, but beyond that, I would be looking for alternative options. Hopefully, by then, your diet changes will have made some progress on healing your intestines, so that weaning off the prednisone will not result in an all-out relapse of symptoms. Whatever you do, don't stop taking it cold turkey. You will need to taper the dose gradually, for at least a couple of weeks, (and longer is better), when you decide to discontinue taking it.

Gallbladder issues are commonly associated with this disease, and so are other problems, such as pancreas issues. Often, those problems will resolve, when we are able to get our MC symptoms under control. In some cases, though, where the pain from apparent gallbladder disease is severe, or frequent, surgical removal of the gallbladder will resolve the problem, (and, of course, in some cases, it doesn't help much, unfortunately). We are all somewhat different in our symptoms, and in the ways that we are affected.

Remember, I'm not a doctor, so this is not medical advice - these are just some of the thoughts that would go through my mind, if I were in your shoes. The main thing is to take life one day at a time, and to try to remain optimistic about your treatment, because stress can only make symptoms worse. IOW, don't worry about what may happen tomorrow, or the day after, or next week; instead, try to make the most of today.

Stress creates a vicious cycle that can be difficult to break, because it has a negative effect on our immune system. Less stress today means less symptoms tomorrow, which will almost always equate to less stress tomorrow, etc.

Tex

[Althea Baillie]

I can sympathise with you re the Prednisone as its used very frequently here in Cape Town (South Africa). Its the devil especially the non sleeping and I always feel completely wired up on it and talk incredibly fast and a lot! The theory is if you are on a fairly large dose - like 8 tablets (of 5mg strength) daily then the D should clear up within a week and you can then stop the Prednisone without any tapering off (but only if you've been on it for 2 weeks or less).

I have done this recently and the D stopped on about day five. I had also while taking the Prednisone gone gluten and dairy free and once the cortisone was stopped and the GF and DF diet maintained all BMs returned to normal - to my astonishment! From here on I suppose its a question of working out by trial and error what particular foods are affecting you. Hope this helps you and good luck. You've come to the right place for advice as everyone on this forum is a mine of information which you won't find anywhere else. Althea.