Can adrenal insufficiency mimic arthitis


Im am still trying to get a diagnosis. I suffer from joint pain and stiffness. All blood test so far have been normal, though prednisolonen helps with both. I have had ultrasound of my hands 3 times, MRI and 2 isotope bone scans, all of which doesn't show anything except what is normal.

I have been examined by several rheumys. The latest one have also checked for Sjögrens. Since I do respond well to prednisolonen she has now tried to refer my for a test for adrenal insufficiency. I never head about this before so does anyone here know if it can mimic the arthritis symptoms?

I am getting quite desperate that no one seem to be able to find out what is causing this. Now I am only taking OTC pain killers and it is getting harder and harder for me to keep up with working full-time.

34 Replies

  • Have you had your thyroid function checked? Thyroid dysfunction can give symptomps that very much resamble RA. Adrenal fatigue is often caused by low thyroid function. May be an idea to take up with your doc, if it hasn't been discussed. Good luck.

  • Thanks for your answer. I had THS level checked in all my blood tests and they are within normal range.

  • If you didn't have the whole thyroid panel done, you don't get the whole picture, unfortunately. If adrenals fatigued there is as good as always a thyroid problem.

  • Until now I've only been examined for atheritis, the THS levels seems to be part of a normal blood panel (at least here in Denmark). I will await my appt end of october for getting the adreanals tested and then maybe ask about thyroid. thanks a lot for your help

  • It's really a shame that thyroid function is not thoroughly examined in every RA patient since it has been shown to be a dysfunction in so many RA patients and that make both symptoms worse as well as increases the risk for CVD. Another important examination is testing your estrogen-progesterone balance since if, which so often in AI, the balance is in favor of estrogen it means that it makes your inflammatory situation worse and adds to symptoms. Both these dysfunctions can be corrected easily without hard meds. Good luck. Hope this of some help😊

  • Thyroid was the first of many tests my GP quickly arranged.

  • My specialist did that here in Australia, there is also no test for Adrenal Exhaustion and it's not mainstreamthinking.

    I order my DHEA supplements from the USA

  • Yes I agree with that.

  • You may have seronegative RA?

  • That should've shown up on the isotope bone scan according to my doctor

  • Bone scans are notorious for being inaccurate.....but the combination of that plus MRI & ultrasound should have shown up something.

    Has Addison's disease been ruled out?

  • Hi.

    I think the adreanal insuffiency test I've been referred to is to test for Addison's disease (from what I've managed to read about the test online)

  • Hi mjf

    Not sure this will help as I do have a confirmed RA diagnosis. I have never had raised inflammatory markers from baseline to the present (ESR, CRP) nor very much visible inflammation.

    I’m currently on a Biologic so keep that in mind but I have also seen a doctor to test for adrenal deficiencies and hormone imbalance. My thyroid panel was in the normal range but the reason I’m responding to you is that my Iodine was very low which is often left off of most testing panels.

    My daily cortisol cycle is a bit strange. Generally we will have the highest level upon waking and then it gradually lowers throughout the day.

    My graph is much like an M. I have very little in the morning, then spikes, lowers again, spikes and then comes down. This will often correlate with Thyroid levels being disrupted. Mine, however, like yours test normal and she believes my Iodine level has a part to play in this along with a few other things.

    We are now in the process of bringing my Iodine levels up and balancing a few other things. I’m unsure if morning stiffness is related to adrenal fatigue but muscle weakness is and lower moods are.

    Not sure any of this is of benefit to you but I’ve been feeling loads better and maybe, just maybe, it’s all related and your RA like symptoms will subside if you address adrenal issues?

    Good luck.


  • Hello Lucy,

    I think you are on the right track concerning the spiking of your colesterol during the day. It is usually a sign that your adrenals are compensating the lack of glucose that is needed for body energy. The cortisol is then taking the energy from body tissues. The lack of glucose storage in your liver again has usually to do with a thyroid problem where T4 is not properly converted to T3 that helps store the glucose in your liver. By taking a small amount of T3 often resolves the situation as does a diet where giving carbs often enough during the day so that your adrenals won't get going. There is a thyroid forum on HU where there is a lot of useful information and where you can get knowledgeable answers to your thyroid questions.😊All the best to you. Simba

  • Hi Lucy

    Thanks for sharing. I will await my appt end of october to see test cortisol production. But I will keep this in mind

  • Here a discussion that may interest you about cortisol spiking.

  • Hi Simba, I don't want to hijack her post so I will leave it at this comment. I have a very low resting HR. When I wake it's in the low 50's. When I'm getting my infusion treatment it's in the low 60's. This, I believe is due to the fact that I was an athlete my whole life. I never have cold hands or feet. My Thyroid panel is normal except for my Iodine levels being very low ( most likely due to long endurance racing) I've also had adequate glucose and carbs throughout the day as that is what got me over many of those mountains on my bike but I'm now cutting way back on that and trying to limit processed foods and sugar. I do very much thank you for your thoughts though.

