ADRENALS FAQ–the most frequently asked questions

[Guest guest]

ADRENALS FAQ–the most frequently asked questions

_http://www.stopthethyroidmadness.com/adrenal-info/faq/_

(http://www.stopthethyroidmadness.com/adrenal-info/faq/)

Below are some of the most frequently-asked questions by hypothyroid

patients concerning the problem of adrenal fatigue…and answers are below.

This was

written by Bob, a man who has dealt with both hypothyroid and adrenal issues.

1) What are the symptoms of adrenal problems?

2) How can I tell if my problems are adrenal, or thyroid?

3) What is Adrenal Insufficiency?

4) Is Adrenal Fatigue the same thing as Adrenal Insufficiency?

5) How do I test the condition of my adrenals?

6) Is saliva testing as accurate as blood labs for cortisol levels?

7) How can I produce all of that saliva to fill up the tubes?

8.) Can I test my cortisol levels if I am taking HC or Isocort or other

adrenal glandular?

9) Will my Dr agree with the 24 hour cortisol test (saliva testing)?

10) Will my Dr agree to treat my adrenals?

11) What if my doctor refuses to treat my adrenals because I don’t have

Addison’s?

12) Can you help me understand my 24 hour cortisol saliva labs

13) Is stress the only thing that causes Adrenal Fatigue?

14) I have bloodwork for the adrenals, can you help me interpret the results?

15) How can I order some lab tests?

16) Do adrenal glandulars work?

17) Isocort does not require a prescription - where do I get it?

18) What else should I be doing to help the adrenals?

19) What medications are prescribed for the adrenals?

20) How do I start HydroCortisone?

21) Where do you get the dosing information?

22) How do I dose 20mg, 25mg, or 30mg of HC?

23) Why take more HC in the morning?

24) Why can’t I take a lower amount of HC, such as 10mg per day?

25) What if I feel nauseated, or shaky?

26) Why do I have trouble sleeping after starting HC?

27) How can I tell if I am low on cortisol, or too much?

28) Aren’t steroids dangerous - don’t they have side effects?

29) If I take HC or Isocort, will it put my adrenals to sleep?

30) How much cortisol does the body normally produce?

31) What is stress dosing - what if I get sick?

32) What is the difference between Primary and Secondary Adrenal

Insufficiency?

33) What causes Primary Adrenal Insufficiency?

34) What causes Secondary Adrenal Insufficiency?

35) How do I test for Secondary Adrenal Insufficiency?

36) Why does it matter if I am Primary or Secondary?

37) Will I be stuck on HC for life?

38) Will I be able to wean off the HC?

39) How do I wean off HC?

40) Will HC kill my immune system?

41) What is a physiologic dose of cortisol?

42) What precautions should I consider before starting HC?

43) Do some people have a reaction to the medication?

44) What is a “Thyroid Dump�

45) What is an adrenal crisis? (AKA “addisons crisisâ€)

46) The HC doesn’t seem to last long enough - what is Medrol?

47) How do I dose Medrol?

48) Can I take time-release HC, Prednisone, or other steroid to treat the

adrenals?

49) Are there other adrenal hormones that I need to worry about?

50) What are the symptoms of low aldosterone?

51) Why should I test renin along with aldosterone?

52) What sequence do I treat the hormones? What about the sex hormones?

53) Will hormone medication affect my blood pressure?

54) Do these hormones affect fluid retention?

55) Will I recover 100% and feel normal?

1) What are the symptoms of adrenal problems? Fatigue, anxiety,

light-headedness, shakiness, dizziness, nausea, and difficulty dealing with

stressful

situations. Dr. Rind says “Most people have a mixture of poor thyroid and

poor

adrenal function rather than purely one or the other, and therefore a mixture

of symptomsâ€. He also says that poor thyroid and/or adrenal function is the

most common cause of low metabolic energy. Metabolism is defined as the

chemical changes in living cells by which energy is provided for vital

processes

(Websters). Please refer to this chart of symptoms

_http://www.drrind.com/scorecardmatrix.asp_

(http://www.drrind.com/scorecardmatrix.asp)

2) How can I tell if my problems are adrenal, or thyroid? The body’s

temperature drops as the metabolism drops. Low temperatures are caused by low

thyroid. If the adrenal hormone cortisol is low, the average daily temperature

will

fluctuate when comparing one day’s average to the next. We are not talking

about temperature changes during one day - it is normal to wake up with lower

temperatures and hitting a peak in the later afternoon. Take your temperature

3 hours after waking, again 3 hours later, and again in another 3 hours. You

average those 3 readings to get one single number for that day. Please read

Janie’s page _http://www.stopthethyroidmadness.com/temperature/_

(http://www.stopthethyroidmadness.com/temperature/) and follow her link to Dr.

Rind. Look

at his examples and download his blank chart. Begin filling in your

temperatures. If you post a question about your dosing, someone is going to ask

about

your temps.

3) What is Adrenal Insufficiency? In 1855, Thomas Addison first described

adrenal insufficiency, which was subsequently named after him. Originally,

tuberculosis was the most common reason for the adrenal gland failure.

Currently,

Addison disease most commonly results from autoimmune destruction of the

adrenal gland. The adrenal hormones Cortisol and Aldosterone are vital for

life,

so Addison’s disease can be fatal.

If you search for information on Addison’s disease, you fill find quotes

such as this one: “Adrenal insufficiency occurs when at least 90 percent of

the

adrenal cortex has been destroyed.â€

_http://endocrine.niddk.nih.gov/pubs/addison/addison.htm_

(http://endocrine.niddk.nih.gov/pubs/addison/addison.htm)

4) Is Adrenal Fatigue the same thing as Adrenal Insufficiency?

