Adrenal Fatigue & Glucocorticoid Use

Discussion in 'Men's Health Forum' started by Michael Scally MD, Feb 28, 2010.

  1. PeterSam

    PeterSam Junior Member

    Another thought I had on this subject was whether long term corticosteroid use for the treatment of asthma. especially childhood asthma could have an impact the HPTA axis in adulthood. I haven't scene many studies on this, but it would seem to be a possibility to me. When I have asked this question of my PCP's they have just brushed it aside as not really a possibility.
     
  2. mlc2010

    mlc2010 Member

    good point, I was given them when I was around 3-5 for my asthma, I wonder if it had any negative effects
     
  3. PeterSam

    PeterSam Junior Member

    Thought I would mention I basically followed an adrenal protocol outlined in a book by Dr. shames called feeling fat fuzzy and frazzled if anyone is interested.
     
  4. PeterSam

    PeterSam Junior Member


    There seems to be some research showing a correlation. I have yet to determine if this is a long term risk or more of a short term impact.
     
  5. jonyoung

    jonyoung Junior Member

    Could long term adrenal fatigue cause penis shrinkage?
     
  6. tendency

    tendency Member

    based upon symptoms and salivary cortisol as well as serum aldosterone testing i was treated with cortisol/florinef for one year. dosing was:

    waking: 10mg cortisol. 1/2mg florinef.
    4 hours later: 10mg cortisol. 1/2mg florinef.
    mid afternoon: 7.5mg cortisol
    bedtime: 5mg cortisol.

    did this for a year. i was told to not exceed 40mg cortisol in one day, ever. for the first 3-4 months i felt better: better energy, mood improvement etc. after 4 months i felt progressively worse: my stamina decreased and i just felt 'off'. so, after 12 months i tapered and quit. feel better off it and now use circadian t3 dosing (im hypothyroid) which has improved adrenal function based upon salivary testing. feel much better now.
     
  7. mberam

    mberam Junior Member

    I was actually interested in contacting Dr. Scally, after reading some of his posts, however this is a really irresponsible post - especially coming from a Doctor. In addition, from reading some of his responses to users, he clearly lacks bedside manner. I urge you to actually read the studies he has posted here, because what he posted above is very misleading.

    1. The first report Dr. Scally references - Brown ES, Chandler PA. Mood and Cognitive Changes During Systemic Corticosteroid Therapy. Prim Care Companion J Clin Psychiatry 2001;3(1):17-21.

    This report is about high doses of Prednisone in patients with issues like Asthma, COPD and other respiratory issues. It does not deal with low dose Hydrocortisone in patients with adrenal issues. The report only mentions Hydrocortisone once, AND it references it in extremely high doses of 160MG/day. In fact it states that no adverse affects were noticed in a dose under 40MG/day. You can read the report here

    2. Tollenaar MS, Elzinga BM, Spinhoven P, Everaerd W. Immediate and prolonged effects of cortisol, but not propranolol, on memory retrieval in healthy young men. Neurobiology of Learning and Memory 2009;91(1):23-31.

    Almost exactly the same thing as the first report. Deals with high dose Prednisone. You can read it here

    Keep in mind that the above two reports Dr. Scally references are not actual studies. They are peer reviews of studies already conducted. In fact, they both reference some of the exact same studies.

    3. Tollenaar MS, Elzinga BM, Spinhoven P, Everaerd W. Immediate and prolonged effects of cortisol, but not propranolol, on memory retrieval in healthy young men. Neurobiology of Learning and Memory 2009;91(1):23-31

    Although this is a valid study, there are several things to note here:

    -Study was conducted on HEALTHY volunteers - not volunteers with low cortisol levels or suffering from adrenal issues.

    -There were only 85 participants - hardly an exhaustive study

    -They also do not state if they used a single does of 35mg/day or if they attempted to mimic the bodies natural production of cortisol by administering it 3-4 times/day.

    You can read this study here

    4. de Quervain DJF, Aerni A, Roozendaal B. Preventive Effect of {beta}-Adrenoceptor Blockade on Glucocorticoid-Induced Memory Retrieval Deficits. Am J Psychiatry 2007;164(6):967-9.

    - Again, not related to people with adrenal issues

    -42 volunteers of which 42% experienced impairment. That's almost 18 people. AND, it was in combination with the administration of propranolol.

    It's absurd, irresponsible and upsetting that Dr. Scally would post this in regards to using low dose Hydrocortisone for people with adrenal issues. If you're going to cite reports and studies, they use ones that are relevant. None of these studies deal with people who have low cortisol levels. It's the same thing with testosterone - if you have normal to high levels of Testosterone, you shouldn't be taking TRT - you may have some adverse affects. But if you're low T, then it works wonders. It's the same with many medications, vitamins, etc. There's a big difference in giving your body something it needs as opposed to having it in excess.

