MESO-Rx
Anabolic Steroids
Adrenal Fatigue & Glucocorticoid Use
- Thread starter Michael Scally MD
- Start date
It helps if you include a quote for reference. Otherwise, it is unclear what you are talking about.
I read fine, but you seem to continually make a point and quote references from studies where people are defined as having addison's or hypopituitarism for some reason when "adrenal fatigue" doesn't fall into those defined categories.
First, it is recommended that a 24hr urine or 4x saliva testing be performed to determine if one even has low cortisol. Next, if a low level is determined, further testing using the standard methods (ACTH Stim) to rule out disease like Addison's/hypopituitarism would be good.
If you don't fall into the latter diagnosis, yet have low cortisol, one could make the argument that there is "fatigue" of the adrenal glands that could possibly be recovered with low dose HC over many months time.
A regime of upwards of 20mg/day HC in divided doses, starting with larger 10mg AM, 5mg, 2.5mg and 2.5mg approximately 3 hours apart a day to emulate the natural rise and taper of normal cortisone in the body throughout the day.
After tapering off HC, the 4x saliva and a 24hr urine test should be performed again to check levels of cortisol.
Lastly, I still don't know anybody recommending 100mg of HC a day on the forums. That is foolish and proven to be a very high dose by any standards unless they have a diagnosis of Addison's, then you have quoted those sources yourself that they are probably over treated.
This subject has been talked about for years now on several forums, as mentioned, it is widely acknowledged, based off the work done by one person William McK Jefferies MD.
Amazon.com: Jeffrey Dach MD's review of Safe Uses of Cortisol
The second post actually pointed you to this source, which most of the people that dose HC to treat "fatigue" of the adrenal glands have received their information along with other doctors who have treated people with HC for fatigue using this same method.
/thread
First, it is recommended that a 24hr urine or 4x saliva testing be performed to determine if one even has low cortisol. Next, if a low level is determined, further testing using the standard methods (ACTH Stim) to rule out disease like Addison's/hypopituitarism would be good.
If you don't fall into the latter diagnosis, yet have low cortisol, one could make the argument that there is "fatigue" of the adrenal glands that could possibly be recovered with low dose HC over many months time.
A regime of upwards of 20mg/day HC in divided doses, starting with larger 10mg AM, 5mg, 2.5mg and 2.5mg approximately 3 hours apart a day to emulate the natural rise and taper of normal cortisone in the body throughout the day.
After tapering off HC, the 4x saliva and a 24hr urine test should be performed again to check levels of cortisol.
Lastly, I still don't know anybody recommending 100mg of HC a day on the forums. That is foolish and proven to be a very high dose by any standards unless they have a diagnosis of Addison's, then you have quoted those sources yourself that they are probably over treated.
This subject has been talked about for years now on several forums, as mentioned, it is widely acknowledged, based off the work done by one person William McK Jefferies MD.
Amazon.com: Jeffrey Dach MD's review of Safe Uses of Cortisol
The second post actually pointed you to this source, which most of the people that dose HC to treat "fatigue" of the adrenal glands have received their information along with other doctors who have treated people with HC for fatigue using this same method.
/thread
Last edited by a moderator:
ROTFLMFAOPIMP
Thanks for the cite. I have included the abstract and article link. Apparently, posters are want to read into this thread what they want. This study used ~30 mg HC AM and 5 mg HC PM. At this dose there was a "degree of adrenal suppression precludes its practical use."
Importantly, this is a clinical study on HC use and not the prior provided link to total and complete contradictory BS. Those that post or support adrenal fatigue or liked to legitimize themselves by now saying adrenal insufficiency are unable to point to a single peer reviewed article in support of the "disorder."
McKenzie R, O'Fallon A, Dale J, et al. Low-Dose Hydrocortisone for Treatment of Chronic Fatigue Syndrome: A Randomized Controlled Trial. JAMA 1998;280(12):1061-6.
Context.-- Chronic fatigue syndrome (CFS) is associated with a dysregulated hypothalamic-pituitary adrenal axis and hypocortisolemia.
Objective.-- To evaluate the efficacy and safety of low-dose oral hydrocortisone as a treatment for CFS.
Design.-- A randomized, placebo-controlled, double-blind therapeutic trial, conducted between 1992 and 1996.
Setting.-- A single-center study in a tertiary care research institution. Patients.-- A total of 56 women and 14 men aged 18 to 55 years who met the 1988 Centers for Disease Control and Prevention case criteria for CFS and who withheld concomitant treatment with other medications.
Intervention.-- Oral hydrocortisone, 13 mg/m2 of body surface area every morning and 3 mg/m2 every afternoon, or placebo, for approximately 12 weeks.
Main Outcome Measures.-- A global Wellness scale and other self-rating instruments were completed repeatedly before and during treatment. Resting and cosyntropin-stimulated cortisol levels were obtained before and at the end of treatment. Patients recorded adverse effects on a checklist.
Results.-- The number of patients showing improvement on the Wellness scale was 19 (54.3%) of 35 placebo recipients vs 20 (66.7%) of 30 hydrocortisone recipients (P=.31). Hydrocortisone recipients had a greater improvement in mean Wellness score (6.3 vs 1.7 points; P=.06), a greater percentage (53% vs 29%; P=.04) recording an improvement of 5 or more points in Wellness score, and a higher average improvement in Wellness score on more days than did placebo recipients (P<.001). Statistical evidence of improvement was not seen with other self-rating scales. Although adverse symptoms reported by patients taking hydrocortisone were mild, suppression of adrenal glucocorticoid responsiveness was documented in 12 patients who received it vs none in the placebo group (P<.001).
Conclusions.-- Although hydrocortisone treatment was associated with some improvement in symptoms of CFS, the degree of adrenal suppression precludes its practical use for CFS.
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Better to dose once a day as early as possible upon awakening. Less effect on the diurnal secretion patterns.