No. The person with Adrenal Fatigue may have less severe symptoms, and there

are lots of shades of gray. Here is an example from a medical site: “A

significant number of patients with partial loss of adrenal function (limited

adrenocortical reserve) appear well but experience adrenal crisis when under

physiologic stress (eg, surgery, infection, burns, critical illness)â€

_http://www.merck.com/mmpe/sec12/ch153/ch153b.html_

(http://www.merck.com/mmpe/sec12/ch153/ch153b.html)

A person with a more serious case of adrenal fatigue may have chronic

symptoms of fatigue. They may have symptoms associated with low blood sugar

(one of

cortisol’s jobs is to help regulate glucose). They may feel light headed

upon standing, as another function of cortisol is to maintain blood pressure.

Dr. Ron Kennedy says “Addison’s disease is so rare, and adrenal fatigue so

common, that I prefer to spend most of our space here on the latter. This

syndrome is marked by loss of energy with the experience of fatigue and

oversleepingâ€. _http://www.med-library.net/content/view/75/41/_

(http://www.med-library.net/content/view/75/41/)

Dr. Tintera was making comments like this way back in 1955 “a former

hypothesis - that the adrenal cortex functioned according to the classic “all

or none

†law - is repudiated as being contrary to both clinical and experimental

evidence. Hypoadrenocorticism may be congenital or acquired, complete or

partial. The two former subdivisions frequently fail of recognition.â€

_http://www.fred.net/slowup/tint01.html_

(http://www.fred.net/slowup/tint01.html)

Many members discovered their adrenal fatigue when they started thyroid

medication - because the increased metabolism strained the adrenals.

_http://www.stopthethyroidmadness.com/things-we-have-learned_

(http://www.stopthethyroidmadness.com/things-we-have-learned) Doctor Broda

Barnes describes this in his

lectures “And the thing that we have to think of very often, is a partial

adrenal deficiency too. If the blood pressure of a patient is 100 systolic or

below, I hesitate, in fact I won’t start them on thyroid, without giving them

5mg

of prednisone at the same time. Because, if you raise the metabolism a

little as we’re doing with the thyroid, you also have to have a little more

secretion from the adrenal. The normal gland, can furnish it and do all right.

But

if the blood pressure is too low in the beginning, the chances are that this

patient is going to get worse, about four days after you start them on

thyroid, they will become worse than they were.†(5 mg of Prednisone is = to

20 mg

of hydrocortisone)

5) How do I test the condition of my adrenals? Please read what Janie says

here _http://www.stopthethyroidmadness.com/adrenal-info/_

(http://www.stopthethyroidmadness.com/adrenal-info/) If your doctor insists on

blood tests for

cortisol, that is fine - just order the saliva labs in addition so you can see

the 24 hour cortisol rhythm.

_http://www.stopthethyroidmadness.com/recommended-labwork/_

(http://www.stopthethyroidmadness.com/recommended-labwork/)

6) Is saliva testing as accurate as blood labs for cortisol levels? Yes.

Here is an article citing many medical references

_http://www.diagnostechs.com/mainFrame.asp?refPage=http://www.diagnostechs.com/b\

ody_text/articles.htm_

(http://www.diagnostechs.com/mainFrame.asp?refPage=http://www.diagnostechs.com/b\

ody_t

ext/articles.htm)

7) How can I produce all of that saliva to fill up the tubes? Sniff on a jar

of pickles, relish, or a lemon. Dr Peatfield says to do the test under

routine stress conditions, not on a relaxing day off.

Can I test my cortisol levels if I am taking HC or Isocort or other adrenal

glandular? No. the medicine will throw off the result of the test.

_http://www.macses.ucsf.edu/Research/Allostatic/notebook/FAQs-salivcort.pdf_

(http://www.macses.ucsf.edu/Research/Allostatic/notebook/FAQs-salivcort.pdf)

9) Will my Dr agree with the 24 hour cortisol test (saliva testing)? Mine

did, he had the saliva lab boxes right in his office. You may have to drive to

a larger city to find a doctor familiar with treating adrenal fatigue. You

can order the lab test yourself, see what result comes back, and learn as much

as you can about this condition so you will be an educated partner in your

health care.

10) Will my Dr agree to treat my adrenals? Dr. Lam says “Unfortunately,

conventional medicine only recognizes Addison’s disease as hypoadrenia,

despite

the fact that adrenal fatigue is a fully recognizable condition. As such, do

not be surprised if your doctor is unfamiliar with this condition.†_h

ttp://www.drlam.com/A3R_brief_in_doc_format/adrenal_fatigue.cfm_

(http://www.drlam.com/A3R_brief_in_doc_format/adrenal_fatigue.cfm)

Some members, especially those that are shackled by the constraints of “

health insurance†approvals, have difficulty when their doctor doesn’t

recognize

their condition. Please review this page

_http://www.stopthethyroidmadness.com/how-to-find-a-good-doc/_

(http://www.stopthethyroidmadness.com/how-to-find-a-good-doc/) You can ask if

the doctor is familiar with the book “Safe uses of

Cortisol†by Dr Jefferies

_http://www.ccthomas.com/details.cfm?P_ISBN13=9780398075002_

(http://www.ccthomas.com/details.cfm?P_ISBN13=9780398075002) or

the books by Dr Peatfield

_http://featherstone.bravehost.com/thyroid/peatfieldadrenal.html_

(http://featherstone.bravehost.com/thyroid/peatfieldadrenal.html)

11) What if my doctor refuses to treat my adrenals because I don’t have

Addison’s? You might explain to him that even people with Addisons have

varying

degrees of hormone production, as per this guide that you can download

“Addison

’s disease is not an ‘all or nothing’ condition. In the early stages of

the

disease many individuals are still able to produce some cortisol and enough

aldosterone. This is partly why individuals with the disease take varying

amounts of medication and why the amount of medication you need may alter over

the years.†_http://www.addisons.org.uk/info/manual/adshgguidelines.pdf_

(http://www.addisons.org.uk/info/manual/adshgguidelines.pdf)

12) Can you help me understand my 24 hour cortisol saliva labs? A normal

cortisol rhythm is highest in the morning, tapering off later in the day. In

the

early stages of adrenal fatigue, there can be excessively high levels of

cortisol as the body responds to stress. Dr Lam explains the stress response

here _http://www.drlam.com/A3R_brief_in_doc_format/adrenal_fatigue.cfm_

(http://www.drlam.com/A3R_brief_in_doc_format/adrenal_fatigue.cfm)

As adrenal fatigue progresses, the cortisol rhythm becomes disrupted, and

often “flattens outâ€. This can happen even with somewhat normal levels of

cortisol being produced - but the “below normal†morning cortisol tends to

indicate that there is a problem. Often the person lacks adrenal reserve.

