Adrenal Insufficiency Community
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Advice on cortisol results


I'm a 26 year old female. After going through two years of extreme emotional stress and consequently not taking good care of my body, I developed extreme fatigue, depression, loss of interest in life, pain all over, among other symptoms. I recently got a saliva cortisol test, which took the reading at 4 different times throughout the day. The results were:

morning: 4.5 ng/ml (range 8-10)
midday: 2.0 ng/ml  (range 3.1-7.3
afternoon: 1.5 ng/ml (range 2.1-3.9
evening: 1.1 ng/ml (range 1.5-2.5)

My DHEA was 377 (range 23.8-291)

Since my levels are low all day, what treatment is best? I also had a low free T3 and free T4 reading and have been on 1 grain of Naturethroid for 1 month (which made me feel worse). I also started on 2.5 mg Hydrocortisone (which I requested from my doctor) and bumped it up to 5 mg a week later, which is the amount I'm currently on. I felt better than I had felt the first 3 days that I went on the Hydrocortisone, but now all of the symptoms have returned. I am so fatigued I lay in bed or watch tv all day, cry, have pains all over my body, and am severely depressed.

How does the Hydrocortisone work? Is the idea to give the adrenals a break, with the hope that they'll be able to produce on their own once I wean off, if good food, rest, and supplements have been used during this time to support the healing process?

How much Hydrocortisone would be recommended for my condition? How fast do you think I could increase to that dose?

In my case, do you think that taking Hydrocortisone is the right approach, verses a more conservative approach with just supplements, herbs, rest, diet, etc?

Thank you.
1 Responses
Avatar universal
I will explain how this works.

First, one set of testing is not really a good enough basis for replacement as cortisol normally varies. You should get several sets of testing and not just saliva, but blood as well (free cortisol can sometimes have issues with cortisol binding globulin if estrogen levels are high). You also need other tests like sodium and potassium (it is a salt wasting disease) and a stimulation test.

Hydrocortisone suppresses the adrenal gland, if the dose is high enough. A normal replacement dose varies from 10-30mg daily, divided up to mimic a normal diurnal rhythm. Doses vary on the training of the doctor, your health and other conditions (if you have other auto-immune conditions you may need more).

It is a balance. Too little and there is no effect, too much and you actually give yourself steroid-induced Cushing's and have very similar side effects. You also need to know how and when to stress dose, and the signs of a crisis and when to seek help.

While adrenals are suppressed, they simply atrophy. They do not rest. That is a myth. If you look up pathology pics of Addison't patients, they have tiny, atrophied adrenals.

If you are diagnosed properly, one takes the proper replacement dose immediately. However there are times where you have to taper up and down and you have to have a good doctor know how to taper you as it can be dangerous (it may induce a crisis).

If you truly have AI, a salty diet is needed. Salt is your friend. Other than that, no other supplements (other than most of us seem to need D3)...

You need an endocrinologist. Get copies of your tests and get more of them IMHO.
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