I gotta read this entire thread one of these days.
I gotta read this entire thread one of these days.
I have seen very significant improvements in my symptoms while on a medrol dose pack.
I have verified low cortisol through saliva testing.
My symptoms came about after extreme physical, emotional, and chemical (arimidex) stress.
Thus, I do believe in "adrenal fatigue" at this point.
The question though is which part of the HPA axis is faulty.
I have verified low cortisol through saliva testing.
My symptoms came about after extreme physical, emotional, and chemical (arimidex) stress.
Thus, I do believe in "adrenal fatigue" at this point.
The question though is which part of the HPA axis is faulty.
My levels on saliva tests we're normal but this was on a lower dose of thyroid medication for my hashimoto's but they would still be low normal once i go higher with my thyroid dosages i crash further due to my adrenals. I basically know when i'm on enough HC when my temperatures don't fluctuate anymore because that is a sign your cortisol is too low. So checking your body temperature 3x per day and comparing it through a few days of taking temperatures could be another reliable indicator of adrenal fatigue.
In my case nor was my saliva cortisol (to a significant degree), blood ACTH/Cortisol, or ACTH stim test abnormal yet i have adrenal fatigue.
In my case nor was my saliva cortisol (to a significant degree), blood ACTH/Cortisol, or ACTH stim test abnormal yet i have adrenal fatigue.
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Most Physicians Skeptical Of Diagnosis Of Adrenal Fatigue.
The Chicago Tribune (8/21, Deardorff) reported that "those who diagnose adrenal fatigue or exhaustion are fighting an uphill battle for legitimacy, even as the terms gain traction in alternative health circles and among Americans seeking a solution for chronic and unexplained fatigue, depression, weight gain, and malaise." Notably the "disorder is not recognized by most conventional endocrinologists or internists, major medical associations, and even integrative medicine pioneers." Some physicians have even called it "a worthless diagnosis" and while others, like "endocrinologist Seymour Reichlin, an expert on the brain-endocrine system and stress," do not "believe in adrenal fatigue," he "says 'it's not unreasonable to carry out lab tests, because the symptoms of adrenal fatigue overlap with true adrenal insufficiency.'" [Note: It is the use of GC that is most disturbing and harmful, even dangerous. Also, proponents almost all seem to ignore that GC have the side effect of euphoria, lending "credibility" to its use. I do not argue with treatment that includes diet, exercise, and certain supplements. This is good advice to all.]
An exhausting battle over adrenal fatigue
Adrenal fatigue: Adrenal fatigue diagnosis gaining traction, but is it real? - chicagotribune.com
Those who suffer its effects say treating it brought them renewed energy, while most doctors say the disorder doesn't exist
"Adrenal fatigue" is the sort of diagnosis that might hit home during a late-night Internet search. Do you, for example, have trouble waking up in the morning without caffeine? Do you crave salty foods? Do people seem a lot more irritating than in the past?
If so, it could mean your adrenal glands are underperforming because of illness or constant emotional or physical stress, according to some medical practitioners who suggest patients make dietary and lifestyle changes in response — as well as take supplements they frequently sell.
But those who diagnose adrenal fatigue or exhaustion are fighting an uphill battle for legitimacy, even as the terms gain traction in alternative health circles and among Americans seeking a solution for chronic and unexplained fatigue, depression, weight gain and malaise.
The disorder is not recognized by most conventional endocrinologists or internists, major medical associations and even integrative medicine pioneers such as Dr. Andrew Weil, who reject the idea that excessive stress weakens the adrenals and causes health issues.
"Adrenal fatigue is a worthless diagnosis, and lavish testimonials and anecdotal claims of marked improvement following some intervention are most likely fraudulent or transient placebo effects," said Dr. Paul Rosch, president of the American Institute of Stress and a clinical professor of medicine and psychiatry at New York Medical College.
Other critics say there is room for further study. Endocrinologist Seymour Reichlin, an expert on the brain-endocrine system and stress, doesn't believe in adrenal fatigue but says "it's not unreasonable to carry out lab tests because the symptoms of adrenal fatigue overlap with true adrenal insufficiency."
According to the adrenal fatigue theory, modern life is so relentlessly stressful that the walnut-size adrenal glands, which produce hormones needed to cope with stress, get overworked and peter out. If you're tired for no reason, get lightheaded when you stand up quickly, can't shake colds or infections and feel as if you're constantly walking uphill, you may have something going on at the adrenal level, proponents say.
Supporters say the condition differs from adrenal failure (or adrenal insufficiency) and from extremely low adrenal function (Addison's disease), which are usually caused by an autoimmune reaction, a tumor, cancer or an infection such as tuberculosis.
"The adrenals aren't failing, as in Addison's. They aren't destroyed as in an autoimmune issue. They simply can't keep up with the demands placed on them," said James Wilson, an Arizona-based naturopath and chiropractor who coined the term in 1998 and has written what some call the definitive guide for patients. "We know all organs do that," Wilson said. "But for some reason, medicine has resisted the same concept with adrenals."
Skeptics say it's true that prolonged stress can enlarge the adrenals and disrupt almost all the body's processes because of the constant flood of adrenaline and cortisol coursing through the body. But they say there's no gray area on adrenal function — the glands either work or they don't.
They say evidence has not shown that prolonged stress results in the adrenals producing less cortisol. Moreover, many symptoms linked to adrenal fatigue, including feeling tired, depressed, irritable or unable to concentrate, could be caused by dozens of things, including stress, fractured sleep, poor nutrition and a lack of exercise.
And they say doctors who sell supplements to treat adrenal fatigue should raise a red flag for patients.
"Is adrenal fatigue real? Yes and no," said Dr. Brent Bauer, director of the complementary and integrative medicine program at Mayo Clinic. "Like many things in this arena, it's a grain of truth surrounded by a lot of hype and peddlers of quick fixes."