During

times of stress the adrenals cannot produce the extra cortisol required by the

body.

As the problem gets worse, the “flattened†cortisol rhythm becomes so

severe that the pattern is “flat-lining†closer to the bottom of the chart.

This

person could be said to have Adrenal Failure, also known as Adrenal

Insufficiency. The combined cortisol readings of all 4 points of the day (called

the “

cortisol burdenâ€) will be below normal range. As the adrenal fatigue

progresses, the amounts of DHEA produced by the adrenals often become lower as

well.

Dr Lam’s article explains the reason for this. Low DHEA can be a clue to the

condition of the adrenals.

You can compare your labs with the examples shown in this article

_http://www.stopthethyroidmadness.com/community/viewtopic.php?t=12149_

(http://www.stopthethyroidmadness.com/community/viewtopic.php?t=12149)

 

13) Is stress the only thing that causes Adrenal Fatigue? No - there are

actually a number of things that can be wrong. Please keep reading, and we will

explore some of the causes of adrenal problems.

14) I have bloodwork for the adrenals; can you help me interpret the

results? Emedicine.com says this: The preliminary test for adrenal

insufficiency is

the measurement of serum cortisol levels from a sample of blood obtained in

the morning. Because of variations in cortisol levels due to the circadian

rhythm, blood should be drawn when the levels are highest, usually between 6:00

and 8:00 am.

- Morning cortisol levels greater than 19 mg/dL (reference range, 9-25

mg/dL) are considered normal, and no further workup is required.

- Values less than 3 mg/dL are diagnostic of Addison disease.

- Values in the range of 3-19 mg/dL are indeterminate, and further workup is

needed.

_http://www.emedicine.com/derm/topic761.htm_

(http://www.emedicine.com/derm/topic761.htm)

Over the years, members have posted their lab results and symptoms on

numerous adrenal forums. When the morning cortisol is not greater than 19 mg/dL

the

members tend to complain of low cortisol symptoms. In the book “Safe uses of

Cortisol†Dr Jefferies says “It is important to be aware that test results

that fall within the “normal range†do not rule out the possibility that a

patient might have mild adrenal deficiencyâ€. If you want to determine the

CAUSE

of adrenal problems, additional tests must be done prior to starting

treatment. Please continue reading these FAQ’s for additional information.

15) How can I order some lab tests? Many blood labs, can be ordered directly

by the patient from

_https://orders.directlabs.com/dl-locator/order_tests.aspx_

(https://orders.directlabs.com/dl-locator/order_tests.aspx) including the

elusive aldosterone test. They also do the Renin test but it is not listed on

the website, you have to call them and ask for it. Many other blood tests

can be ordered from _www.healthcheckusa.com,_ (http://www.healthcheckusa.com,/)

and the saliva cortisol labs can be ordered directly by the patient from

_www.canaryclub.org_ (http://www.canaryclub.org/)

16) Do adrenal glandulars that I can get at a health food store work? There

are some members with very mild cases of adrenal fatigue who feel some

improvement from over-the-counter supplements. But most often we hear members

complain that they wasted their time and their money because most of these

products have the hormones removed, and did not provide the adrenal support

they

needed. One exception is IsoCort.

17) Isocort does not require a prescription - where do I get it? It is not

typically found on store shelves and must be ordered. Read this page for more

on IsoCort _http://www.stopthethyroidmadness.com/isocort/_

(http://www.stopthethyroidmadness.com/isocort/)

18) What else should I be doing to help the adrenals? Good sleep is very

important, and try to keep a consistent schedule every day. 1/2 teaspoon Sea

Salt

mixed with a large glass of water in the morning, and again later in the

day. Small but frequent meals (to help with blood sugar). Vitamins including

B-complex after meals. There are good recommendations from Dr Lam

_http://www.drlam.com/A3R_brief_in_doc_format/adrenal_fatigue.cfm_

(http://www.drlam.com/A3R_brief_in_doc_format/adrenal_fatigue.cfm) and this

from Dr Jay Mead

_http://www.thecompounder.com/hormonesadrenalprotocol.php_

(http://www.thecompounder.com/hormonesadrenalprotocol.php)

 

19) What medications are prescribed for the adrenals? In Dr Peatfield’s

book, he says “Undoubtedly for the physician, the replacement of choice is

hydrocortisone, since this though synthetically produced, is identical to

naturally

produced cortisone.

_http://featherstone.bravehost.com/thyroid/peatfieldadrenal.html_

(http://featherstone.bravehost.com/thyroid/peatfieldadrenal.html)

Hydrocortisone requires a prescription, and is sold under the brand name

Cortef, as well as the generic names such as “Hydrocortoneâ€. Some patients

do

better with a Medrol because it has a longer half life. Keep reading for more

information on Medrol.

20) How do I start HydroCortisone?

_http://www.stopthethyroidmadness.com/adrenal-info/how-to-treat_

(http://www.stopthethyroidmadness.com/adrenal-info/how-to-treat)

21) Where do you get the dosing information? In Dr Peatfield’s book, he says

“the initial approach has to be restrained and cautious, and the lowest

possible dose given at the start. I find that 1/4 of a 10 mg. hydrocortisone

(that is 2.5 mg) is an excellent starting point.

