Usually performed following 2x24 hour urinary free cortisol collections and prior to admission for formal diagnosis. The high dose test is performed in patients with confirned Cushing's to help distinguish between adrenal and other causes.
We created this guide to address the growing need for information on a misunderstood topic. Primary adrenal Isufficiency from autoimmune causes remains a rare condition the number of Secondary Adrenal Insufficient and Adrenal Suppressed patients is growing at an alarming rate.
Although most endocrine organizations agree the numbers are rising, there are no current statistics of actual numbers. Physicians who primarily treat other diseases find themselves lacking current information and design their own programs. This is a solid document based on available medical information and patient experience.
It took many months to compile. It is reviewed and endorsed by physicians at the top of their fields.
The medical information is referenced throughout. As it states on page one, our guide is meant to be a tool to bridge the gap between patient and physician. We hope it will help those finding it difficult to taper and provide a way to discuss program adjustments with their physician.
This guide is taken directly from the pdf and may be formatted differently. Glucocorticoid tapering and adrenal suppression testing guide This tapering guide is a compilation of medical information available and patient experience.
References for the medical information are provided at the end of the document.
This guide is not a substitute for advice and direction from your own physician. You may find this a useful discussion point if you are encountering difficulties in your attempts at tapering. Research is lacking on the topic of glucocorticoid tapering and our guide hopes to provide parameters for patients and medical providers in an easy to use format that will keep patients safe during the process.
Discuss any tapering program with your doctor before you begin. This is meant to be an aid in discussing tapering with your physician. Tapering must be done carefully to avoid both a reoccurrence of the underlying disease activity, and possible cortisol deficiency resulting from Hypothalamus-pituitary-adrenal, HPA axis suppression from glucocorticoid use.
Primary and Secondary Adrenal Insufficiency patients may require a tapering program to return to physiologic levels after a prolonged illness, or in the presence of serious side effects such as hypertension or Cushing symptoms.
Corticosteroid induced Secondary Adrenal Insufficiency patients may be put on a tapering program with the objective of restarting adrenal cortisol production and discontinuing steroid therapy.
Patients taking a physiological dose of 5 mg prednisone or 20 mg hydrocortisone per day or higher, for a period of three weeks or more should be considered at risk of HPA axis suppression. The route of administration of corticosteroids associated with adrenal suppression includes intra-articular, topical, ocular, rectal, inhaled and systemic.
It is recommended that patients continue to wear medic alert jewelry for up to one year. Some patients may require more time adjusting due to coexisting conditions, medications, emotional stress and other factors.
Programs should to be tailored to fit individual patient profiles. The clinical experience of the physician is paramount. Specialists treating the primary diseases must monitor the clinical and physiologic responses to the taper for recurrence of the disease.
Until the glucocorticoids are successfully tapered to physiologic equivalence of normal production, the dosage started and the rate of taper are entirely dependent on the disease response.
The following schedules for tapering may be too slow for a disease that only requires a short course of therapy, and therefore may contribute to the complication of secondary adrenal insufficiency.
A general guideline is that recovery takes one month for every month of suppression, with up to 9 to 12 months when steroids are used for more than one year.Research shows an early application of Proxy (ethephon) provides consistent Poa annua seedhead suppression.
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