Adrenal Insufficiency Community
Insight would be GRATELY appreciated...
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Insight would be GRATELY appreciated...

I'm new at this and could really use a second opinion.....Is Cortef a good idea?  My doc just prescribed 15mg a day based on the saliva test results below. He said I could take Isocort if I preferred, but that Cortef would work better. I'd like to go with the more natural Isocort, but why would Cortef work better and are my levels low enough for Cortef?

I am taking 3/4 grain NDT and would like to raise it based on fatigue. He told me to take the Cortef for 2 weeks and then rasie the NDT to 1 grain.  And I'm trying to raise Ferritin.

Cortisol
morning  15  (13-24)
noon  5 (5-10)
afternoon   4  (3-8)
midnight  3 (1-4)

Total Salivary SIgA  15 Depressed (normal 25-60)
DHEA 2 Depressed (3-10)

ISN Insulin fasting  < 3 Normal (3-12)
ISN Insulin non-fasting 8 Normal (5-20)
17-OH Progesterone 32 Normal

Cortisol-DHEA correlation spectrum: 4. Maladapted Phase II

Recent Lab work:
TSH 3.5
T4  1.0  (.8-1.8)
T3  2.4  (2.3-4.2)

Ferritin 18 (10-232)
DHEA 31 (25-220)
22 Comments Post a Comment
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Avatar_m_tn
Oops...GREATLY!
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657231_tn?1390151580
Your saliva test was in normal ranges and showed a normal rhythm... and this is your only test?

Steroids are nothing to mess with - so unless you have low sodium readings (AI is a salt wasting disease), as well as a LOT of testing to warrant the replacements including a stim test,  I would hesitate a lot to get on a medication where the potential for damage outweighs the good.

It does seem like your thyroid is off as well as iron. I would look to just take replacements there first and see how you do. You may consider DHEA. Too much and you will find acne and greasy skin so  it is easy to know it you have gone to far.
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596605_tn?1369950227
I thought the same thing as Rumpled. Try to get your thyroid stabilized first, as your cortisol readings are not bad. Taking cortisol could cause your adrenal glands to shut down and make things worse for you.

Was the morning cortisol test done at 8 am? (Given that you follow a 9 to 5 schedule) Even an hour or two later your levels are naturally a little lower.

Taking ferritin with a vit C source can help with absorption. Ur fatigue could be related to the anemia or thyroid.

Good luck and feel better.
Horselip
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Avatar_m_tn
Thanks so much for the replies!  My doctor said that 15 mg of HC would have absolutely no side effects, but I read all kinds of things online. I think that upping my NDT dose from .5 to .75 made my adrenals worse. The fatigue has been really bad, and I'm normally very active.

Yes, this is my only saliva test and I wasn't told to go off of my adrenal support before the test.  I've been taking my doctor's brand of adrenal support  25mg of 7Keto DHEA for almost  year.  I'm taking elemental iron 2x a day with C.

Would Isocort be as potentially damaging as HC?  I thought that I needed to strengthen the adrenals before I worked more on the thyroid?  

The morning test was done at 9:30 because I usually wake up late.  

Thanks again to both of you!
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Avatar_f_tn
I'm a little leary of your doctor. I am full blown AI (idiopathic, but probably primary) and I take 15-17.5 mg hydrocortisone (cortef) per day. My all day saliva was flat across the bottom; 15 (your morning result) is normal. It is on the bottom of normal, but not to the level he's prescribing meds the way he is.

The adrenal glands and thyroid have some interaction and it is possible that your thyroid is causing your adrenals to be a little sluggish. I would simply take the thyroid medicine for now (make sure he gave you the lowest dose to start...too high too quickly will crank your blood pressure up and make you jittery in a bad way). If, about 3 months from now, you are getting NO resolution of your symptoms, retest the morning cortisol (NLT 8 am, with nothing to eat or drink before, and timed so it is approx one hour after you get up).

