Corticosteroid treatment can cause lethal adrenal insufficiency

[Chocolove]

Please be advised use of corticosteroids can be very dangerous.

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Eur J Intern Med. 2013 Dec;24(8):714-20. doi: 10.1016/j.ejim.2013.05.014. Epub 2013 Jun 25.
Why glucocorticoid withdrawal may sometimes be as dangerous as the treatment itself.
Dinsen S1, Baslund B, Klose M, Rasmussen AK, Friis-Hansen L, Hilsted L, Feldt-Rasmussen U.
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• Eur J Intern Med. 2014 Oct;25(8):781-3.

Abstract
Glucocorticoid therapy is widely used, but withdrawal from glucocorticoids comes with a potential life-threatening risk of adrenal insufficiency. Recent case reports document that adrenal crisis after glucocorticoid withdrawal remains a serious problem in clinical practice. Partly due to difficulties in inter-study comparison the true prevalence of glucocorticoid-induced adrenal insufficiency is unknown, but it might be somewhere between 46 and 100% 24h after glucocorticoid withdrawal, 26-49% after approximately one week, and some patients show prolonged suppression lasting months to years. Adrenal insufficiency might therefore be underdiagnosed in clinical practice. Clinical data do not permit accurate estimates of a lower limit of glucocorticoid dose and duration of treatment, where adrenal insufficiency will not occur. Due to individual variation, neither the glucocorticoid dose nor the duration of treatment can be used reliably to predict adrenal function after glucocorticoid withdrawal. Also the recovery rate of the adrenal glands shows individual variation, which may be why there is currently insufficient evidence to prove the efficacy and safety of different withdrawal regimens. Whether a patient with an insufficient response to an adrenal stimulating test develops clinically significant adrenal insufficiency depends on the presence of stress and resulting glucocorticoid demand and it is thus totally unpredictable and can change relative fast. Adrenal insufficiency should therefore always be taken seriously. Individual variation in hypothalamic-pituitary-adrenal axis function might be due to differences in glucocorticoid sensitivity and might be genetic. Further awareness of the potential side effect of withdrawal of glucocorticoid and further research are urgently needed.

Copyright © 2013 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

KEYWORDS:
Adrenal insufficiency; Glucocorticoid withdrawal; Glucocorticoid-induced adrenal insufficiency; Glucocorticoids

PMID:
23806261
DOI:
10.1016/j.ejim.2013.05.014
[PubMed - indexed for MEDLINE]

 

[slysaint]

http://mentalhealthdaily.com/2014/06/10/prednisone-withdrawal-symptoms-how-long-do-they-last/
"Anytime a person is on 5+ mg of Prednisone for 7 to 14 days, sudden discontinuation can result in an adrenal crisis. Work closely with your doctor, follow guidelines, get plenty of rest, and lay low as your body and mind recover. Eventually you will return to normal functioning once your body and brain readjust to functioning without steroids. It should be noted that some people report “Secondary Adrenal Insufficiency” as a result of taking corticosteroids like Prednisone.

In this event, it has taken people 12 to 24 months before they experience full “recovery” back to homeostasis."

 

[Chocolove]

Well, you might be that lucky or not. I thought 3 years after successful taper off prednisone that I was recovered. But a respiratory infection got me and that really requires your adrenals to work. It was too much and I ended up in adrenal crisis. You may not fully recover.

 

[Chocolove]

Review of corticosteroid use and adrenal recovery in Medicine

"The takeaway message of the study is that in corticosteroid use there is a substantial risk of adrenal insufficiency," senior author Dr. Olaf Dekkers, an endocrinologist at Aarhus University in Denmark, said by email. "Patients should be aware of this risk and be informed about potential symptoms."Dekkers and colleagues analyzed 74 research articles published from 1975 to 2014, covering a total of 3753 study participants, to see how different doses and types of corticosteroid treatment might impact the likelihood of developing adrenal insufficiency after treatment. There is no way to safely halt treatment with corticosteroids that can rule out the potential for adrenal insufficiency, Dekkers said.

The dangers of corticosteroids are frequently overlooked because most often the doctors who are prescribing corticosteroids are not Endocrinologists; they are in other specialties. They don't recognize the subtle beginning symptoms of adrenal insufficiency, nor do they realize when it progresses in severity to the point that death is imminent. At that point they may suspect a stomach virus or the flu. Or they may accuse the patient of simply being drunk. This may quickly result in fatality.

Patients on corticosteroids should always wear medical identification bracelets or necklaces so they can be identified as at risk for adrenal insufficiency in an emergency. This is a very important issue that is not on the medical system radar screen.

The grim finding of this comprehensive review of current medical studies, is that even after successfully tapering off steroids, a significant number of people may experience signs of serious malfunction in the adrenal glands. The adrenal glands may not fully recover. The result is adrenal crisis, secondary adrenal insufficiency, and possibly permanent adrenal insufficiency, or death.

 

[Sing]

It is necessary always to specify the quantity taken. 5 mg prednisone is equal to 20 mg hydrocortisone or cortisol. If you had no adrenal gland at all, a full replacement dose might be 30 mg or possibly 40mg of cortisol daily. This would be only 7 to 10 mg prednisone. There is no evidence that people with ME/CFS would need this much, but there is evidence that some have low circulating cortisol due to an underfunctioning HPA axis.

Overdosing beyond whatever your physiological need is will cause problems and the longer you do so, the more serious they will be. However, it can be very helpful to have a low dose of cortisol if that is what it takes to bring up an abnormally low level of circulating cortisol, as occurs with some of us wth ME/CFS. Low dose means low. Perhaps 5 or 10 mg daily of cortisol is the equivalent of 1.25 to 2.5 mg of prednisone a day.

Neither doctors who prescribe more than the lowest dose needed to balance the system, nor studies which give participants higher doses than needed then question the benefit of cortisol, are serving patients in our community. As a master hormone with many functions, cortisol is one that we need in just the right amount when we need it. Both too little and too much are problems.

 

[ebethc]

prednisone makes me so unbelievably sick... awful