    Take a simple vitamin - vitamin D. Someone who is deficient in Vitamin D, may need to take a high dose of Vitamin D to feel good, whereas that same dose taken by someone who already has a healthy amount of vitamin D, could cause Vitamin D toxicity.

    Get your stuff straight Dr. Scally and stop misleading people.
     
  8. Gator8

    Gator8 Member

    Addison's could. There is no such thing as adrenal fatigue.
     
    Michael Scally MD likes this.
  9. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    idmd likes this.
  10. searay

    searay Member

    Add 3 5g scoops of d-ribose daily and within 3 days youll notice improvement! Helps everyone just varies how much!!
     
  11. jonyoung

    jonyoung Junior Member

    is a cortisol level of 23.8 any reason for concern for adrenal fatigue or anything of that nature?
     
  12. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Habib G, Khazin F, Jabbour A, et al. Simultaneous bilateral knee injection of methylprednisolone acetate and the hypothalamic-pituitary adrenal axis: a single-blind case-control study. J Investig Med 2014;62(3):621-6. http://journals.lww.com/jinvestigat...=2014&issue=03000&article=00005&type=abstract

    OBJECTIVE: The objective of this study was to evaluate the effect of simultaneous bilateral intra-articular injection (IAI) of methylprednisolone acetate (MPA) on the hypothalamic-pituitary-adrenal axis in patients with knee osteoarthritis.

    METHODS: Nonselected patients with symptomatic bilateral knee osteoarthritis had simultaneous IAI of 80 mg MPA at each knee (group 1). Just before the injection and on weeks 1, 2, 4, 6, and 8 after it, patients had 1 microg adrenocorticotropin hormone stimulation test. Age- and sex-matched patients had simultaneous IAI of 60 mg of hyaluronic acid in each knee (group 2) and the same protocol of adrenocorticotropin hormone stimulation tests. Demographic, clinical, and laboratory parameters were documented in all the patients. Secondary adrenal insufficiency (SAI) was defined as poststimulation serum cortisol levels of less than 18 microg/dL.

    RESULTS: Twenty patients were enrolled in each group. There were 15 women and 5 men in each group. Mean age of the patients in group 1 was 60.3 (SD, 7.6) years. Twelve patients (60%) from group 1 had evidence of SAI versus 3 patients in group 2 (P = 0.003). In all the patients who had SAI in group 1, it was observed in week 1 with decreasing frequency of SAI at the subsequent time points. Yet, 2 patients (10%) from group 1 had evidence of SAI 8 weeks after the IAI. Secondary adrenal insufficiency did not significantly correlate with any demographic, clinical, or laboratory parameter.

    CONCLUSIONS: Secondary adrenal insufficiency was very common following simultaneous bilateral IAI of 80 mg of MPA. Although it was transient, SAI could still be observed nearly 2 months after the IAI, in 10% of the patients.
     
  13. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Broersen LHA, Pereira AM, Jorgensen JOL, Dekkers OM. Adrenal insufficiency in corticosteroids use: systematic review and meta-analysis. The Journal of Clinical Endocrinology & Metabolism. http://press.endocrine.org/doi/abs/10.1210/jc.2015-1218

    Objective: We aimed to estimate pooled percentages of patients with adrenal insufficiency after treatment with corticosteroids for various conditions in a meta-analysis. Secondly, we aimed to stratify the results by route of administration, disease, treatment dose and duration.

    Methods: We searched seven electronic databases (PubMed, MEDLINE, EMBASE, COCHRANE, CENTRAL, Web of Science and CINAHL/Academic Search Premier) in February 2014 to identify potentially relevant studies. Original articles testing adult corticosteroid users for adrenal insufficiency were eligible.

    Results: We included 74 articles with a total of 3753 participants.

    Stratified by administration form, percentages of patients with adrenal insufficiency ranged from 4.2% for nasal administration (95% CI: 0.5–28.9) to 52.2% for intra-articular administration (95% CI: 40.5–63.6).

    Stratified by disease, percentages ranged from 6.8% for asthma with inhalation corticosteroids only (95% CI: 3.8–12.0) to 60.0% for haematological malignancies (95% CI: 38.0–78.6).

    The risk also varied according to dose from 2.4% (95% CI: 0.6–9.3) (low dose) to 21.5% (95% CI: 12.0–35.5) (high dose), and according to treatment duration from 1.4% (95% CI: 0.3–7.4) (<28 days) to 27.4% (95% CI: 17.7–39.8) (>1 year) in asthma patients.