…The 1/4 tablet a day is increased to 1/4 tablet twice a day; then after a

few days, three times a day and up to a 1/4 four times a day spread out

throughout the waking day. The reason for this is that it is not store by the

body

and gets rapidly used; 2 or 3 hours will see it pretty well used up

completely. Since a smooth level of support is desirable, the dose does need to

be

spread out. The final dose is usually 20 mg. daily, that is 1/2 tablet four

times a day; but careful adjustments relating to the response, may take the

dose

to 25 or 30 mg. daily, exceptionally even 40 mg. These higher doses are

related more to absorption in the stomach, not to deficiency, but low adrenal

reserve reaching Addisonian levels may make such doses necessary.â€

22) How do I dose 20mg, 25mg, or 30mg of HC?

To dose for 20mg: 10 - 5 - 2.5 - 2.5 (4 hours apart, sooner if needed)

To dose for 25mg: 10 - 7.5 - 5 - 2.5 (4 hours apart, sooner if needed)

To dose for 30mg: 10 - 10 - 5 - 5 (4 hours apart, sooner if needed)

23) Why take more HC in the morning? To follow the body’s natural cortisol

rhythm, which is higher in the morning. For example In Wilson’s book, Adrenal

Fatigue 21st Century, he recommends the following: 12 mg. first thing in the

morning, then 5 mgs at noon, then 2 mgs at 3 pm, and finally 1 mg at 6 pm.

You don’t want to dose too high in the morning, or the body will sense the

extra cortisol and the pituitary gland will reduce it’s request for the

body’

s natural cortisol production - and this can make you tired later in the day.

24) Why can’t I take a lower amount of HC, such as 10mg per day? Dr

Jefferies states: “Most patients can be maintained on between 20 and 30 mgs.

daily in

divided doses. Although some patients may feel well on less than 20 mg.

daily, it seems preferable to give at least this much cortisol, even to

patients

with low adrenal reserve, because it takes the strain off of the residual

adrenal tissue and provides for more functional reserve in times of stress.

Under some circumstances, it appears to provide an opportunity for residual

tissue to regenerate. A few patients with low reserve have demonstrated

evidence

of recovery of reserve after months of even years of such treatment, but most

seem to require some replacement for the remainder of their lives.â€

Keep in mind that when you take a small dose such as 10mg of HC per day, the

body is going to sense that cortisol in the blood and “down regulateâ€

it’s

own production of cortisol somewhat. So it is not just adding to your

cortisol, but reducing it to some extent at the same time. The same thing

happens

when you take thyroid hormones, the body lowers its own thyroid hormone

production by lowering the TSH. But if the adrenal (or thyroid) hormones are

below

optimum levels, this is a decision the patient and doctor need to make.

25) What if I feel nauseated, or shaky? These are symptoms of low cortisol -

you should take your next dose even if it hasn’t been 4 hours. Some people

need to move their doses closer together, or switch to a longer lasting

medicine such as Medrol. Shakes can also result from low aldosterone, which is

mentioned later in the FAQ’s. Too much cortisol can cause shakes. Low blood

sugar

can cause shakes - and for persons with adrenal issues this can be a big

problem. This is why Dr Lam (and others) stress not to skip breakfast, and eat

frequent small meals.

26) Why do I have trouble sleeping after starting HC? When cortisol is too

high, or low, it can affect your sleep. And when members comment that they

have more trouble sleeping after starting HC, it is often within the first

month

as the body’s metabolism is starting to wake up. During this “honeymoonâ€

period, it is important to get good sleep - even if that means slowing down on

the “normal†dose schedule, or taking a sleep remedy such as melatonin.

There are a variety of published medical articles and books saying not to

take HC past the afternoon - yet many patients find that after they become

accustomed to the medicine this is not a problem. If you let your cortisol get

too low at night, it can wake you up with low blood sugar symptoms. Eating a

small amount of protein, and a small dose of HC as you are getting to bed may

help you sleep.

27) How can I tell if I am low on cortisol, or too much? As mentioned before,

take your temperature and see if the daily average is consistent day to day,

within .2 degrees measured by a dependable thermometer. Do the “blood

pressure test†to see if your adrenals are supported. In order to learn the

symptoms of too much cortisol, please do a search for “cushings syndromeâ€.

It is vital for anyone on this journey to keep a daily log, a journal with

how you are doing, your dosing schedule, and any changes that you make. Write

something in it every day, and review what you wrote for clues if things

aren’

t going well. Resist the urge to change more than one thing at a time, and

be patient. Don’t change your dosing every day - try to be consistent within

medically accepted amounts.

28) Aren’t steroids dangerous - don’t they have side effects? Cortisone

type medications are often prescribed for arthritis, severe allergies and

asthma

because of their anti-inflammatory qualities. For someone with low cortisol,

the info sheet from Merck puts this into perspective: Your doctor has

prescribed Hydrocortone for you because your body is not making enough

hydrocortisone, either because part of the adrenal gland isn’t working, or

because of

injuries, surgery or other stressful events. Steroids are also used by people

with other illnesses. Some of the side effects and other warnings in this

leaflet may apply more to them than to you. Because your tablets are being

given

to you to replace natural hormones that your body lacks, you should be less l

ikely to get side effects.

“Cortisol is a normal hormone, essential for life.†McCormack Jefferies MD,

Safe Uses of Cortisol

Doctor Lam says “Supplementing With Natural Hydrocortisone or cortisone

acetate in doses of 2.5 to 5 mg two to four times a day can be a safe and

effective way to replenish depleted adrenals. However, this should be done

under the

guidance of a physician and it is a prescription drug.â€

There is a potential danger if you start supplementing cortisol, then stop

suddenly or skip doses. See “What is an adrenal crisis†below.