Adrenal fatigue proponents say the condition can affect anyone but is often triggered by a serious illness or injury, allergies, poor nutrition or intense social, emotional or physical pressure. Perfectionists and those who feel trapped or helpless, don't get enough rest or have a stressful job are especially vulnerable, they say.
Kathy Hart, a co-host of the popular Eric & Kathy radio show on WTMX-FM, was diagnosed with adrenal fatigue about four years ago after she began having panic attacks, feeling unusually lethargic and experiencing numb and tingly arms. Normally, Hart bounded out of bed at 3:15 a.m. to get ready for work. But during the show's 10th anniversary in 2006, she often had engagements that kept her out late.
"I didn't want to complain," said Hart, who has three children. "It was like, 'Yeah, I'm tired,' but who isn't? Any woman with kids and a hectic job feels like this. You just complain to your husband and do it."
Hart's doctor prescribed anti-anxiety drugs and antidepressants, but Hart felt the medication made things worse and sought a holistic physician who diagnosed her with adrenal fatigue. Hart changed her diet, began meditating and started taking supplements the doctor sold.
It took a year, but today Hart credits the supplements and lifestyle changes with helping to restore her health. "I think poor nutrition and (a lack of) exercise had a lot to do with it," said Hart, who started the "Healthy With Hart" Web site to educate others about adrenal fatigue.
Hart said saliva testing showed she had low cortisol levels, but testing for adrenal fatigue is controversial. True adrenal insufficiency is usually diagnosed by measuring cortisol levels in blood as well as saliva. But adrenal fatigue proponents say blood tests are inaccurate because the values are too broad and don't catch the early-stage symptoms.
Saliva tests, they argue, are more precise because they measure the amount of cortisol available to the tissues. But there's no agreement on what constitutes low levels on these tests.
"Many people are told they have adrenal fatigue, and they take a homeopathic remedy, but their baseline cortisol testing is completely normal," said endocrinologist Adrian Vella, a specialist in adrenal disorders at Mayo Clinic.
Testing can tell how much of a hormone the adrenals are releasing but doesn't necessarily indicate how well things are working because people have different numbers of cortisol receptors, among other factors, said Dr. Daniel Clauw, director of the Chronic Pain and Research Center at the University of Michigan.
"There's no question that fatigue is at least partly due to the interactions between the brain and the adrenal glands," he said. But it's a "gross oversimplification" of the origins of fatigue, he said, to imply that the adrenals are a major cause.
For Chicago Pilates teacher Jenna Wilayto, hearing about adrenal fatigue was what prompted her to seek additional testing and care for chronic health issues.
Shortly after the ceiling of her new business collapsed, Wilayto, 33, suffered from chronic sinus infections and troubling fatigue. Her skin broke out, she ached and she couldn't sleep despite feeling exhausted. When conventional doctors couldn't help, she turned to a holistic physician, who ran blood tests and told her she was anemic and vitamin-deficient, and that her adrenals were working overtime to regulate her body.
Along with learning some relaxation techniques, Wilayto began following an anti-inflammatory diet; removed caffeine, alcohol, gluten, dairy and citrus fruits; and started taking several supplements, including iron, ubiquinol, vitamin C, vitamin D, fish oil and B complex.
"What I needed was someone who was willing to look outside of the box," said Wilayto, director of the Helios Center for Movement. "The other answers I had gotten were 'Go home and drink wine,' and 'Take a day off; you work too hard.'"
Dr. Melinda Ring, medical director of the Center for Integrative Medicine at Northwestern Memorial Hospital, says it's worth looking into adrenal-related disorders, especially since similar syndromes were described — and discredited — as "rheumatism" in the 16th century.
"I realize 'adrenal stress' and 'fatigue' are trendy terms, but I do believe there are real symptoms that result from true physical manifestations of chronic stress," she said. "Only recently have disturbances in the central nervous system and neurotransmitters been defined by science and accepted by Western medicine and pharmaceutical companies."
Tips
If you decide to investigate a possible diagnosis of adrenal fatigue, keep the following factors in mind:
• Get multiple blood or saliva tests. Single blood or cortisol tests are useless because cortisol levels peak around 8 a.m. and fluctuate widely during the day. The tricky part is reducing stress while you're in the doctor's office. "You have to be very careful as there can be false positives and negatives," said Dr. Esther Sternberg, chief of the section on neuroendocrine immunology and behavior at the National Institute of Mental Health. Simply getting a needle stick can raise cortisol levels.
• Don't take extracts of bovine adrenal cortex. "These are absolutely ineffective because the hormones are present in extremely low concentration and, as they occur in nature, cannot be absorbed from the gastrointestinal tract," said Dr. Seymour Reichlin of Tufts University School of Medicine.
• Consider supplements from a class called adaptogens. "Adaptogens (ashwagandha, rhodiola, licorice root, ginseng, schizandra and maca) help support adrenal function, but use them under the guidance of a trained integrative provider," said Dr. Melinda Ring of Northwestern Memorial Hospital.
The Chicago Tribune (8/21, Deardorff) reported that "those who diagnose adrenal fatigue or exhaustion are fighting an uphill battle for legitimacy, even as the terms gain traction in alternative health circles and among Americans seeking a solution for chronic and unexplained fatigue, depression, weight gain, and malaise." Notably the "disorder is not recognized by most conventional endocrinologists or internists, major medical associations, and even integrative medicine pioneers." Some physicians have even called it "a worthless diagnosis" and while others, like "endocrinologist Seymour Reichlin, an expert on the brain-endocrine system and stress," do not "believe in adrenal fatigue," he "says 'it's not unreasonable to carry out lab tests, because the symptoms of adrenal fatigue overlap with true adrenal insufficiency.'" [Note: It is the use of GC that is most disturbing and harmful, even dangerous. Also, proponents almost all seem to ignore that GC have the side effect of euphoria, lending "credibility" to its use. I do not argue with treatment that includes diet, exercise, and certain supplements. This is good advice to all.]
