Many ABPA patients spend a lot of time taking steroid medication, oral or inhaled. For some, particularly those who are on the higher doses for longer periods of time, this can lead to the suppression of the production of the stress hormone cortisol by their adrenal glands. For the most part, this will be unnoticeable while you are still taking the steroid medication.
Once your doctor asks you to start reducing the dose of steroid medication, your adrenal glands usually recover but it can take some time and that is why you will be asked to reduce your dose very slowly, often over several weeks. This is usually referred to as ‘tapering’. You must be careful to never stop taking steroid medication too quickly.
Insufficiency
Some people who take oral or inhaled steroid medication at higher doses and for longer times (eg. more than 3-4 weeks on high doses) can more severely inactivate their cortisol production such that their adrenal glands only recover very slowly or not at all when the steroid medication is stopped. This leaves them needing to supplement their natural cortisol with medication such as prednisolone or hydrocortisone, which works very well. Under these circumstances your doctor may ask you to take a cortisol test (ie. synacthen test) if this affects you, which establishes how much of your own cortisol is still being made by your adrenal glands, and that helps them judge how much steroid medication you need to take.
In these circumstances, it is worth being aware of symptoms you may experience if you have too little cortisol. There are at least two occasions when this could be important:
-
- If you are ever unable to take your steroid medication eg during a hospital stay NB you will be given a steroid card by your doctor to always keep with you that tells medical staff that you need supplementary corticosteroid
- Cortisol is a stress hormone that is needed by your body when you are ill or otherwise stressed eg. if you have a fever or you have to undertake a medical procedure (see leaflet below). At these times your body needs more cortisol and you will be given Sick Day rules to follow (see leaflet below).
What are the symptoms of adrenal insufficiency?
- Symptoms of long-term (chronic) adrenal insufficiency include:
• feeling more tired
• feeling dizzy
• feeling sick
• loss of appetite
• weight loss.
If your need for cortisol becomes more acute you may have the following symptoms:
- Symptoms of adrenal crisis (acute adrenal insufficiency), which
means you need to seek medical attention urgently include:
• nausea and vomiting
• collapse
• low blood pressure
• confusion
• pale skin and sweating.
For full details of the management of secondary adrenal insufficiency read this leaflet.