As for your question on cortef: it is bio-identical to the cortisol your body makes. That means, under a microscope, they look the same. Your body can't tell the difference, so it processes it the same. Prednisone is not bio-identical, but your body processes it similar to cortisol; it is "more concentrated", for lack of a better term. Unlike some drugs that have justified reasons for concern, cortef is perfectly normal...for those who need it.
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Avatar_m_tn
Thank you, TerryAnne.  I was questioning him too. even though I like him and  he has such a great reputation and ratings.  About 10 months ago he said I had weak adrenals based on my symptoms and very low DHEA.  I went on supplements  and improved a bit, but then my TSH dropped to 6.5. So  he put me on NDT and I felt better for a few weeks and then crashed again. Then he raised it .25 grain and I felt better for a bit but then really crashed and have been low energy on this same thyroid dose for about 4 months. Then I did the saliva cortisol test and said I need to raise my cortisol before raising NDT.  So you think I should stick with what I've been doing for 3 more  months?  Thank you again.
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Avatar_f_tn
It definitely sounds more thyroid than adrenal. Kudos to him for paying attention to symptoms, since there are loads of bloodwork only docs out there; however, hypothyroid and adrenal insufficiency symptoms can have some overlap (fatigue, pain, fluid retention). I would decline the adrenal stuff for now and just keep working on the thyroid.
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Avatar_m_tn
Won't upping  the NDT make the adrenals worse?

Thank you.
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Avatar_f_tn
It could, since there is an interaction there, but your adrenals are pretty normal right now. An odd phenomenon could be that your thyroid medicine is too high. There's serious symptom overlap in endocrine problems. AI gets tired but wired, while hyperthyroid is wired. To some doctors, the explanation for either makes them think the same thing. Another culprit could be that the thyroid medicine you are on isn't cutting it. I understand the desire to keep it natural (I'm on nature-throid and we tried Isocort, which made me sicker), but it may not be best for you. Some people do better with Synthroid and a T3 kicker.

We started working on my thyroid before my adrenals. Primarily because my thyroid nodules were gagging me to death; secondly, because we though my thyroid was the worse of the two. When the low dose of nature-throid didn't help, we went to the next dose. But, since my dying adrenal glands were just hanging out, my blood pressure shot up and I got fierce headaches. So we looked more into the adrenals and realized they were the big problem. I started low dose hydrocort to bring me up to 15 mg over a few months, and was then able to raise the nature-throid to the next dose (can't go higher; I get jittery).

While that might show the benefits of treating the adrenals first, please note there are definite signs when your adrenals are the bigger problem. Jitters while on a low dose; high BP, when your BP is normally low.

The main thing the thyroid medicine does is relax my nodules. I thought it was fixing the symptoms, but realized it wasn't until I started hydrocort. The symptoms: abdominal pain I couldn't describe; started with low BP, but it went all over the place until I got on florinef; wild sugar cravings (still can't kick them) and salt cravings (better with florinef); debilitating fatigue to the point I had to use a cane to walk; major pain down my legs that really settles in my quads (comes back still when I'm dumping my cortisol stores); hair loss; extreme thirst; extreme urination; constipation to diarrhea in no time; could not physically get out of bed at times; difficulty waking up in the morning (like waking up at 11 am, even though I had 3 alarms). And on and on.

The symptoms are similar, but the debilitation is the difference.
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Avatar_f_tn
Another thing I forgot to mention: your thyroid medicine will change from time to time. You get your comfort dose, but you may need more or less at different times. Now that I think things over and reread your first post, this sounds like the exact culprit. You have either not found your optimum dose (comfort dose) of thyroid medicine, or you are just going through a phase where you need more for a bit. Keep in mind that many endocrine disorders are sensitive to temperatures. Hypothyroid patients typically have lower than normal body temperatures and cannot tolerate cold weather as well as some. Because your symptoms date back 4 months, that seems to be right when fall was switching to winter. Therefore, you may need to adjust your medicine to a slightly higher dose in the winter, and then taper off come spring.
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Avatar_m_tn
Wow, you've been through a lot!  I appreciate your taking time to share with me and give me a better understanding of all of this.  Each time I was somewhat comfortable with the thyroid dose, it only lasted for a couple of weeks. I had two good weeks again recently after I started eating red meat, which I hadn't had in 18 years (was willing to try anything), and taking elemental iron, and I was very excited about my progress and then the symptoms came back.  I still feel better after eating meat.   When you said "jitters on a low dose" did you mean on a low dose of NDT?  Thanks again for all of the great info. I really appreciate it.  I hope you're feeling good now that you've got your system balanced.

ps: my adrenals are normal even though the test said I was "maladapted phase II" and my DHEA is depressed, SIgA is depressed  and the cortisol is so low?
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Avatar_f_tn
The jitters are like you can't sit still. You feel like you need to move around a lot and can't sit still for very long. It's hard to describe, but you can definitely feel a difference.