    Conclusions:
    1) Adrenal insufficiency after discontinuation of glucocorticoid occurs frequently;
    2) there is no administration form, dosing, treatment duration, or underlying disease for which adrenal insufficiency can be excluded with certainty, although higher dose and longer use give the highest risk;
    3) the threshold to test corticosteroid users for adrenal insufficiency should be low in clinical practice, especially for those patients with nonspecific symptoms after cessation.
     
  14. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Tirabassi G, Corona G, Lamonica GR, Lenzi A, Maggi M, et al. Diabetes Mellitus-Associated Functional Hypercortisolism Impairs Sexual Function in Male Late-Onset Hypogonadism. Horm Metab Res. https://www.thieme-connect.de/products/ejournals/abstract/10.1055/s-0035-1548870

    Functional hypercortisolism is generated by conditions able to chronically activate hypothalamic-pituitary-adrenal axis and has been proven to have a negative role in several complications. However, no study has evaluated the possible influence of diabetes mellitus-associated functional hypercortisolism on male hypogonadism and sexual function.

    We aimed to identify any association of hypothalamic-pituitary-adrenal axis dysregulation measures with testosterone and sexual function in men simultaneously affected by diabetes mellitus and late-onset hypogonadism.

    Fifteen diabetes mellitus and late-onset hypogonadism subjects suffering from functional hypercortisolism and fifteen diabetes mellitus and late-onset hypogonadism subjects who were free of functional hypercortisolism were retrospectively reviewed.

    Clinical, hormonal, and sexual parameters were considered. Hypercortisolemic subjects showed higher values of body mass index, waist, and glycated hemoglobin and lower ones of testosterone compared to normocortisolemic ones.

    All sexual parameters, except for orgasmic function, were significantly worse in hypercortisolemic than in normocortisolemic subjects. Hypercortisolemic patients showed higher values of cortisol after dexamethasone and urinary free cortisol as well as a lesser ACTH response after corticotropin releasing hormone test (ACTH area under curve) compared to normocortisolemic ones. No significant association was found at Poisson regression analysis between hormonal and sexual variables in normocortisolemic patients.

    In hypercortisolemic subjects, negative and significant associations of cortisol response after corticotropin releasing hormone (cortisol area under curve) with erectile function (beta: -0.0008; p: 0.015) and total international index of erectile function score (beta: -0.0006; p: 0.001) were evident.

    This study suggests for the first time the impairing influence of the dysregulated hypothalamic-pituitary-adrenal axis on sexual function in diabetes mellitus-associated late-onset hypogonadism.
     
  15. larkasaur

    larkasaur Junior Member

    Hi, I found this interesting thread online and have some things to add to it.
    First, the ACTH stimulation test is the main test used by endocrinologists to diagnose adrenal insufficiency.
    But, different endocrinologists use different standards for interpreting this test.
    So are their standards sensitive enough that someone who doesn't have adrenal insuffiency according an endocrinologist's standard, won't benefit from adrenal replacement (hydrocortisone, etc.)?
    Or are endocrinologists generally very cautious in diagnosing adrenal insufficiency, so that they only give adrenal replacement when a person is very sick?
    If someone doesn't have adrenal insufficiency according to one standard, but does according to another standard, is it probable that they won't benefit from adrenal replacement? Or is it likely that they would?
    The ACTH stimulation test is not a very reliable way of diagnosing adrenal insufficiency. The gold standard is the insulin tolerance test, but it's quite unpleasant and risky, and it requires a hospital stay. So the ACTH stimulation test is more often used.

    This happened to me. I have lots of symptoms of adrenal insufficiency:
    - I have been feeling generally unwell for the past year or so. I have a hard time staying awake in the afternoon.
    - my blood pressure has been tanking for the last month or so. I get dizzy and lightheaded often when I stand up. I got a blood pressure monitor and I've had lots of readings below 90/60. The lowest has been 68/39!
    - I don't have any armpit hair.
    - I have some skin discolorations - a faint darkening in one of my elbow creases, and a faint blue-grayness where a man would have a mustache.
    - I have delayed reactions to allergy shots, they can make me hazy and sick for days. This has gotten worse over the past year or so.
    - Also I have severe delayed reactions to allergens, a fuzzy-headed wiped-out feeling that goes on for days.

    So I went to an endocrinologist, got an ACTH stimulation test. He said it's normal.
    But according to some standards that are published, the test does show adrenal insufficiency; according to other standards, it's in a range where further testing such as an insulin tolerance test would be necessary to find out if I have adrenal insufficiency.