An exhausting battle over adrenal fatigue
Adrenal fatigue: Adrenal fatigue diagnosis gaining traction, but is it real? - chicagotribune.com
Those who suffer its effects say treating it brought them renewed energy, while most doctors say the disorder doesn't exist
"Adrenal fatigue" is the sort of diagnosis that might hit home during a late-night Internet search. Do you, for example, have trouble waking up in the morning without caffeine? Do you crave salty foods? Do people seem a lot more irritating than in the past?
If so, it could mean your adrenal glands are underperforming because of illness or constant emotional or physical stress, according to some medical practitioners who suggest patients make dietary and lifestyle changes in response — as well as take supplements they frequently sell.
But those who diagnose adrenal fatigue or exhaustion are fighting an uphill battle for legitimacy, even as the terms gain traction in alternative health circles and among Americans seeking a solution for chronic and unexplained fatigue, depression, weight gain and malaise.
The disorder is not recognized by most conventional endocrinologists or internists, major medical associations and even integrative medicine pioneers such as Dr. Andrew Weil, who reject the idea that excessive stress weakens the adrenals and causes health issues.
"Adrenal fatigue is a worthless diagnosis, and lavish testimonials and anecdotal claims of marked improvement following some intervention are most likely fraudulent or transient placebo effects," said Dr. Paul Rosch, president of the American Institute of Stress and a clinical professor of medicine and psychiatry at New York Medical College.
Other critics say there is room for further study. Endocrinologist Seymour Reichlin, an expert on the brain-endocrine system and stress, doesn't believe in adrenal fatigue but says "it's not unreasonable to carry out lab tests because the symptoms of adrenal fatigue overlap with true adrenal insufficiency."
According to the adrenal fatigue theory, modern life is so relentlessly stressful that the walnut-size adrenal glands, which produce hormones needed to cope with stress, get overworked and peter out. If you're tired for no reason, get lightheaded when you stand up quickly, can't shake colds or infections and feel as if you're constantly walking uphill, you may have something going on at the adrenal level, proponents say.
Supporters say the condition differs from adrenal failure (or adrenal insufficiency) and from extremely low adrenal function (Addison's disease), which are usually caused by an autoimmune reaction, a tumor, cancer or an infection such as tuberculosis.
"The adrenals aren't failing, as in Addison's. They aren't destroyed as in an autoimmune issue. They simply can't keep up with the demands placed on them," said James Wilson, an Arizona-based naturopath and chiropractor who coined the term in 1998 and has written what some call the definitive guide for patients. "We know all organs do that," Wilson said. "But for some reason, medicine has resisted the same concept with adrenals."
Skeptics say it's true that prolonged stress can enlarge the adrenals and disrupt almost all the body's processes because of the constant flood of adrenaline and cortisol coursing through the body. But they say there's no gray area on adrenal function — the glands either work or they don't.
They say evidence has not shown that prolonged stress results in the adrenals producing less cortisol. Moreover, many symptoms linked to adrenal fatigue, including feeling tired, depressed, irritable or unable to concentrate, could be caused by dozens of things, including stress, fractured sleep, poor nutrition and a lack of exercise.
And they say doctors who sell supplements to treat adrenal fatigue should raise a red flag for patients.
"Is adrenal fatigue real? Yes and no," said Dr. Brent Bauer, director of the complementary and integrative medicine program at Mayo Clinic. "Like many things in this arena, it's a grain of truth surrounded by a lot of hype and peddlers of quick fixes."
Adrenal fatigue proponents say the condition can affect anyone but is often triggered by a serious illness or injury, allergies, poor nutrition or intense social, emotional or physical pressure. Perfectionists and those who feel trapped or helpless, don't get enough rest or have a stressful job are especially vulnerable, they say.
Kathy Hart, a co-host of the popular Eric & Kathy radio show on WTMX-FM, was diagnosed with adrenal fatigue about four years ago after she began having panic attacks, feeling unusually lethargic and experiencing numb and tingly arms. Normally, Hart bounded out of bed at 3:15 a.m. to get ready for work. But during the show's 10th anniversary in 2006, she often had engagements that kept her out late.
"I didn't want to complain," said Hart, who has three children. "It was like, 'Yeah, I'm tired,' but who isn't? Any woman with kids and a hectic job feels like this. You just complain to your husband and do it."
Hart's doctor prescribed anti-anxiety drugs and antidepressants, but Hart felt the medication made things worse and sought a holistic physician who diagnosed her with adrenal fatigue. Hart changed her diet, began meditating and started taking supplements the doctor sold.
It took a year, but today Hart credits the supplements and lifestyle changes with helping to restore her health. "I think poor nutrition and (a lack of) exercise had a lot to do with it," said Hart, who started the "Healthy With Hart" Web site to educate others about adrenal fatigue.
Hart said saliva testing showed she had low cortisol levels, but testing for adrenal fatigue is controversial. True adrenal insufficiency is usually diagnosed by measuring cortisol levels in blood as well as saliva. But adrenal fatigue proponents say blood tests are inaccurate because the values are too broad and don't catch the early-stage symptoms.
Saliva tests, they argue, are more precise because they measure the amount of cortisol available to the tissues. But there's no agreement on what constitutes low levels on these tests.
"Many people are told they have adrenal fatigue, and they take a homeopathic remedy, but their baseline cortisol testing is completely normal," said endocrinologist Adrian Vella, a specialist in adrenal disorders at Mayo Clinic.
Testing can tell how much of a hormone the adrenals are releasing but doesn't necessarily indicate how well things are working because people have different numbers of cortisol receptors, among other factors, said Dr. Daniel Clauw, director of the Chronic Pain and Research Center at the University of Michigan.
