Help, I Cannot Wean Off My Steroids!
No Thumbnail Available
Authors
Papadopoulou D.A.
Htut Z.
Akker S.A.
Meeran, K.
Check for full-text access
Issue Date
2025
Type
Article
Language
Keywords
Alternative Title
Abstract
Help, I cannot wean off my steroids! Steroid treatment is mainstay for many non-endocrine conditions. A 70-year old woman with asthma had frequent short courses of high dose prednisolone. She was referred to a specialist lung physician in January 2013, and diagnosed with eosinophilic granulomatosis with polyangitis (EGPA) previously known as Churg-Strauss syndrome. She commenced prednisolone 2.5mg daily which was increased to 5mg and often 10mg for some weeks. She subsequently commenced biologic treatment for eosinophilia and did not realise that she could stop steroids. After attending a talk on circadian rhythm and with guidance from her endocrinologist, she switched to hydrocortisone three times daily to better mimic the body's natural circadian rhythm. The lowest tolerable dose was 5 mg on waking, 5 mg at midday and 2.5 mg in the afternoon. Further reduction made her feel unwell. She maintained this regimen for several years. In May 2024 she was referred for a research study to switch to prednisolone. The 8am cortisol and ACTH were undetectable. We switched her to prednisolone and performed prednisolone day curves to determine the best dose. A daily dose of prednisolone 3mg resulted in an 8hour level of 30 mug/L (normal values 15 to 25 mug/L), so we advised reducing to 2mg once daily. She was keen to reduce further and started a weaning protocol to 1mg daily and a prednisolone level on 1mg showed that this was a suppressive dose for this patient. A short synacthen test (SST) on 1 mg of prednisolone per day demonstrated 0min ACTH <5ng/L, cortisol <28nmol/L, 30min 45nmol/L, 60min 59nmol/L. In order to go below 1mg of prednisolone, she switched to hydrocortisone 7.5mg once a day to aid further weaning. A repeat SST on 5mg hydrocortisone; ACTH 45.6ng/L, Cortisol 111nmol/L at baseline, 120nmol/L at 30min, 125nmol/L at 60 min. She continues to wean from 5mg day to 2.5mg over 7 weeks and we aim to wean her off steroids completely. Individualised care for patients on long term steroids wishing to wean is paramount to success. As a slow metabolizer, even a low steroid dose caused adrenal and pituitary suppression. She experienced significant effects on emotion, cognition and memory, impacting her daily life. Supporting patients to wean off steroids negates risks like osteoporosis and diabetes caused by long term steroid use in chronic conditions.Having reduced her dose significantly, she is extremely happy and optimistic about stopping steroids completely.
Description
Citation
Publisher
License
Journal
J.Endocr Soc.