29) If I take HC or Isocort, will it put my adrenals to sleep? There are

some doctors that simply do not prescribe HC, and warn their fatigued patient

that it will put their adrenals to sleep. If the doctor tested the adrenals, he

may find that patient is already suffering from low levels of adrenal

hormone. They may already be “asleepâ€.

In his book “Safe Uses of Cortisol†Dr Jefferies says “It has been

demonstrated that when subjects with intact adrenals receive less than full

replacement dosages of cortisol, endogenous adrenal function is suppressed only

sufficiently to achieve a normal glucocorticoid level. For example, subjects

receiving 20 mg (5 mg. four times) daily of cortisol have their endogenous

adrenal

steroid production decreased by approx. 60%, and subjects receiving 10 mg.

(2.5 mg. four times) daily have their adrenal steroid production decreased by

approx. 30%.â€

“endogenous†means “originating within or produced by the bodyâ€

“glucocorticoid†means “any of a group of corticosteroids (as cortisol)

that are involved especially in carbohydrate, protein, and fat metabolism, that

are anti-inflammatory and immunosuppressive, and that are used widely in

medicine (as to alleviate the symptoms of rheumatoid arthritis)†(Websters).

But what if you do not HAVE a normal glucocorticoid level? There have been

studies on Chronic Fatigue patients taking “hydrocortisone - 25 to 35 mg per

day: leads to a 20 to 35% decrease in endogenous ACTH and cortisol

production…

After stopping, it may take several days to several weeks to recover the

previous adrenocortical status.â€

_http://www.intlhormonesociety.org/ref_cons/Ref_cons_3_mild_glucocorticoid_defic\

iency.pdf_

(http://www.intlhormonesociety.org/ref_cons/Ref_cons_3_mild_glucocorticoid_defic\

iency.pdf)

30) How much cortisol does the body normally produce? In doctor Peatfield’s

book, he says “The natural output of hydrocortisone is actually variable and

may be as much as 200 mg. daily under stress and 40 - 6o mg. in a normal

resting state. Obviously then, a dose significantly greater than 40 mg. daily

will

tend to take over the adrenal production of cortisone, and the adrenals

could shut down completely. It must be said at once, so long as this

suppression

doesn’t last too long, the adrenals will pick themselves up again, and

restart producing the necessary cortisone for themselves as before.â€

_http://featherstone.bravehost.com/thyroid/peatfieldadrenal.html_

(http://featherstone.bravehost.com/thyroid/peatfieldadrenal.html)

 

31) What is stress dosing - what if I get sick? As Dr Peatfield just said,

the body makes more cortisol during times of stress. In Dr Jefferies book he

says “A patient with untreated mild adrenal insufficiency or low adrenal

reserve may function reasonably well when environmental conditions are optimum

but

tends to tire more easily, and if strenuous physical exercise is undertaken

or a meal skipped, hypoglycemic symptoms may develop. If an infection such as

a common cold develops, symptoms tend to be more severe and last longer than

in a person with normal adrenocortical reserve.†“When a patient with

adrenal insufficiency encounters stress, additional cortisol is necessary to

maintain normal health and sense of well-being.â€

The first rule is to take as little as you need to get through the stress.

This does NOT mean to run your body low on cortisol, but to only dose if you

really need it.

ILLNESS: for colds or slight fevers unrelated to a flu take 20MG at the

first sign of illness, even at bedtime. According to Jefferies some people need

up to 80MG a day to get through an illness.

FLU: Take 20MG four times a day till symptoms subside. Flu viruses attack

the adrenals and the cortisol directly so you need a lot extra for this.

DAILY STRESSES: At the first sign of nausea or shaking that can’t be

controlled take 5MG, wait 20-30 minutes for it to work and if nausea or shakes

are

still present, take another 5MG, repeat till it stops. After a few such times

you will learn the dose that works for you, usually 5-10 MG will handle most

usual stresses.

SURGERIES: Make sure your anesthesiologist knows you have adrenal

insufficiency! ASK for solumedrol in the anesthesia IV. It is a normal

precaution they

will readily do for you for safety.

EXERCISE: While it is preferable you do not exercise to the point of needing

extra cortisol, some feel it is a necessity of life to continue strenuous

exercising while on adrenal meds. If you are exhausted after exercise, or take

hours to recover, STOP. You are doing more damage to your adrenals and are

undoing any good you might be doing by treating them. If you just need energy

boost to do light exercise, try 5-10MG before starting the exercise. The trick

is to supply the cortisol before your adrenals are being beat up for not

having it.

Tapering off stress doses: If over three days, then you must go down slowly,

no more than dropping 5MG every 2-3 days, but if it was just 3 days then you

can drop 10MG every 3 days. If you start to feel exhaustion or especially

flu like symptoms, go back up immediately and slow the decrease down.

 

32) What is the difference between Primary and Secondary Adrenal

Insufficiency? “Failure to produce adequate levels of cortisol can occur for

different

reasons. The problem may be due to a disorder of the adrenal glands themselves

(primary adrenal insufficiency) or to inadequate secretion of ACTH by the

pituitary gland (secondary adrenal insufficiency).â€

_http://endocrine.niddk.nih.gov/pubs/addison/addison.htm_

(http://endocrine.niddk.nih.gov/pubs/addison/addison.htm)

ACTH is an abbreviation for adrenocorticotropic hormone, produced by the

pituitary gland, which stimulates the adrenal glands to produce cortisone. As

you know, the pituitary also controls the amount of thyroid hormones by

secreting Thyroid Stimulating Hormone (TSH). It is a similar concept.

There is no cure for Secondary Adrenal Insufficiency, the missing hormones

will need to be taken for life.