"There's no question that fatigue is at least partly due to the interactions between the brain and the adrenal glands," he said. But it's a "gross oversimplification" of the origins of fatigue, he said, to imply that the adrenals are a major cause.
For Chicago Pilates teacher Jenna Wilayto, hearing about adrenal fatigue was what prompted her to seek additional testing and care for chronic health issues.
Shortly after the ceiling of her new business collapsed, Wilayto, 33, suffered from chronic sinus infections and troubling fatigue. Her skin broke out, she ached and she couldn't sleep despite feeling exhausted. When conventional doctors couldn't help, she turned to a holistic physician, who ran blood tests and told her she was anemic and vitamin-deficient, and that her adrenals were working overtime to regulate her body.
Along with learning some relaxation techniques, Wilayto began following an anti-inflammatory diet; removed caffeine, alcohol, gluten, dairy and citrus fruits; and started taking several supplements, including iron, ubiquinol, vitamin C, vitamin D, fish oil and B complex.
"What I needed was someone who was willing to look outside of the box," said Wilayto, director of the Helios Center for Movement. "The other answers I had gotten were 'Go home and drink wine,' and 'Take a day off; you work too hard.'"
Dr. Melinda Ring, medical director of the Center for Integrative Medicine at Northwestern Memorial Hospital, says it's worth looking into adrenal-related disorders, especially since similar syndromes were described — and discredited — as "rheumatism" in the 16th century.
"I realize 'adrenal stress' and 'fatigue' are trendy terms, but I do believe there are real symptoms that result from true physical manifestations of chronic stress," she said. "Only recently have disturbances in the central nervous system and neurotransmitters been defined by science and accepted by Western medicine and pharmaceutical companies."
Tips
If you decide to investigate a possible diagnosis of adrenal fatigue, keep the following factors in mind:
• Get multiple blood or saliva tests. Single blood or cortisol tests are useless because cortisol levels peak around 8 a.m. and fluctuate widely during the day. The tricky part is reducing stress while you're in the doctor's office. "You have to be very careful as there can be false positives and negatives," said Dr. Esther Sternberg, chief of the section on neuroendocrine immunology and behavior at the National Institute of Mental Health. Simply getting a needle stick can raise cortisol levels.
• Don't take extracts of bovine adrenal cortex. "These are absolutely ineffective because the hormones are present in extremely low concentration and, as they occur in nature, cannot be absorbed from the gastrointestinal tract," said Dr. Seymour Reichlin of Tufts University School of Medicine.
• Consider supplements from a class called adaptogens. "Adaptogens (ashwagandha, rhodiola, licorice root, ginseng, schizandra and maca) help support adrenal function, but use them under the guidance of a trained integrative provider," said Dr. Melinda Ring of Northwestern Memorial Hospital.
Interesting to see that in a mainstream newspaper. Thanks for the find.
2 character error message
New Member
The real question isnt if it exists but what will treatment for it do harm in the long term.
zkt
zkt
In the long term, GCs exhibit disease-modifying capacities in rheumatoid arthritis (RA), such as protective effects on joint destruction. However, their use is restrained by the occurrence of adverse events (AEs). Despite the established use, there is no definite consensus on the relevant AE-profile of this medication. The aim of this study was to develop recommendations for the monitoring of GC-related AEs of low-dose GC (?7.5 mg prednisone or equivalent daily) treatment in rheumatic diseases (1) in clinical trials for obtaining high-quality data on the occurrence of AEs and (2) in daily practice for treating patients safely.
van der Goes MC, Jacobs JWG, Boers M, et al. Monitoring adverse events of low-dose glucocorticoid therapy: EULAR recommendations for clinical trials and daily practice. Annals of the Rheumatic Diseases 2010;69(11):1913-9. Monitoring adverse events of low-dose glucocortico... [Ann Rheum Dis. 2010] - PubMed result
OBJECTIVE: To develop recommendations on monitoring for adverse events (AEs) of low-dose glucocorticoid (GC) therapy (?7.5 mg prednisone or equivalent daily) in clinical trials and daily practice.
METHODS: Literature was searched for articles containing information on incidence and monitoring of GC-related AEs using PubMed, EMBASE and Cochrane databases. Second, the authors searched for broad accepted guidelines on the monitoring of certain AEs (eg, WHO guidelines on screening for diabetes). Available data were summarised and discussed among experts (rheumatologists and patients) of the EULAR Task Force to decide which potential AEs should be monitored, how and at which interval.
RESULTS: Data on monitoring proved to be scarce; most articles were focused on therapeutic effects of GCs, not on occurrence and monitoring of AEs. Most recommendations had to be based on consensus. Those for clinical trials aimed at getting insights into incidence, prevalence and clinical relevance of AEs to create a comprehensive and valid AE-profile of GC therapy. The set of AEs to monitor is therefore more extensive, and often consists of assessments at baseline and at end of trials. Recommendations for daily practice are meant to protect patients from real dangers, which can be prevented or treated. Standard care monitoring needs NOT be extended for patients on low-dose GC therapy, except for osteoporosis (follow national guidelines), and baseline assessments of ankle edema, fasting blood glucose and risk factors for glaucoma.
CONCLUSION: Given the incompleteness of literature data, consensus-based recommendations on monitoring for GC-related AEs were created, separately for daily practice and clinical trials.
van der Goes MC, Jacobs JWG, Boers M, et al. Monitoring adverse events of low-dose glucocorticoid therapy: EULAR recommendations for clinical trials and daily practice. Annals of the Rheumatic Diseases 2010;69(11):1913-9. Monitoring adverse events of low-dose glucocortico... [Ann Rheum Dis. 2010] - PubMed result
OBJECTIVE: To develop recommendations on monitoring for adverse events (AEs) of low-dose glucocorticoid (GC) therapy (?7.5 mg prednisone or equivalent daily) in clinical trials and daily practice.
