Steroids & The Tapering Process

When secondary adrenal insufficiency is diagnosed, the treatment is a steroid pill - hydrocortisone or prednisone. For the hydrocortisone that is total for the day it is split into 2-4 different doses throughout the day.

I was originally prescribed hydrocortisone with the unqualified provider, when I switched to my very well-equipped provider she transitioned me to prednisone. They do the same thing, but hydrocortisone is shorter acting typically taken in multiple doses throughout the day (mimicking a natural circadian rhythm). Prednisone is longer acting, so for me, because of the 3 months I was underdosed, I needed something stronger to last the full day coverage for my protection. In a study I will reference many more times, "Extensive Clinical Experience: Hypothalamic-Pituitary Adrenal Axis Recovery after Adrenalectomy for Corticotropin-Independent Cortisol Excess" by Hurtado, et al (2018), they found there was no statistical significance on duration of recovery by using hydrocortisone or Prednisone. I'll cite this 500 times more: article.

Below is the taper schedule I was put on: with two caveats: (1) if I don't feel well at the end of the week to repeat that week before tapering down and (2) if I am sick, to follow "sick day" rules. Explained here from Society for Endocrinology.

Schedule:

Week 1: 10mg

Week 2: 9mg

Week 3: 8mg

Week 4: 7mg

Week 5: 6mg

Week 6: 5mg - stay on for 4 weeks, then test blood levels ACTH and AM Cortisol.

So, if you do not get sick and each taper works without issues, the taper schedule takes 2 months, 1 week.

After my first adrenal crisis, my doctor told me to do micro tapers between the steps like 9.5mg, 8.5mg, etc. She said to do a couple days in between as needed.

Back to my favorite study, there is a chart that identifies19 different 'characteristics" and then provides the average amount of time a patient with that characteristic took to recover. I did the exercise; I had the less-than-ideal level in almost every category. Then, for a 'general' gauge of what to expect, the characteristic causing the longest recovery time, for me was 13.1 months.

Make it make sense, please.

So needless to say, after adrenal crisis #2 - I decided to take my recovery into my own hands. Yes - still taking prednisone and yes - still going to all endocrinologist appointments but completely redesigning the approach.