    My allergist gave me a short course of 15 mg hydrocortisone/day as a trial.
    It does help. I feel more alert, I haven't had any extremely low blood pressure readings, and it makes my reactions to allergy shots more mild.

    So what are the criteria by which endocrinologists diagnose adrenal insufficiency? When AI gets really bad, people get electrolyte abnormalities like low sodium, high potassium, severe low blood pressure, etc. Are those the criteria on which the tests are based?

    There are other changes that happen with adrenal insufficiency, such as increased inflammation and fatigue. Is there evidence for allergies worsening in mild adrenal insufficiency in the research? How about more severe delayed inflammatory reactions?

    Is there evidence that low-dose hydrocortisone might be beneficial? It's known that high doses quell inflammation. But what about sustained low doses?
     
  16. IndigoSunset

    IndigoSunset Junior Member



    yea. me. you're looking at someone with hypoadrenalism.
     
  17. IndigoSunset

    IndigoSunset Junior Member

    no.
    but corticoids they can shut down your androgens completely or somewhat which will affect your dht levels and shrink everything including your penis. but the shrinkage wouldnt be very noticable.

    wrong.

    here is the reason why doctors wanna claim that hypoadrenalism doesnt exist. which it does.

    watch the vid.



    they(docs) screwed up royally back when hydrocortisone was first synthesized and they've been covering up that major act of united malpractice for years.
    but worse...far worse they convinced the health insurance companies to not recognize hypoadrenalism as a infirmity.
    which means when you go to a doctor...the doctor will refuse to test adrenal hormone because there is no box to check on a diagnosis form...so to avoid all that docs will contradict the scientific fact of addison's disease and cushings syndrome.

    its a mess.
    i cant tell you how much i've suffered with the retarded doctors over this.
    its also why i have to put some lawsuits on some hospitals for making me go 10 months while suffering through a life threatening adrenal crisis. which is needless to say...unacceptable.

    my hypoadrenalism was so bad it caused my blood pressure to drop so low my lungs would cease to function. total respiratory failure.
    i'm very lucky to be alive. no thanks to the useless waste of space know nothing corrupt doctors in this country.

    if you have any questions about hypoadrenalism...ask away. i'm an open book.
     
  18. IndigoSunset

    IndigoSunset Junior Member

    you dont need a doc to run cortisol tests. you can order them online on your own. but its costly.
    saliva tests are what you want.

    you dont need hydrocortisone unless your hypoadrenalism is like mine. life threatening.
    not saying hydrocortisone is to avoided, no. but i am saying there are over the counter adrenal glandulars that can take care of your hypoadrenalism unless its really bad.

    lastly...get a Ansar test. its the best most sensitive test regarding how your adrenals are functioning.
    my Ansar test revealed hypoadrenalism even when i wasnt experienced any of my hypoadrenal symptoms. the test is that good at sensing if something is wrong. an ACTH test isnt very good regarding sensitivity.

    best way, without formal tests...to test how well your adrenals are functioning...believe or not..is caffeine.
    this only works if you do NOT drink coffee every day btw.

    if you dont drink coffee on a regular basis. this is a good test of adrenal function.

    drink a cup of coffee w caffeine.
    how do you feel after?

    do you feel warm, sweaty, energized?
    does the effect last a long time?
    in other words...do you feel stimulated for hours on end?

    or...

    do you feel weak? especially at the knees?
    fainty? light headed? dizzy? weaker instead of stronger than before?
    dull ache in the middle or lower back?
    if so....yeah. your adrenal function is no good.


    low blood pressure and dizziness upon standing are classic symptoms of hypoadrenalism.
    as for a doctor diagnosis of any possible hypoadrenalism...good fucking luck with that notion.
    send out for a cortisol test kit.
    get your neurologist to run a Ansar test
     
  19. larkasaur

    larkasaur Junior Member

    There's research on various conditions where people tend to have low cortisol but not so low as to be called adrenal insufficient.
    People with CFS for example, tend to have low cortisol.
    And there was one study where people with CFS were given 5-10 mg of cortisol per day, and it reduced their fatigue more than placebo. The study was "Low-dose hydrocortisone in chronic fatigue syndrome: a randomised crossover trial", Lancet 1999.
    And allergic people had less of a cortisol response to stress when they were suffering from allergic inflammation. "Blunted HPA axis responsiveness to stress in atopic patients is associated with
    the acuity and severeness of allergic inflammation", Brain, Behavior, and Immunity 2010.
    And so on.
     
  20. larkasaur

    larkasaur Junior Member

    Do you know of research supporting what the doctor says in the video, about low-dose hydrocortisone helping people?