METHODS: Literature was searched for articles containing information on incidence and monitoring of GC-related AEs using PubMed, EMBASE and Cochrane databases. Second, the authors searched for broad accepted guidelines on the monitoring of certain AEs (eg, WHO guidelines on screening for diabetes). Available data were summarised and discussed among experts (rheumatologists and patients) of the EULAR Task Force to decide which potential AEs should be monitored, how and at which interval.
RESULTS: Data on monitoring proved to be scarce; most articles were focused on therapeutic effects of GCs, not on occurrence and monitoring of AEs. Most recommendations had to be based on consensus. Those for clinical trials aimed at getting insights into incidence, prevalence and clinical relevance of AEs to create a comprehensive and valid AE-profile of GC therapy. The set of AEs to monitor is therefore more extensive, and often consists of assessments at baseline and at end of trials. Recommendations for daily practice are meant to protect patients from real dangers, which can be prevented or treated. Standard care monitoring needs NOT be extended for patients on low-dose GC therapy, except for osteoporosis (follow national guidelines), and baseline assessments of ankle edema, fasting blood glucose and risk factors for glaucoma.
CONCLUSION: Given the incompleteness of literature data, consensus-based recommendations on monitoring for GC-related AEs were created, separately for daily practice and clinical trials.
chrisworcs
New Member
I took hydrocortisone for about 18 months, from jan 2009, to july 2010. i had a low normal saliva test in 2007, then a low one at the end of 2008 - it was 50% lower than the first.
I saw a practitioner in the UK who was no longer a dr but felt my adrenals weren't working well based on these tests. i didn't take the decision to take HC lightly, but it was after consulting this expert in this field, reading Jeffries safe uses of cortisol and physically not being able to cope and literally starting to have my legs go from under me that i started it.
HC made me feel very depressed at first but then helped me cope once i got used to it. i had to go up to about 40mg at first, maybe even 50mg (60mg probably at highest) but soon found i didn't need as much, i went back down and in the end just 10mg helped, then just came off it when an endo said i needed to be off it for accurate blood test results. it was quite hard to come off that last 5mg or so.
after 18 mnths of hc, urinary 24 h test was within normal limits, dexa 1mg suppression test was ok, ACTH test was ok (850 something after 30 mins, 300 at 0 minutes i think or something like that)
the HC did help but i don't think it's as simple as i was led to believe. I understand there might be other factors that affect saliva tests such as high levels of CBG. I also read that people can have low saliva levels because they metabolise cortisol quickly. If i remember rightly the endo i saw said that although he agreed with the theory of adrenal fatigue he felt it was a signalling condition in the brain, the link between brain and adrenals wasn't working well. but as i say i think it helped me. not sure if it's caused more problems with 'metabolic syndrome' but i know my testsosterone is low but i think it's been low all my 20s .
i have firsthand knowledge only one person taking about 100mg, he had previously taken steroids and thyroid for weight loss puproses, but then i think he said adrenal fatigue fitted and he had low saliva tests but the drs tested him and he was ok on an ACTH test but went ahead with taking prednisone i think, then changed to HC. he said he needed to take huge amounts like 100mg to function once he was on it. well he ended up needing to take a lot and he's ended up with either primary or secondary adrenal failure. i don't know of anyone else who's ended up in that state but then again i don't know of anyone else who took or felt they needed to take that much HC, i wonder what else was going on with his body at the time.
these are just my experiences....
chris
I saw a practitioner in the UK who was no longer a dr but felt my adrenals weren't working well based on these tests. i didn't take the decision to take HC lightly, but it was after consulting this expert in this field, reading Jeffries safe uses of cortisol and physically not being able to cope and literally starting to have my legs go from under me that i started it.
HC made me feel very depressed at first but then helped me cope once i got used to it. i had to go up to about 40mg at first, maybe even 50mg (60mg probably at highest) but soon found i didn't need as much, i went back down and in the end just 10mg helped, then just came off it when an endo said i needed to be off it for accurate blood test results. it was quite hard to come off that last 5mg or so.
after 18 mnths of hc, urinary 24 h test was within normal limits, dexa 1mg suppression test was ok, ACTH test was ok (850 something after 30 mins, 300 at 0 minutes i think or something like that)
the HC did help but i don't think it's as simple as i was led to believe. I understand there might be other factors that affect saliva tests such as high levels of CBG. I also read that people can have low saliva levels because they metabolise cortisol quickly. If i remember rightly the endo i saw said that although he agreed with the theory of adrenal fatigue he felt it was a signalling condition in the brain, the link between brain and adrenals wasn't working well. but as i say i think it helped me. not sure if it's caused more problems with 'metabolic syndrome' but i know my testsosterone is low but i think it's been low all my 20s .
i have firsthand knowledge only one person taking about 100mg, he had previously taken steroids and thyroid for weight loss puproses, but then i think he said adrenal fatigue fitted and he had low saliva tests but the drs tested him and he was ok on an ACTH test but went ahead with taking prednisone i think, then changed to HC. he said he needed to take huge amounts like 100mg to function once he was on it. well he ended up needing to take a lot and he's ended up with either primary or secondary adrenal failure. i don't know of anyone else who's ended up in that state but then again i don't know of anyone else who took or felt they needed to take that much HC, i wonder what else was going on with his body at the time.
these are just my experiences....
chris
The guy that did this study must have been there, why couldnt he of just said 34 people chose to stay on the treatment. Its not like he was testing 40,000 patients
He could of rounded it off and said 35 or just 30 patients decided for the treatment not like they'd of been known by their firstnames.
see what bothers me about all this is I have a pituitary disorder and I am secondary hypopituitary.....so I dont make hardly any ACTH even during stress so my cortisol levels are always in the tank.....
now here is the deal.....even with that going on for years my adrenal responded extremly well when I had the ACTH stim test done...my cortisol rised from 4 to 27 !!!
