STEROIDSafterCOVID

You have had steroids as part of your treatment for Covid-19. These are given in large doses.

What are steroids?

Steroids are hormones (chemical messengers). We all make a steroid called cortisol from our adrenal glands. It is vital for health, it plays a part in regulating things such as blood pressure, blood sugar levels and the immune system and in helping the body respond to stress.

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.

Where will the SYNACTHEN test be done?

You may have the test whilst you are still in hospital, when the course of steroids has nearly finished. If you have to take steroids for longer and you have to take them after you go home, you will have a telephone appointment and invitation to come back as a day patient to have the test at a more suitable time.

Where can I find more information?

http://www.imperialendo.com/prednisolonewithdrawal

https://www.addisonsdisease.org.uk/

Who can I contact if I haven’t had an appointment for steroids?

Endocrine Specialist Nurse 07500 10 14 10

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