33) What causes Primary Adrenal Insufficiency? Tuberculosis remains a cause

of Addison’s disease in undeveloped countries, but the most common reason

today is an autoimmune attack on the adrenal gland - which can be determined by

blood test. Those situations will gradually destroy the adrenal glands. There

can be lesser degrees of insufficiency of the adrenal glands - and you could

say that if the problem is not a progressive destruction of the gland it is

not addisons. In Dr Gerald Poesnecker’s book, Chronic Fatigue Unmasked, he

talks about simple heredity - some people are born with weak adrenals. If you

do an internet search using the terms “adrenal enzyme deficiency†you will

discover that some people are born with genetic issues that affect the body’s

ability to make cortisol (and sometimes aldosterone). This is not as rare as

you might think: “The estimated prevalence is 1 case per 60 individuals in

the

general population.â€

_http://www.emedicine.com/ped/byname/congenital-adrenal-hyperplasia.htm_

(http://www.emedicine.com/ped/byname/congenital-adrenal-hyperplasia.htm)

These can be rather permanent - something to keep in mind if you have been

trying to restore full adrenal function by taking supplements. The adrenal

glands can also be affected by viral and fungal infections. Dr Hans Selye’s

early work demonstrated how stress can affect the adrenal glands - and many

doctors believe that this type of adrenal fatigue can be reversed.

 

34) What causes Secondary Adrenal Insufficiency? Low functioning of the

pituitary (hypo-pituitary) can be caused by an impact to the head, a tumor on

the

pituitary gland, antibodies to the pituitary (no lab test for this), or

simply being born that way. In the books by Dr’s Jefferies and Teitelbaum

they

discuss severe illness such as flu affecting the pituitary - adrenal hormone

production. Some doctors believe that Epstein Barr and other viral infections

can affect the pituitary gland, resulting in lowered request for cortisol.

35) How do I test for Secondary Adrenal Insufficiency? Someone with Primary

Adrenal Insufficiency would have high levels of ACTH in the blood, but low

levels of cortisol because the adrenals were failing. With Secondary AI, the

amount of ACTH in the blood is below normal. The pituitary should be asking for

more cortisol, but it isn’t. A “serum ACTH†test will help answer this

question, and it should be done in the early morning.

Your Dr. may want to just check serum ACTH and Serum cortisol levels before

ordering more tests - or the lab could draw blood for those tests and then

proceed immediately to an ACTH stimulation test, where artificial ACTH is

injected, and serum cortisol levels are measured from blood samples drawn after

30

and 60 minutes. If the amount of cortisol produced by the adrenals responds

adequately to the injection, you will be able to learn if the problem is with

the adrenal gland itself, or the pituitary.

Sometimes both can be a source of trouble - for example the low pituitary

output of ACTH has gone on so long that the adrenal gland has atrophied. And

there can be shades of gray with the pituitary production of ACTH.

Hypo-pituitary problems are not always a simple “black and white†lab

result. Dr

Jefferies says “Mild secondary adrenocortical deficiency is characterized by

a

baseline plasma cortisol level either low or in the low normal range, but with

a

normal response to Cortrosyn stimulation.†(Cortrosyn is a synthetic acth

that

is injected to determine the adrenal gland’s response to stimulation).

The members of the hypo-pituitary forum are familiar with these various

blood tests for adrenals, and the educational materials listed on that forum

will

help you to interpret your results.

Remember - you cannot test for cortisol or ACTH if you are already taking

HC.

36) Why does it matter if I am Primary or Secondary? These concepts are

important to understand, because you may be seeing a well meaning holistic

practitioner who is selling you bags full of supplements to “heal†your

adrenals -

rather than doing a lab test to determine if there is a problem, and why.

Some practitioners are vitamin experts - but unable to write the prescription

you need, or order medical tests. There is no “cure†for secondary adrenal

insufficiency, the replacement hormones need to be taken for life.

Over-the-counter supplements will not provide the missing hormones, and will

not restore

your adrenal function to normal if you have secondary adrenal insufficiency.

One medical site says that secondary adrenal insufficiency “is much more

common than primary adrenal insufficiency and can be traced to a lack of

ACTH.â€

_http://endocrine.niddk.nih.gov/pubs/addison/addison.htm_

(http://endocrine.niddk.nih.gov/pubs/addison/addison.htm) Remember, saliva

based lab tests are

great for measuring cortisol levels at various points in the day, but will not

tell you if the problem is with the adrenal glands (primary) or with the

pituitary (secondary). None of these tests can be performed while you are

taking

HC, IsoCort, or adrenal glandulars, or licorice supplements - so consider

getting all testing done before starting medication.

37) Will I be stuck on HC for life? Maybe. It depends on the severity of

your condition, and the cause of your adrenal problem. This is a decision that

the patient and doctor need to consider before starting. My adrenal

insufficiency was not diagnosed for many years. Taking the proper remedy was

like

putting on glasses, and being able to see clearly for the first time. You

wouldn’t

have a problem wearing glasses every day, if you needed them. If I don’t

wear my glasses (or contacts) I cannot see well enough to drive. I am thankful

to be born in a century where glasses are available, and I can buy pills to

replace my missing hormones.

38) Will I be able to wean off the HC? In Dr Peatfield’s book he says “The

length of time necessary to provide adrenal support is really infinitely

variable. My normal practice has usually been to obtain the best result with

thyroid and adrenal support, and after six or eight weeks, start to tail off

the

cortisone supplement. If there is no adverse result it may then be stopped -

taking, say, four weeks in the process. Sometimes the patient starts to lose

ground; and it must then be restarted, and in another eight weeks or so

another attempt to tail off is made. Sometimes, the adrenals have been so badly

hit that the adrenal support may be required for months; and if the adrenals

never fully recover, for a more indefinite time. Again I emphasis, that if

adrenal support is required, it must be given for as long as it takes; there is

no risk to this since one is simply restoring the situation to normal, in the

same way, and for the same reason, that thyroid support may have to be given

indefinitely.â€

39) How do I wean off HC? Remember, Dr Peatfield just told you to obtain the

best result with thyroid and adrenal support. And after six or eight weeks,

start to tail off the cortisone supplement. In other words, you wouldn’t want

to wean off HC before you gradually worked up to your optimum dose of Armour’

s thyroid. That is the whole point of supporting the adrenals for many

members - so they can tolerate a replacement dose of Armours (which for the

average adult is at least 3 grains).