so all this BS about your adrenal atrophies if you take HC because it doesnt get stimulated...thats all got be BS right?? otherwise my adrenals would be the size of a rice grain by now...yet they kicked ass like no tomorrow....
but what bothers me even more is stupid endo refused to treat me with HC suplementation...says its too risky and could mess me up long term,....shit am messed up as it is with all kinds crap from low cortisol (low sugar, chronic inflamations, allergies, etc)
so whats a guy like me to do? just live crappy for life? I guess.....
and why the phuck can you take something like HCG which stimulates your testes to make their own hormones (doing what the pit is suppose to do) but they havent come up with a way for doing the same for ACTH so that HC supplementation isnt always needed????
now here is the deal.....even with that going on for years my adrenal responded extremly well when I had the ACTH stim test done...my cortisol rised from 4 to 27 !!!
so all this BS about your adrenal atrophies if you take HC because it doesnt get stimulated...thats all got be BS right?? otherwise my adrenals would be the size of a rice grain by now...yet they kicked ass like no tomorrow....
but what bothers me even more is stupid endo refused to treat me with HC suplementation...says its too risky and could mess me up long term,....shit am messed up as it is with all kinds crap from low cortisol (low sugar, chronic inflamations, allergies, etc)
so whats a guy like me to do? just live crappy for life? I guess.....
and why the phuck can you take something like HCG which stimulates your testes to make their own hormones (doing what the pit is suppose to do) but they havent come up with a way for doing the same for ACTH so that HC supplementation isnt always needed????
I'd post this on the existing adrenal fatigue thread, but that thread is long enough (eight pages already). Years ago, I was given a diagnosis of "adrenal fatigue." The following recount is my own personal experience with adrenal fatigue, and my opinion of the diagnosis in general.
Years ago, I went to see an endocrinologist for various non-specific symptoms, including fatigue, anxiety, insomnia, and mood disturbances. Failing to find anything wrong with me except an impaired glucose tolerance test, he told me that my symptoms were due to prediabetes, and that I would feel much better if I adopted the Atkins diet.
Being a well disciplined and compliant patient, I took to the diet wholeheartedly. Nothing but chicken breasts and leafy greens all day every day (I'd be surprised if I had over 20 g carbohydrates on any given day). I was already quite skinny at the time, but I lost a shit-load of weight anyway. To give you an idea: I wasn't working out at the time, but I would routinely register a 6% bodyfat reading on those (albeit inaccurate) bodyfat reading scales.
I had noticed some other changes as well: elevated heart rate, increased moodiness and anxiety, tremors, etc. My blood pressure was routinely on the lowish side at 100/70. I would often "brown out" when I stood up. I felt like shit.
I brought my complaints to my endocrinologist, and he tested my adrenal glands. My ACTH was highish, usually in the 40s (but sometimes in the 80s), and my cortisol was high as well. He told me that I had adrenal fatigue, and prescribed me .5 mg tablets of dexamethasone, to be taken once per day.
I was suspicious. I knew that GCs were nothing to fuck around with, so I decided I would try a small dose first. I started on 1/4 of a .5 mg tablet. I didn't notice any change at all, so I decided to increase my dose to 1/2 a tablet. At this dosage, I couldn't be sure if I actually felt better, or if it was just the placebo effect. In any case, I decided that I'd just keep taking it, since it was such a small dosage, I figured that it couldn't really suppress my HPA axis.
I noticed that my morning blood sugar readings were slowly creeping upwards. I went from the low to mid 80s up to the mid 90s all of a sudden. My skin was oily all the time, and I was getting some acne.
My blood work was still coming back with highish cortisol, so my doctor insisted that I take the full dosage. I agreed, and went up to the full .5 mg tablet, once per day.
Within a few weeks, my acne got pretty bad. And suddenly, my morning blood sugar was 105. I was on my way to becoming diabetic. I brought this concern up to my doctor, and he assured me that if and when I became diabetic, that there were good treatments available.
That was enough for me. I got a 2nd and 3rd opinion, and both of them said "Get off the glucocorticoids!!" Needless to say, I didn't go back to the first doctor.
I did some research, and found that keeping your body in a perpetual state of ketosis (a la the Atkins diet) often raises cortisol levels. I decided that I would treat my "prediabetes" with a low-glycemic diet (as opposed to low carb), and most importantly, I started exercising regularly.
My fasting blood sugar came back down to normal, I gained a significant amount of muscle, and I was feeling better. My blood tests showed normal ACTH and normal cortisol levels.
I don't expect to convince anyone that adrenal fatigue is a fictional diagnosis, nor do I expect to convince anyone that I didn't have adrenal fatigue; I understand that this issue has some pretty intense advocates with equally intense feelings fueling their opinions, and most people reading this thread will leave with the same opinion that they started with. However, I would like to point out the following:
My opinion: glucocorticoids are a miracle drug for those who actually need them. For everyone else, they are just a great way to help your body destroy itself, even if you feel better in the short term.
Years ago, I went to see an endocrinologist for various non-specific symptoms, including fatigue, anxiety, insomnia, and mood disturbances. Failing to find anything wrong with me except an impaired glucose tolerance test, he told me that my symptoms were due to prediabetes, and that I would feel much better if I adopted the Atkins diet.
Being a well disciplined and compliant patient, I took to the diet wholeheartedly. Nothing but chicken breasts and leafy greens all day every day (I'd be surprised if I had over 20 g carbohydrates on any given day). I was already quite skinny at the time, but I lost a shit-load of weight anyway. To give you an idea: I wasn't working out at the time, but I would routinely register a 6% bodyfat reading on those (albeit inaccurate) bodyfat reading scales.
I had noticed some other changes as well: elevated heart rate, increased moodiness and anxiety, tremors, etc. My blood pressure was routinely on the lowish side at 100/70. I would often "brown out" when I stood up. I felt like shit.
