Adrenal Function Does Most Usually Recover After Steroid Treatment.

So many times we hear stories about permanent suppression of the adrenals after taking steroids as a reason to deny those with "marginal" stim test results access to HC replacement treatment along the lines of OMG, you will wreck your adrenals forever!

This article shows that it can take up to 3 years, but only 5% of people never recover adrenal function. And they were likely AI to begin with...so this fear should not be a reason to deny a person with borderline labs and clinical low cortisol symptoms a therapeutic trial of HC.

At the first ACTH test, 74 (49%) patients were non-responders: of these, the mean time until recovery of adrenal function was 14 months (max: 51 months). A normal test response occurred within 36 months in 85% of patients. However, adrenal function never recovered in 5% of patients.

PLoS One. 2013 Jul 24;8(7):e68713. doi: 10.1371/journal.pone.0068713. Print 2013.
Recovery of adrenal function after long-term glucocorticoid therapy for giant cell arteritis: a cohort study.
Jamilloux Y1, Liozon E, Pugnet G, Nadalon S, Heang Ly K, Dumonteil S, Gondran G, Fauchais AL, Vidal E.
Author information

Abstract
OBJECTIVES:
Giant cell arteritis (GCA) is a chronic systemic vasculitis of large and medium-sized arteries, for which long-term glucocorticoid (GC) treatment is needed. During GC withdrawal patients can suffer adrenal insufficiency. We sought to determine the time until recovery of adrenal function after long-term GC therapy, and to assess the prevalence and predictors for secondary adrenal insufficiency.

SUBJECTS AND DESIGN:
150 patients meeting the ACR criteria for GCA between 1984 and 2012 were analyzed. All received the same GC treatment protocol. The low-dose ACTH stimulation test was repeated annually until adrenal recovery. Biographical, clinical and laboratory data were collected prospectively and compared.

RESULTS:
At the first ACTH test, 74 (49%) patients were non-responders: of these, the mean time until recovery of adrenal function was 14 months (max: 51 months). A normal test response occurred within 36 months in 85% of patients. However, adrenal function never recovered in 5% of patients. GC of >15 mg/day at 6 months, GC of >9.5 mg/day at 12 months, treatment duration of >19 months, a cumulative GC dose of >8.5 g, and a basal cortisol concentration of <386 nmol/L were all statistically associated with a negative response in the first ACTH test (p <0.05).

CONCLUSION:
Adrenal insufficiency in patients with GCA, treated long-term with GC, was frequent but transitory. Thus, physicians' vigilance should be increased and an ACTH test should be performed when GC causes the above associated statistical factors.

PMID:

23894335

[PubMed - indexed for MEDLINE]
PMCID:

PMC3722149

Free PMC Article

 

thank you for posting this, this gives me good hope.

 

This study was also based on the use of prednisone which is at least 4 to 6 times stronger than hydrocortisone (depending on the source) which had some of these participants taking hydrocortisone equivalent doses of approximately 245 mg. for a 150 pound person. After several weeks their prednisone was reduced by a half to an equivalent HC dose of 125 mg.

Then began a slow taper which probably lasted 3 to 4 months down to 5 mg of prednisone (equal approximately 25 mg of hydrocortisone). This is still a large dose for ending the taper at. They could have switched to HC an tapered down even further, which would have been typical in a HC protocol. They stopped at the upper limits of a typical HC protocol.

I was on HC for 15 months and my long term stable dose was 10 mg @ 8am, 5 mg @ 12pm and 5 mg @ 4pm. I tapered from the 20 mg/day down to 5 mg/day over a 4 week period and stopped after 2 weeks at 5 mg/day and I never appeared to have any feedback suppression. After 8 weeks my 4 times/day saliva test was pretty close to being perfect as all were just a little above mid-range. After 6 months though my sleep really went all to hell and my last 4 times/day saliva test was low at 8am, then went high by 12pm and flat-lined from then through my 11pm. This was obvious why my sleep was and still is messed up. I can't fall asleep till between 3am and 6am, then I wake up 4 to 5 hours after I fall asleep. It also takes me 2 hours to wake up good and at one time I was given 10mg of Adderall to take at 8am no matter what. I could take it and sleep till 11am easily, but it didn't take me 2 hours to get awake. They also had me try 10mg of Ambien at 11pm with all electronic devices (TV, computer, cellphone and etc.....) turned off at 10pm, but I would lay in the dark until around 2am to 3am before falling to sleep.