Wean off HC very gradually, starting with a 2.5mg reduction in the morning

dose, and hold this for at least a week to 10 days. By reducing the first dose

of the day, you are giving the body a chance to start “ramping up†it’s

own

production of cortisol. If you experience low cortisol symptoms such as

nausea or extreme fatigue, then you are not ready to wean off.

The next dose reduction could be taken from a later part of the day, and

again hold that reduction for at least 7-10 days. Next, take 2.5 out of the

middle of the day and try to adjust your reduced dosing so the rhythm is

natural

as possible.

While on the reduced dose, be alert for the need to “stress dose†rather

than suffer through symptoms of low cortisol. This will help your chances of

successfully weaning off. And if you do wean completely off HC, be alert for

the need to stress dose if there are signs of low cortisol during times of

stress or illness.

40) Will HC kill my immune system? Too much cortisol can suppress immunity,

so it is listed as one of the possible side effects on the warning label. But

if a person is low on cortisol, there may be other problems, as Dr Ron

Kennedy says “Anyone who is especially susceptible to infections probably has

weakened adrenals, thyroid gland, or both — therefore, a weakened immune

system.â€

_http://www.med-library.net/content/view/200/41/_

(http://www.med-library.net/content/view/200/41/)

Dr Jefferies says “The mobilization of at least some of the components of

the immune response may depend upon the presence of adequate cortisol, since

adrenally insufficient subjects are not able to produce a normal immune

response. Hence, administration of physiologic dosages of cortisol may help to

prevent the lowering of resistance that enables an infection to start or, after

an

infection has started, may assist the immune response and enable the person

to recover more quickly. If, however, an excessive amount of glucocorticoid

is present before an infection develops, the immune response may be blocked or

misdirected, allowing infections to develop and progress abnormally.â€

Dr Jefferies also says “Most patients can be maintained on between 20 and 30

mgs. daily in divided doses.†From this, you could assume that doses beyond

30 mg HC would not be good for the body’s natural immune system.

 

41) What is a physiologic dose of cortisol? Dr Jefferies says “When applied

to hormone actions, a “physiologic†dosage implies one that promotes normal

function, whereas a “pharmacologic†dosage is one in excess of normal

requirements and hence, one that might alter normal function.†Doses of HC up

to

30 mg may be considered a “physiologic†dose per doctors Jefferies and

Peatfield.

42) What precautions should I consider before starting HC? You should have

enough medicine so that you never run out, and always take a few extra days

worth of medication with you whenever you leave the house. Dr. Jefferies says

“

Patients with adrenal insufficiency should be cautioned to carry ID cards

stating their diagnosis, treatment, etc.†A medical bracelet is a good idea.

If

a person is not going to be consistent with taking their medicine, skipping

doses, or leaving the house without their pills, it may be better not to start.

 

43) Do some people have a reaction to the medication? If someone is going

to have an adverse reaction to HC, it will usually happen within an hour of

taking the medicine. This is important to remember, because there is a

completely different reaction that can happen a few hours after taking the

medicine,

which is a LOW CORTISOL reaction (different than a reaction to the medicine).

The person’s ACTH will be lowered somewhat by the HC, then after a few hours

the HC begins to run out, and the person may feel fatigue, nausea, or shaky.

The solution is to take the next dose, and consider smaller doses closer

together.

If the person starts with the small 2.5 mg HC dose recommended by Dr

Peatfield, reactions to the medicine are rare. We have seen some members who

had to

cut that dose in 1/2, and stay on it for a week before introducing the 2nd

dose. In his book, Dr Peatfield says “Normally there are no symptoms good or

bad; but everyone is different and occasional marked sensitivity occurs. In

such a case the hydrocortisone will be stopped for a day or so, and a much

lower

replacement level will be sought for. The most valuable alternative is the

use of an adrenal glandular, such as “Adrenolyph†from Nutri Ltd, or in the

USA, Isocort, which being natural adrenal extracts, require no prescription.

The amount of cortisone is extremely low, only in trace amounts, but will be

sufficient to start the adrenal support going.â€

_http://featherstone.bravehost.com/thyroid/peatfieldadrenal.html_

(http://featherstone.bravehost.com/thyroid/peatfieldadrenal.html)

44) What is a “Thyroid Dump� Persons who have been low on cortisol may

have had the thyroid hormones “pooling†in the blood. One of the reasons to

start HC with very small doses, and increase gradually, is to avoid a sudden

rush of thyroid hormones into the cells of the body. When that happens, you may

feel extreme anxiety, racing heart, and/or other uncomfortable symptoms. If

you feel this discomfort, even after decreasing the Armour, patients find it

helpful to stop the Armour completely for a day or two or more, then raise

back up.

45) What is an adrenal crisis? (AKA “addisons crisisâ€) An abrupt

life-threatening state which is caused by insufficient production of cortisol

by the

adrenal gland. A typical finding in Addison’s disease. Individuals who have

been taking corticosteroids (glucocorticoids) for a prolonged period of time

(weeks to months) are at risk for acute adrenal crisis if the medication is

stopped abruptly. For this reason, corticosteroid medication are withdrawn

slowly

on a diminishing dosing schedule.

Symptoms include low blood pressure (shock), weakness, headache, vomiting,

fever chills, tachycardia and sweating.

Treatment includes blood pressure support and intravenous hydrocortisone.

