Steroids & the Risk of Adrenal Suppression Are you weaning off or have taken steroids for a long time and are feeling extreme fatigue, joint pain, nausea, or intolerance to hot and cold? If so, you may be experiencing adrenal suppression. What are adrenal glands? Adrenal glands are triangular-shaped glands that sit on top of your kidneys. They produce cortisol, a hormone that plays many important roles in keeping your body functioning, including: Suppressing inflammation Regulating blood pressure Increasing blood sugar Helping to control your body’s use of fats, proteins, and carbohydrates What is adrenal suppression? Many individuals with rare, protein-spilling diseases take steroids to prevent protein from spilling into their urine. While short-term steroid treatment does not pose major risks, long-term use of steroids can put one at risk of adrenal suppression. Adrenal suppression occurs when the adrenal glands don’t produce enough cortisol. This condition can be caused by suddenly stopping or slowly weaning off chronic or high-dose steroid medication, and can also affect patients who take chronic, low-dose steroid medication on a daily basis. Taking steroids for a prolonged period of time can cause the adrenal glands to stop producing enough cortisol for the body’s normal needs. Symptoms of adrenal suppression include: Fatigue Weakness Nausea Vomiting Diarrhea Intolerance to hot and cold temperatures Headaches Abdominal pain Muscle pain Joint pain Muscle spasms Stunted growth Weight loss Adrenal suppression can lead to an “adrenal crisis,” a medical emergency caused by a lack of cortisol. When your body becomes stressed, which can be due to an infection, surgery, extreme physical activity, or emotional stress, among other causes, you may need a “stress dose,” or an emergency dose of steroids, to prevent severe complications. If left untreated, an adrenal crisis can be fatal. How is adrenal suppression diagnosed? If your doctor thinks you may be suffering from adrenal suppression, they will order blood work to check your blood for cortisol and ACTH (a hormone released from the pituitary gland, a small gland in your brain). In some cases, your doctor may order other tests to determine how your adrenal glands are functioning. If you are concerned about your risk of acquiring adrenal suppression, talk to your doctor and ask for a referral to see an endocrinologist. Should you see an endocrinologist? If you are weaning from long-term steroid use or taking low-dose steroids daily, you should consider seeing a doctor who specializes in endocrine glands and hormones, called an endocrinologist. An endocrinologist will be able to look at your lab work to see if you are experiencing adrenal suppression and talk to you about your risk for an adrenal crisis. Talk to your doctor. See an endocrinologist. Make a plan. References Elshimy, G., Alghoula, F., & Jeong, J.M. (2020). Adrenal Crisis. https://www.ncbi.nlm.nih.gov/books/NBK499968/ Rushworth, R.L., Torpy, D.J., & Falhammar, H. (2019). Adrenal Crisis. The New England Journal of Medicine 381(9), 852-861. https://doi.org/10.1056/NEJMra1807486