I brought my complaints to my endocrinologist, and he tested my adrenal glands. My ACTH was highish, usually in the 40s (but sometimes in the 80s), and my cortisol was high as well. He told me that I had adrenal fatigue, and prescribed me .5 mg tablets of dexamethasone, to be taken once per day.
I was suspicious. I knew that GCs were nothing to fuck around with, so I decided I would try a small dose first. I started on 1/4 of a .5 mg tablet. I didn't notice any change at all, so I decided to increase my dose to 1/2 a tablet. At this dosage, I couldn't be sure if I actually felt better, or if it was just the placebo effect. In any case, I decided that I'd just keep taking it, since it was such a small dosage, I figured that it couldn't really suppress my HPA axis.
I noticed that my morning blood sugar readings were slowly creeping upwards. I went from the low to mid 80s up to the mid 90s all of a sudden. My skin was oily all the time, and I was getting some acne.
My blood work was still coming back with highish cortisol, so my doctor insisted that I take the full dosage. I agreed, and went up to the full .5 mg tablet, once per day.
Within a few weeks, my acne got pretty bad. And suddenly, my morning blood sugar was 105. I was on my way to becoming diabetic. I brought this concern up to my doctor, and he assured me that if and when I became diabetic, that there were good treatments available.
That was enough for me. I got a 2nd and 3rd opinion, and both of them said "Get off the glucocorticoids!!" Needless to say, I didn't go back to the first doctor.
I did some research, and found that keeping your body in a perpetual state of ketosis (a la the Atkins diet) often raises cortisol levels. I decided that I would treat my "prediabetes" with a low-glycemic diet (as opposed to low carb), and most importantly, I started exercising regularly.
My fasting blood sugar came back down to normal, I gained a significant amount of muscle, and I was feeling better. My blood tests showed normal ACTH and normal cortisol levels.
I don't expect to convince anyone that adrenal fatigue is a fictional diagnosis, nor do I expect to convince anyone that I didn't have adrenal fatigue; I understand that this issue has some pretty intense advocates with equally intense feelings fueling their opinions, and most people reading this thread will leave with the same opinion that they started with. However, I would like to point out the following:
- Glucocorticoids can and will fuck you up. They have dangerous side effects. This is why so many doctors don't support the diagnosis of adrenal fatigue: the treatment can be worse than the disease.
- Far too many people are getting diabetes. There are obviously serious health consequences from diabetes that I won't mention, but I will mention the often overlooked ones: ED, fatigue, and moodiness. Sound familiar? These are symptoms of adrenal fatigue. In other words, treating these symptoms with glucocorticoids can make them permanent!
- If you really believe you have something wrong with your HPA, then get it tested properly. This includes a dexamethasone suppresion test, an ACTH stimulation test, AM cortisol and ACTH blood tests, 24 hour urinary cortisol, etc. If there is anything wrong with your HPA, this will find it. In my opinion, I just had a form of chronic stress (lack of carbohydrate) that was keeping my cortisol elevated, and taking dexamethasone was just helping my body catabolize its own tissues! Sure, I felt better, but that was probably just due to the catabolic effect of the GCs (my brain was getting all the sugar it needed).
- Lastly, consider the dose that you will be taking. The dexamethasone suppression test is meant to completely suppress HPA activity. The dosage given for this suppression is 1 mg. That is equivalent to 26.67 mg of hydrocortisone, 6.67 mg of prednisone, or 5.33 mg of methylprednisolone. Do you really want to completely suppress your adrenal glands, even if only for part of the day? (See http://www.globalrph.com/steroid.cgi for a calculator to determine steroid equivalence.) If you must use GCs for adrenal fatigue, use a very low dose, and have your ACTH tested while on this dose. If your ACTH is being suppressed, then you are taking too much.
My opinion: glucocorticoids are a miracle drug for those who actually need them. For everyone else, they are just a great way to help your body destroy itself, even if you feel better in the short term.
A bit off-topic, but I found it interesting!
Uthoff H, Wiesli P. Auricular Cartilage Calcification and Adrenal Insufficiency. New England Journal of Medicine 2010;364(2):157.
A healthy 60-year-old man presented to the emergency department with profound hypotension 1 day after sustaining a minor hand laceration with minimal blood loss. Physical examination revealed stiffness in both ears, and calcification of the ears was subsequently revealed on computed tomography (Panel A, arrows) and radiography (Panel B, arrows). The patient's hemodynamic status improved promptly after administration of antibiotics and glucocorticoids, and he recovered with support from the intensive care unit. Subsequent detailed investigations showed adrenal insufficiency. Long-term glucocorticoid-replacement therapy has resulted in marked abatement of the patient's long-standing fatigue. Although rare, calcification and even true ossification of the auricular cartilages have been described in association with mechanical tissue injury, exposure to cold, inflammatory conditions, and endocrinopathies. Recognition of the association between auricular calcification and adrenal insufficiency can be an important step toward the identification of a life-threatening cortisol deficiency.
Uthoff H, Wiesli P. Auricular Cartilage Calcification and Adrenal Insufficiency. New England Journal of Medicine 2010;364(2):157.
A healthy 60-year-old man presented to the emergency department with profound hypotension 1 day after sustaining a minor hand laceration with minimal blood loss. Physical examination revealed stiffness in both ears, and calcification of the ears was subsequently revealed on computed tomography (Panel A, arrows) and radiography (Panel B, arrows). The patient's hemodynamic status improved promptly after administration of antibiotics and glucocorticoids, and he recovered with support from the intensive care unit. Subsequent detailed investigations showed adrenal insufficiency. Long-term glucocorticoid-replacement therapy has resulted in marked abatement of the patient's long-standing fatigue. Although rare, calcification and even true ossification of the auricular cartilages have been described in association with mechanical tissue injury, exposure to cold, inflammatory conditions, and endocrinopathies. Recognition of the association between auricular calcification and adrenal insufficiency can be an important step toward the identification of a life-threatening cortisol deficiency.
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