Steroid Withdrawal (cont.)
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 -he 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.
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 how he/she may react 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.
Next: Steroid Withdrawal At A Glance »
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