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Is it possible to get off steroids?
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R Swamy Venuturupalli, MD, FACR posted:
Steroids are produced in the adrenal gland and you need some amount of steroid hormone in your body at all times. Your body normally produces 7.5 mg of prednisone equivalent cortisone. As steroids inhibit the adrenal glands, some patients who have been on steroids for 20 years are not producing adrenal hormone because their adrenal glands have shut down, they not producing cortisone. To get someone like that off steroids is very difficult because your body needs some steroid. At times of stress you're going to need more steroid, you may not like it, but you'll have to increase the dosage because the adrenal gland which would normally have kicked in is not functioning correctly. Also, if you have an infection of some sort, normally your adrenal glands would produce more steroid hormone, so in times of illness you may need to supplement it.

The glands can be stimulated and one way we can do this is by going on an alternate day regimen. What we try to do is cut down from say 8 one day, to 7 the next day, going back to 8 again, and then 6 the following day and so on. The idea is to slowly coax your adrenals to start producing a little bit of hormone. Sometimes on these alternate day steroid regimens, your adrenal gland may start working on the day that it doesn't see any steroid. Sometimes there's an autoantibody working against the adrenal gland in which case it's not going to work. If you have antiphospholipid syndrome, the adrenal gland gets infected and it's no longer functional. So if you have a functional adrenal gland, most people should be able to get off steroid, but it takes a really long time.
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