Sleep medication or stimulant medication would not change my sleep pattern that had been dictated by my backward cortisol rhythm. It really feels bad when I'm just getting sleepy and the sun has already started to come up.

I am getting ready to try an adrenal extract in the morning and phosphatidylserine in the afternoon and early evening as it is suppose to suppress cortisol, but it is still considered as a psychostimulant.

 

@August59 do u use dhea to balance out cortisol?

Have u used pregnenolone to try and increase cortisol? I have read it doesnt have any negative feedback issues either similar to dhea?

I had some success with withania for high night time cortisol.

It still takes me a combination of things to get me to sleep, still miss the target sometimes. It makes such a big difference to get a good nights sleep.

cheers!!!

 

If your DHEA is low, taking a dose at around 8AM may also help to correct circadian rhythm problems.

 

whats your opinion of taking it at night to help counteract cortisol?
Its recommended amongst guys who aromatise dhea to estrogen easily to split there dose which can help reduce estrogen levels.

I know crazy kruse also recommends night time dhea for sleep.

I have been splitting my dose, 25mg twice a day for awhile. I cant tell if my sleep has improved from it or other measures, but my sleep isnt as bad as it use to be?????

 

This was the article that switched me from taking it at night to taking it in the AM in one dose:

Metabolism. 2000 Apr;49(4):548-51.
Evaluation of the circadian profiles of serum dehydroepiandrosterone (DHEA), cortisol, and cortisol/DHEA molar ratio after a single oral administration of DHEA in elderly subjects.
Ceresini G1, Morganti S, Rebecchi I, Freddi M, Ceda GP, Banchini A, Solerte SB, Ferrari E, Ablondi F, Valenti G.
Author information

Abstract
Aging is associated with a selective decline in circulating levels of dehydroepiandrosterone (DHEA) and its sulfate, with no major changes in cortisol secretion.

In young subjects, serum levels of both DHEA and cortisol are regulated according to a circadian rhythm, and an age-related attenuation of DHEA, but not cortisol, circadian rhythmicity has been reported.

Several trials have evaluated the effects of DHEA supplementation in elderly subjects, although the results are still controversial. However, no data are available on the 24-hour profile of DHEA circulating levels in elderly subjects with DHEA administration.

In the present study, we evaluated the circadian rhythms of DHEA, cortisol, and the cortisol/DHEA molar ratio in old subjects treated with either placebo (old-PL) or a single 50-mg dose of DHEA (old-D), both administered orally at 0700 hours.

For each variable, the circadian profiles were compared with those obtained in young control subjects. The group of young subjects displayed a circadian rhythm for both DHEA and cortisol serum concentrations but no rhythm for the cortisol/DHEA molar ratio.

In the old-PL group, the circadian rhythm of DHEA was completely abolished, whereas significant rhythms for both cortisol and the cortisol/DHEA molar ratio were observed. Particularly, at each time point, the cortisol/DHEA molar ratio was significantly higher in these subjects versus the young group.

In the old-D group, the circadian rhythm of DHEA was completely restored and was comparable to that observed in the young group. Analogous to the observations in young subjects, the profile of the cortisol/DHEA molar ratio in old-D subjects did not display any circadian rhythmicity, the values being almost completely comparable to those observed in young controls.

Our data demonstrate that the circadian rhythm of DHEA is totally abolished in elderly subjects.

A single 50-mg dose of DHEA administered orally at 0700 hours restores the circadian rhythmicity of serum DHEA and almost completely normalizes the 24-hour profile of the cortisol/DHEA molar ratio in old subjects without affecting the cortisol circadian rhythm.

PMID:
10778884
[PubMed - indexed for MEDLINE]

 

Boss, you need to figure out a way to go to sleep on time and not try and get your adrenals producing cortisol 24/7. The problem sounds like that of my friend - his AM cortisol was low and PM was high. In taking melatonin or low dose xanax he was able to fall asleep at normal hours and reverse his opposite diurnal cortisol patterns. I think throwing more gas on the fire is the last thing your body is asking for. I am unique in that I do not sleep easy and most drugs for sleep give me a huge hangover. 1mg xanax before bed works perfectly. You might have to tell the doc you need it for anxiety but it works like a charm for me.

 

DHEA wakes you up in the morning so I would stick to just a morning dose of it.