Newly diagnosed - Stress Dosing

[Firefly234]

I was diagnosed last week with adrenal insufficiency (the ACTH Stim test results aren't back yet, but based on the Cortisol test and ACTH test, I presume it's secondary) and given my medication. I think some of my symptoms are from the hydrocortisone and not from the AI. How am I supposed to tell the difference? Other than getting the flu or having a surgery, when do I stress dose? Do I need to do it for exercising? I take 15 mgs in the morning and 5mgs in the early afternoon. It seemed so simple when the doctor reviewed this in her office, but now it just seems so complicated.
Thanks!

[rumpled]

On paper yes, in real life - it takes a bit of tweaking. And every *body* is different.

[Firefly234]

I woke up to a charlie horse this morning, so I guess I'm doing something wrong! Ugh. This is so frustrating! Then I just get agitated, which makes me feel worse. This all seems so easy on paper! LOL

[rumpled]

That low DHEAS shows your adrenals are unhappy - that is an adrenal androgen - precursor to testosterone and estrogen. Other glands may have picked up the slack but in case you notice a change in libido or anything, it is your adrenals.

The salt craving going down is a god sign. So no renin or aldosterone... They should with your high BP... you may need it.

[Firefly234]

My DHEAS was <15 [31-228 ug/dL] but that was back in February in a separate testing (at noon). BP is up since starting HC. Pulse is in the mid-high 60s (65-68). I seem to be craving salt less this week than before the HC even though I've only been on the HC less than a week.

I've done a lot of reading this week for sure! I think I just have to practice some patience until the rest of the test results come back. :)

[rumpled]

Did they do renin, aldosterone, dhea sulfate? Do you crave salt?

So you gained weight with low cortisol from the very beginning? Nausea means you need something - It may be salt, fluids or a tad bit more cortef or even florinef - to hold the salt.

I would say that BP is a tad low - normal is 120/80 - how is your pulse?

Read up... there is a lot to learn.

[Firefly234]

Thanks for your help! I would like to exercise daily, but I have been too afraid to try, which is funny since I was doing them last week before I knew I had AI. The side affects seem to be when I take the meds...nausea mostly which is leading to a lack of appetite - neither of which was too much of an issue before I got on the HC (I haven't been presenting normal, from what I understand - weigh gain instead of loss - 10 lbs.).

My BP is normal (100/65  -ish, sometimes goes all the way up to 115/75) - but hypertension runs in the family, so that may be why I've been ok all this time -LOL. I read about the salt, but the doctor didn't really discuss it with me because my levels were ok (I totally binged on salt the day before the blood draw (total coincidence - I had no idea how important that was or that they would be testing for it).

The doctor only prescribed HC, not Florinef (I assume because my NA and K were ok). I won't have my ACTH Stimulant test results until the middle of August unless my doctor sends them to me (like I asked). My appointment with her was an emergency appointment to get me on the HC because my cortisol level was so dangerous. She had to squeeze me in. While she didn't rush me, I didn't have enough time to mentally process everything to think of all the questions I would need to ask.

Some of my test results: All drawn at 9 a.m.

ATCH           <5     [7-50PG/ML]
Sodium        141    [135-145 MMOL/L]
Potassium    3.8    [3.5-5.1 MMOL/L]
Cortisol        0.3    [5.0-23 UG/DL]  

There were more tests, but these ones seem the most relevant.

[rumpled]

How often do you exercise? If you exercise daily, you may need to adjust your dose, if needed, to compensate for it.

You are taking a replacement dose - hence side effects are not supposed to be an issue. If you are having side effects, you are taking too much or too little.

Primary and secondary are treated the same.

Are you also getting florinef? Is your BP high or low? Did she talk to you about salt?