And your cortisol isn't low. It's on the low end of normal, but it is still considered normal. You could be slipping into an adrenal problem, but you would have the debilitating symptoms along with it. The DHEA measure isn't necessarily anything to worry at this stage because you are not showing adrenal hypofunction.

If you are concerned, get the ACTH stimulation test. Your doctor should have sent you to that anyway, prior to placing you on cortef. I did "pass" that test, but I got the lowest possible score (which was considered passing) and felt like death about an hour after. If your adrenals are going bad, but are not dead yet, you can pass the test; the kicker is that you feel fantastic for a bit afterwards, but you then crash hard.

You can also get him to test your aldosterone, serum renin and androgens if you're concerned, but it doesn't sound like you have any problems there. I'd talk to him more about finding your optimal thyroid dose right now and simply keeping an eye on your adrenals. The morning cortisol blood test is worth its weight, provided you get it before 8 am, no more than one hour after waking (to eliminate testing the spike after you wake up), and with no food or drink.

I wouldn't worry about your adrenals at this stage.
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657231_tn?1390151580
I would just do the thyroid meds - I would not mess with your adrenals. You risk more harm than good. Even with isocort.
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Avatar_m_tn
Thanks Terry Anne & Rumpled.

What do you think about Dr. Wilson's adrenal rebuilder?  I heard that some have felt much better on it and also raised cortisol without the use of isocort or cortef.
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Avatar_m_tn
Also, I was told that the adrenal support I've been taking for a year (my doctor's brand) might not be great for me because phosphatidylserine lowers cortisol.

ingredients:Ashwaganda,Skullcap,Eluthero (Siberian Ginsing)
Rhodiola,L-Theanine,Phosphatidylserine

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Avatar_f_tn
Honestly, I think a lot of the OTC/herbal adrenal medicines don't do much. None of them are chemically close to what your adrenals do, despite how you may feel taking them. In addition, licorice can interfere with aldosterone production. Some practitioners will prescribe the active ingredients in licorice for other herbal remedies, but don't realize what it can do. My overall personal thought is that a lot of herbal remedies have the "placebo affect", where people psychosomatically feel better by taking it, despite there being no change. I'd tread lightly around that stuff.

I forgot to ask earlier: elemental iron. Are you taking this for anemia, or did your doctor tell you to take this for energy? I question it because, unless you are majorly deficient in iron, you could be putting too much in, which could thus be adding to fatigue.
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Avatar_m_tn
I see your point about the supplements, TerryAnne. Good to keep in mind.

I'm taking the iron because my ferritin is 18.

Thanks for the reply. :)
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Avatar_f_tn
Ferritin is a protein. It is used to measure iron, but it is not always reliable. Iron supplements are not usually recommended unless you are anemic. I'd look into that a little, as you may be overloading on iron.
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Avatar_f_tn
Just looked up ferritin levels for women. Anything below 11-12 is considered low. 18 is within the normal range; the low end, but not showing your iron is a huge concern. I'd quit the iron, as it sounds like that is adding to your problems. If you're concerned about anemia, have your hemoglobin tested; that will measure the blood's ability to transport oxygen.
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596605_tn?1369950227
For iron the doctor probably looked at your MCV in combo with the ferritin. This is the size of your Red blood cells. Microcytic anemia is usually due to low iron, but sometimes B12.
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Avatar_m_tn
I answered this, but it didn't go through?  Here's my reply again... Thanks for the feedback TerryAnne and Horselip.  I was told that I need to take elemental iron to raise ferritin because ferritin supplements taken to months with C didn't help, even when I doubled them. And I was told and I read that I won't feel well and symptoms will continue until I get my ferritin between 60 & 70. Also, that it's hard to raise NDT with such low ferritin.  So I'll look into it more.
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Avatar_f_tn
I wish I had those cortisol labs....they look awesome to those of us who have no cortisol production.  They are withing the normal range and I wouldn't mess with them...looks more thyroid than adrenal.  My doc says the thyroid is the gas pedal and the adrenal is the engine.  It looks like the engine could use a little gas.
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