If you’re living with psoriasis or psoriatic arthritis (PsA), your doctor may have prescribed prednisone at some point in your treatment journey. Although it can be an effective medication for treating inflammation, prednisone also comes with some unwanted side effects. One example is adrenal insufficiency — a hormonal imbalance in your body.

This article will cover what prednisone is, why it’s used to treat psoriasis and PsA, and what you need to know about adrenal insufficiency. By learning about the potential side effects of prednisone, you can work with your doctor to better manage your condition.

What Is Prednisone, and How Does It Work?

Prednisone belongs to a group of medications known as corticosteroids (steroids) or glucocorticoids. This medication isn’t the kind of steroid used by bodybuilders. Doctors use corticosteroids like prednisone to help treat conditions caused by an overactive immune system, such as psoriasis or rheumatoid arthritis.

Corticosteroids like prednisone work by mimicking the effects of cortisol, which is sometimes called the “stress hormone.” Cortisol helps control inflammation and regulates metabolism, blood sugar, and blood pressure levels. Specifically, prednisone reduces immune system activity. The drug stops cells from making inflammatory chemicals and limits the number of immune cells in the blood.

Prednisone for Treating Psoriasis and Psoriatic Arthritis

Inflammation in psoriasis causes skin cells to grow much faster than normal. Healthy skin cells usually grow and shed off within one month. However, skin cells in psoriasis complete this process in three to four days. Your body can’t keep up with the shedding part, so skin cells build up and form plaques.

Some doctors prescribe an oral (systemic, or bodywide) corticosteroid — like prednisone — for a short time to treat inflammatory skin conditions. Many doctors are more likely to prescribe topical corticosteroid creams or ointments made with other steroids such as hydrocortisone or triamcinolone acetonide. Systemic corticosteroids tend not to be used for psoriasis because dermatologists are taught that these drugs can cause flares, according to the authors of a 2020 study in JAMA Dermatology. However, these researchers found low rates of psoriasis flares linked with the use of systemic corticosteroids among 1,970 people diagnosed with psoriasis.

Prednisone is more commonly prescribed for treating psoriatic arthritis, which affects 30 percent of people with psoriasis. Prednisone may help treat joint inflammation and pain caused by PsA.

What Are the Adrenal Glands?

Your endocrine system works hard to maintain your body’s hormonal balance. This system is made of several glands or organs that make and release hormones. Your adrenal glands are small, triangular glands on your kidneys.

The adrenal glands make and release cortisol and other hormones, including:

• Adrenaline and noradrenaline — These fight-or-flight hormones control heart rate and blood flow.
• Aldosterone — This hormone helps control blood pressure and levels of electrolytes, such as potassium and sodium.
• Dehydroepiandrosterone and androgenic steroids — The body converts these hormones into estrogen or testosterone as needed.

Your adrenal glands work alongside the kidneys, the pituitary gland in the brain, and your nervous system to control your cortisol levels. Think of these systems as a machine, with all the pieces working together to keep your body in balance.

When your cortisol levels are too low, an area of your brain known as the hypothalamus releases corticotropin-releasing hormone. This chemical messenger tells your pituitary gland to make a hormone called adrenocorticotropic hormone (ACTH).

ACTH travels through your bloodstream from your brain to your adrenal glands. ACTH tells your adrenal glands when to make more cortisol. If one part of this system isn’t working, you can develop hormonal imbalances and adrenal insufficiency.

How Do Adrenal Fatigue and Adrenal Insufficiency Differ?

You may have come across the term “adrenal fatigue” when researching information about prednisone. When you’re stressed, your adrenal glands release small bursts of cortisol. A theory called adrenal fatigue suggests that long-term stress can “drain,” or fatigue, the adrenal glands — meaning they can’t keep up with cortisol production. According to this idea, adrenal fatigue may lead to:

• Fatigue
• Brain fog, or trouble thinking and concentrating
• Need for caffeine to get through the day
• Digestive problems
• Sleep problems
• Cravings for sugar or salt
• Depressive moods

However, the Endocrine Society states that there’s no evidence that adrenal fatigue is a true medical condition. Many of the symptoms are caused by other health conditions or by stress in a busy life. If you haven’t been feeling like yourself lately, there may be another condition behind your symptoms.

On the other hand, adrenal insufficiency is a true medical condition. There are two types — primary and secondary. Primary adrenal insufficiency, which is also known as Addison’s disease, occurs when your immune system mistakenly attacks your adrenal glands. When your adrenal glands aren’t working properly, they can’t make the cortisol your body needs.

Secondary adrenal insufficiency develops when the pituitary gland doesn’t release enough ACTH. You may have perfectly healthy adrenal glands that can make cortisol, but they’re not getting enough ACTH to tell them to produce it. This means that your cortisol levels drop, and you experience symptoms of adrenal insufficiency.

Can Using Prednisone Lead to Adrenal Insufficiency?

According to Mayo Clinic, corticosteroids like prednisone can cause secondary adrenal insufficiency. You may also develop this condition if you’re using a steroid cream on your skin or if you receive steroid injections in your joints to treat PsA. The people at highest risk of adrenal insufficiency include those who are:

• Taking steroids for more than four weeks
• Receiving repeated steroid injections in muscles or joints
• Going on back-to-back short courses of steroids
• Using many different steroids at once

When taking prednisone or other steroids for psoriasis, it’s important to look out for signs that your hormone levels are out of balance. Symptoms of adrenal insufficiency usually don’t happen suddenly — they tend to develop over time. Be sure to talk to your doctor if you begin noticing any of the following symptoms:

• Weight loss
• Abdominal pain
• Nausea and vomiting
• Joint aches or pains
• Muscle weakness
• Cravings for salty foods
• Loss of appetite
• Fatigue
• Depression
• Darkening skin on your hands, face, scars, or moles or within skin folds

Treating and Preventing Secondary Adrenal Insufficiency

Fortunately, secondary adrenal insufficiency is reversible. The best way to treat it is to stop taking prednisone. Corticosteroids begin affecting your hypothalamus and pituitary gland after only one dose. This means that the longer you take prednisone, the longer it may take for your body to recover. The general recommendation is to wean off steroids gently, especially if you’ve been taking them for more than two weeks. Your doctor will prescribe a plan to help you taper off safely.

After you stop taking prednisone, your body eventually readjusts and begins making enough hormones on its own. Studies show that it can take six to 12 months to recover from secondary adrenal insufficiency.

Your doctor may also talk to you about the risk of adrenal crisis while taking corticosteroids. This life-threatening complication affects people with Addison’s disease or secondary adrenal insufficiency. An adrenal crisis occurs when your adrenal glands can’t make enough cortisol on their own. Symptoms include:

• Pale skin
• Nausea and vomiting
• Sweating
• Confusion
• Low blood pressure
• Fainting or collapsing

If you begin experiencing any symptoms of adrenal crisis, you need to seek medical attention immediately.

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. On MyPsoriasisTeam, more than 126,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.

Are you taking prednisone or another steroid for psoriasis? Have you been diagnosed with adrenal insufficiency? Share your experience in the comments below, or start a conversation by posting on your Activities page.