Steroids after COVID

Why is it important to check adrenal gland function?

Steroids have been used for many years to treat known chronic conditions. When someone takes steroids for a long time (more than 2 weeks) the adrenal glands can become ‘sleepy’ and don’t produce enough cortisol quickly enough to respond to stress such as illness. If this is the case a small replacement dose of steroid will be prescribed.

In times of stress and illness the body needs extra cortisol. If it cannot produce enough to deal with the stress or illness, a person can develop an adrenal crisis which can be life threatening.

The adrenal glands can often be ‘woken up’ by very slowly reducing the amount of steroid medication over weeks or months (depending on blood test results)

Prednisolone 3mg once a day is a dose sufficient to replace the amount of cortisol that the adrenal glands make on a day to day basis. Many people whose adrenal glands don’t work, or even if they don’t have adrenal glands have a daily dose of prednisolone 3mg for all of their lives.

Dexamethasone 6mg (the standard treatment dose for covid-19) is similar to 40mg of prednisolone.

COVID is a new disease, and treatment often requires large doses of steroids. As it is a new condition we don’t know how suppressed your adrenal glands might be after this treatment. If they are working normally, then it is fine to stop the steroids.

Before we can stop the dexamethasone or prednisolone that you are taking, we need to check that the adrenal glands can make their own cortisol (steroid) when stimulated. We do this by performing a Short SYNACTHEN test. This is a very safe test where we take a small blood sample before giving you a small injection into the upper arm. We next take another small blood test 30minutes after the injection and 60minutes after the injection. The cortisol levels tell us if the adrenal glands are ‘awake’ or not.

Depending on the result, we will advise you whether you can stop the steroid medication completely or whether you will need to wean down the dose very slowly before you stop altogether.

If you need to wean down the dose slowly, you will be advised by the endocrine team (hormone specialists) how to do this safely.