Steroids are typically used for treating medical conditions that involve inflammatory responses. Examples of these are inflammatory bowel disease, asthma, eczema, arthritis, allergic responses, and others.
In addition to treating inflammatory diseases, other uses for steroids include supplementing hormones. Taking steroids, like prednisone, can either help your body feel better or it can cause problems. Or both.
What is cortisol?
Within the body is the endocrine system, which is made up of glands. These glands secrete hormones into the bloodstream for the body to function correctly. There are two important glands, known as the adrenal glands, that release a hormone called cortisol.
Cortisol is the body’s natural form of steroid that regulates metabolism by:
- Turning glucose into energy.
- Helping the immune response to fight off infections.
- Helping the body respond to stress. Cortisol is known for its involvement with the fight-or-flight response in a stressful situation.
Taking steroids, such as prednisone, can affect how the adrenal glands produce cortisol. Prednisone can cause cortisol levels to rise or be part of the reason it is not being produced.
High cortisol levels
When people are taking corticosteroids, like prednisone, side effects can occur, such as increased appetite, weight gain, moonface, and insomnia. There is a danger for more severe side effects when steroids are taken for a prolonged period, including diabetes, cataracts, and bone loss.
When someone must take high doses of steroids for a prolonged period, there is also a risk of developing a condition called Cushing’s syndrome.
It can be dangerous if the cortisol levels in your system are high. The symptoms of Cushing’s syndrome are much like those associated with prolonged steroid use, but more severe, including:
- Obesity above the waist.
- Rounded and red face, known as moonface.
- A lump between the back shoulders, called a buffalo hump.
- Weak muscles or bones, osteoporosis, bone pain, and fractures.
- Skin changes, like stretch marks, acne, and thinning of the skin.
Low cortisol levels
Oddly, taking steroids long-term can also put you at risk of adrenal insufficiency, when cortisol is no longer produced. There are two types of adrenal insufficiency diseases: primary and secondary.
Primary adrenal insufficiency is an autoimmune disease that is caused by damage to the adrenal gland. This is also known as Addison’s disease.
With secondary adrenal insufficiency, the adrenal glands stop producing the adrenocorticotropic (ACTH) and the cortisol hormones. The ACTH hormone helps with the production of cortisol. Secondary insufficiency is mainly caused by long-term exposure to higher doses of corticosteroids. In some cases, the adrenal glands can start to produce ACTH and cortisol again. If so, it usually takes 12 months, depending on how long high doses of steroids were taken.
Symptoms of both types of adrenal insufficiency may start slowly but can become quite serious if untreated. Adrenal insufficiency can cause excessive fatigue, muscle loss, unexplained fevers, weight loss, mood swings, and changes to the skin. A test for adrenal insufficiency can be done through blood work.
Too high for too long
Unfortunately, I have been on high doses of prednisone for more than 10 years to treat severe asthma and Crohn’s disease.
Because I was taking 40 mg daily for years, I developed Cushing’s syndrome. I gained a lot of weight fairly quickly, had moonface that made me barely recognizable, thinning of the skin, which led to stretch marks, and even developed cataracts and diabetes. With everything happening to my body, I became depressed. Thankfully, over the past two years, my health issues have been improving. And within the past year, I tapered down to just 5 mg daily!
Something wasn’t right
Over the past five months, I have been running fevers and was extremely fatigued, even after sleeping all night and taking naps throughout the day. I’ve been very weak and getting physically sick after mild workouts. My doctors ordered some blood work, and everything came back showing secondary adrenal insufficiency. My cortisol and ACTH levels were almost zero each!
For now, I have to increase the dose of the very medication that caused my adrenal glands to stop working: prednisone. This is to supplement the natural steroids my glands are not producing. Hopefully, my adrenal glands will wake up in the next year and I will be able to get off steroids all together! Steroids are both a blessing and a curse!
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