_http://cancerweb.ncl.ac.uk/cgi-bin/omd?adrenal+crisis_

(http://cancerweb.ncl.ac.uk/cgi-bin/omd?adrenal+crisis)

tachycardia means “Rapid beating of the heart, conventionally applied to

rates over 100 per minuteâ€

If you are consistent with your medication and always bring a pill box with

you so that you can stress dose, you can avoid this problem. Persons with

severe adrenal insufficiency are advised to wear a medical bracelet stating “

adrenal insufficiencyâ€

46) The HC doesn’t seem to last long enough - what is Medrol? Dr Peatfield

says that HC is “not stored by the body and gets rapidly used; 2 or 3 hours

will see it pretty well used up completely.†Some people metabolize HC faster

than others. If a person has symptoms of low cortisol despite gradually

working up to about 30mg of HC, they may want to talk with their doctor about

trying Medrol. Depending on the persons metabolism, the 1/2 life of Medrol can

range from 18 to 36 hours.

47) How do I dose Medrol? Conversion tables will tell you that 1mg of Medrol

= 5mg of HC. Persons who are already on HC can gradually switch over to

Medrol, and typically end up with about 6mg of Medrol spread out through the

day.

It does not need to be taken every 4 hours like you would with HC, but a

typical dosing schedule might be 3 mg at wake, 2mg in the afternoon, and 1mg at

bedtime. Further discussion about Medrol can be seen here

_http://www.stopthethyroidmadness.com/community/viewtopic.php?t=9933_

(http://www.stopthethyroidmadness.com/community/viewtopic.php?t=9933)

and here

_http://www.stopthethyroidmadness.com/community/viewtopic.php?t=9783_

(http://www.stopthethyroidmadness.com/community/viewtopic.php?t=9783)

48) Can I take time-release HC, Prednisone, or other steroid to treat the

adrenals? Although a number of members have tried time-release HC, we have not

seen people staying with it. 1 mg of Prednisone is equivalent to 4 mg of HC,

but is harder on the liver to process, so Medrol seems to be the better

choice for long term cortisol replacement.

 

49) Are there other adrenal hormones that I need to worry about? Dr Lam says

“As adrenal fatigue progresses to more advance stages, the amount of

aldosterone production reduces. Sodium and water retention is compromised.. As

the

fluid volume is reduced, low blood pressure ensues. Cells get dehydrated and

become sodium deficient.â€

_http://www.drlam.com/A3R_brief_in_doc_format/adrenal_fatigue.cfm_

(http://www.drlam.com/A3R_brief_in_doc_format/adrenal_fatigue.cfm)

Although the adrenals make more hormones than just cortisol and aldosterone,

persons with severe adrenal insufficiency usually take simply cortisone, and

if needed, supplement aldosterone with Florinef. Further information about

aldosterone can be found here

_http://www.stopthethyroidmadness.com/community/viewtopic.php?t=8562_

(http://www.stopthethyroidmadness.com/community/viewtopic.php?t=8562)

50) What are the symptoms of low aldosterone? Persons with low aldosterone

are unable to retain sodium, and it spills into the bladder, taking water with

it. This results in frequent urination, dehydration, and heat intolerance.

Electrolytes become imbalanced, resulting in muscle twitches, heart

palpitations, and the pupils of the eyes are unable to stay “constrictedâ€

when

subjected to light (they “flutterâ€). See the article above, and follow

it’s links

to learn more about aldosterone, and how to treat it.

 

51) Why should I test renin along with aldosterone? If you didn’t get a full

range of adrenal tests to determine if you were Primary or Secondary adrenal

insufficient before starting HC, you may be able to gain insight on this by

testing Aldosterone with Renin. The article mentioned above will explain this

for you.

52) What sequence do I treat the hormones? What about the sex hormones? If

the adrenals are weak, it is best to treat the low cortisol before working up

to high levels of thyroid medication. And it is best to fully support these 2

before attempting to supplement the sex hormones, as they can change after

the adrenals and thyroid are supported. To put it another way, if there is an

imbalance of the adrenal and thyroid hormones, it can cause problems with the

other hormones. If you know that you have an imbalance, it is fine to

address it, but be alert for changes as your treatment progresses.

53) Will hormone medication affects my blood pressure? Yes, cortisol and

aldosterone both have a direct affect on blood pressure. Persons with adrenal

fatigue typically have low blood pressure, but this is not always the case. If

you have a history of high blood pressure, you should monitor this at least

once a day and note what is going on in your journal. If you are on blood

pressure medication, you should research how it may affect cortisol and

aldosterone. If you are taking Florinef because of low aldosterone, the dose

may need

to be reduced in order to avoid raising a blood pressure that is already high.

 

54) Do these hormones affect fluid retention? They can, especially when

aldosterone levels are not right. The very bottom of this web page has more

information _http://www.tuberose.com/Adrenal_Glands.html_

(http://www.tuberose.com/Adrenal_Glands.html) Low levels of thyroid can also

cause fluid retention,

and in turn this can raise blood pressure. Persons with these difficulties

would want to note any changes in symptoms in their daily journal in order to

learn what is helping, or worsening these conditions.

55) Will I recover 100% and feel normal? You want to feel better. If

hormones are not balanced, some improvement will occur as you supplement those

that

are low.

Many of us suffer from other issues that are not strictly due to a hormone

shortage. For example, Hashimoto’s is the leading cause of low thyroid. Many

people with these thyroid antibodies can have other “autoimmune†disorders

that affect their well being. We see a lot of people with hormone issues that

also have diabetes. Or going through menopause.

After 6 months of adrenal and thyroid support, I noticed that my skin was no

longer dry, cracking, and bleeding. These type of changes will help you

understand that you have made progress. There may be other aspects that are not

directly addressed, but you will have a better chance of success once the

body’

s metabolism engine is functioning.