Diseases

Steroid Withdrawal Information

Discontinuing steroids

Over the years, researchers began to learn why some patients develop symptoms of decreased adrenal function, while others never do. The production of corticosteroids is controlled by a "feedback mechanism," involving the adrenal glands, the pituitary gland, and brain, known as the "Hypothalamic-Pituitary-Adrenal Axis" (HPAA). The continuous administration of corticosteroids inhibits this mechanism, causing the HPAA to "hibernate."We now know that the amount of the drug needed to suppress the HPAA varies from person to person. As a general rule, using large doses for a few days, or smaller doses for more than two weeks, leads to a prolonged decrease in HPAA function. Typically there are no problems with a 5-day moderately high dose burst of steroids regarding withdrawal symptoms.Thus, steroid use cannot be stopped abruptly. Tapering the drug gives the adrenal glands time to return to their normal patterns of secretion. (It may take a period of time for things to get completely back to normal). How quickly steroids can be tapered depends on continued control of the underlying disease with decreasing doses, and on how quickly our body adjusts to the need to produce its own hormones. If things go well, four to six weeks (or longer) is a reasonable period.Unfortunately, tapering may not always completely prevent withdrawal symptoms. Present thinking suggests that steroid withdrawal may involve many factors, including a true physiological dependence on corticosteroids. Further, tests of HPAA function do not always correlate with a patient's symptoms, and these tests are of no value while taking steroids. Therefore, it can be difficult to determine the true cause of a patient's symptoms or reaction to stress (for example, from a disease flare-up, procedure, or surgery). Restarting or increasing dosage may be the only solution.Taking steroids every other morning gives the body a better chance to recover function. The day without the hormone allows natural stimulation of the hypothalamus and pituitary glands. Thus, alternate-day therapy is ideal, if possible, once the disease is under control. It is still not clear whether new steroids being developed will available to decrease the risks of side effects and HPAA suppression.We must assume that all patients exposed to steroid therapy for even a short time have diminished HPAA function. Patients who have taken steroids noticing any of the above or other unusual symptoms should notify their doctor. Keep in mind that some medications or alcohol can increase the need for larger steroid doses. You should carry a list of all your medications in your wallet to alert medical personnel in case of emergency. This is especially important if you are receiving steroid therapy or have recently stopped taking steroids. Supplementation may be needed during periods of stress, even up to a year after discontinuing corticosteroid therapy.

Introduction to steroids

Research conducted by Edward Calvin Kendall at the Mayo Clinic in the medical use of cortisone lead to a Nobel Prize in 1950. The drug simulated cortisol, a naturally occurring, anti-inflammatory hormone produced by the adrenal glands. Such synthetic corticosteroid drugs (prednisone, prednisolone, and many others) have since benefited patients and are commonly used to treat many conditions, including allergic reactions, asthma, rheumatoid arthritis, and inflammatory bowel disease. They are not without serious drawbacks, however. The two major problems related to continuous, long-term steroid treatment are drug side effects and symptoms due to changes in the balance of normal hormone secretion. The latter typically results from taking doses greater than our body's natural production (about the equivalent of 7.5 mg of prednisone per day). Once patients begin to decrease or discontinue the dose, withdrawal symptoms may occur. Thus, steroids are typically given for the shortest possible time possible. Short-term steroid use is commonly without significant side effects and is often a crucial treatment for a variety of issues, including eczema, allergies, and asthma. Moreover, short-term use does not induce steroid withdrawal.

Steroid withdrawal facts

• Synthetic cortisone medications (corticosteroids) simulate cortisol, a naturally occurring, anti-inflammatory hormone produced by the adrenal glands. Such drugs (for example, prednisone) have since benefited many, but are not without potential side effects.
• The two major problems related to continuous steroid treatment are
  1. drug side effects and
  2. symptoms due to changes in the balance of normal hormone secretion (withdrawal symptoms).
• The production of corticosteroids is controlled by a "feedback mechanism," involving the adrenal glands, the pituitary gland, and brain, known as the "hypothalamic-pituitary-adrenal axis" (HPAA).
• Using large doses for a few days, or smaller doses for more than two weeks, leads to a prolonged decrease in HPAA function.
• Steroid use cannot be stopped abruptly; tapering the drug gives the adrenal glands time to return to their normal patterns of secretion.
• Withdrawal symptoms and signs (weakness, fatigue, decreased appetite, weight loss, nausea, vomiting, diarrhea, abdominal pain) can mimic many other medical problems. Some may be life-threatening.
• Tapering may not completely prevent withdrawal symptoms. Steroid withdrawal may involve many factors, including a true physiological dependence on corticosteroids.
• Patients should carry a list of all their medications in their wallet to alert medical personnel in case of emergency.
• Supplementation with corticosteroid medication may be needed during periods of stress (such as surgery), even up to a year after stopping corticosteroid therapy.
• Diagnosis of steroid withdrawal can be difficult. Diagnosis is easier if the patient indicates they have recently stopped or decreased a steroid medication, such as prednisone or prednisolone.
• Treatment of steroid withdrawal is tailored to the individual. Treatment usually involves steroid administration that is decreased gradually over weeks to months.
• Physicians who treat steroid withdrawal include primary care physicians, endocrinologists, internal-medicine specialists, and others.
• The prognosis of steroid withdrawal, if diagnosed early and treated appropriately, is usually good.
• It is possible to prevent steroid withdrawal by using steroids over short lengths of time. Patients who use steroids for lengthy periods of time may prevent steroid withdrawal by slowly tapering or weaning the dose of the steroid under the direction of a physician.