    Iodine was considered by my doctor to have an influence on my cortisol levels as well as being pretty highly stressed for a year trying to get my RA under control. I was given a few other supplements to help my adrenal insufficiency but I just wanted to point out Iodine to mjf as it often isn't tested. She also doesn't have a diagnosis as yet nor had her adrenal tests run.

    What's interesting is that her symptoms micmic RA and not particularly Addisons Disease (at least not as far as I know). I hope that everything is sorted for her soon.

  • Hi Lucy

    Feel free to highjack my post, I am learning so much from all the info here :-)

    I have had symptoms now for over 2 years so getting quite frustrated with no one being able to figure what is wrong. So all advise and information is welcome.

    Until now I have never considered adrenal or thyroid issues and neither have any doctor I've spoken to.

    With the referral for the test for adrenal insufficiency I've started to read a bit about Addison's Disease. Reading about the symptoms I guess I can recognize most of them, but then again it seems they are so broad it could be explained with a lot of other minor reasons too. My worst problem is joint pain, stiffness and fatigue, which I guess is why I until now have been referred to rheumy

  • Joint pain where in particular? Small joints of hands and feet or bigger joints like hips and knees? Did your doctor tell you he was referring you for an adrenal test because he felt it may be Addisons?

    Did anyone say they thought you may have the beginnings of OA? Your scans reveal absolutely no synovitis and yet steroids help?

    Did your symptoms start before, during or after perimenopause?

    I’m not a doctor but it’s my understanding that we can help each other with questions to take back to our physicians or to ask if a specific test could be run and if they feel it would make a difference for us. Twitchytoes, I think that’s her forum name has had her diagnosis changed frequently over the years perhaps you can look at her profile and see if anything fits with you too?

  • Started in hands and feet. During the last 6 months I also started to get some pain in one shoulder.

    Nobody have mentioned OA so I guess I don't have OA since it should have shown up at some of the scans or ultrasound.

    I am only 39 years old so it started before menopause.

    The doctor didn't use the phrase Addisons, she said adrenal insufficiency should be tested since I react to prednisolonen. So I guess she is thinking addisons.

  • Gosh, I know it’s crazy hard to wait for your adrenal tests but maybe that will give you the answers you’re looking for.

    In the mean time keep reaching out to others to see if they can help give you other ideas or at the very least some support. I can’t offer much but I do support you and hope it gets sorted out soon.

  • Hello mjf09,

    Adrenal and thyroid issues usually go hand in hand. If your thyroid function isn't supporting your enrgy production your adrenals will try to do the job with the help of cortisol that actually stresses out your adrenalin gland. Overproduction of cortisol seen in addisons disease is an other thing where there is a tumor in your pituitary gland that causes it. It is much more common that RA symptoms are seen in hypothyroidism and have been helped by supplementation with thyroid hormon.

  • Hi

    Since my THS levels are fine I doubt I can get them to test for more specific thyroid stuff. But I will definitely keep this in mind and try to push for it if the addison test doesn't show anything

  • Here some info that may be of help😊

  • And on the RA hypothyroidism connextion...

  • Thanks so much for the links. Love all the help and support om this site.

    If test shows nothing and doctors won't test thyroid I guess I'll have to look into if it's possible to get tested privately

  • One short question. You don't see the cortisol spiking as a possible compensatory move for the body to get the needed energy? Have you tested your glucose levels during the day in connection with cortisol spiking. In endurence sports the body does swich over to stress mode to cope with the physical stress.

  • I have only heard the phrase but don't know what Addisons Disease is

  • Sorry, I can't recall if I've suggested this before but would it be worth you seeing if you qualify for this trial?


  • Hi

    Thanks for the suggestion, unfortunately I am from Denmark so not really a possibility for me

  • This is quite complex. The release of cortisol indeed spikes during endurance sports when your VO2max is above or around 70% and it’s a normal metabolic function whether it’s because it’s trying to compensate for the need of more energy is irrelevant.

    If you are fitter and more trained you release less cortisol during those spikes. There are specific symptoms that you would notice if cortisol spikes are a big problem like weight gain around the middle, chronic fatigue, etc. All of which I don’t have.

    No one can perfectly balance glucose intake with cortisol spikes and it’s only extremely important to monitor if you are diabetic.

    My body is use to the stress during sport which I can manage with the right fueling before, during and after.

    What it isn’t use to is the mental stress from being diagnosed with an autoimmune disease which is ongoing and with changing hormones due to, well, nature and that gets interesting to me because as you know progesterone and testosterone declines much quicker than estrogen.

    I do think it’s a really good idea to have hormones and micronutrients checked. If your RA is under control with treatment and there’s little to no symptoms and you still feel tired and dealing with chronic fatigue I’m not so convinced it’s always the disease. If the disease is quiet and inactive why should the fatigue be blamed by the disease? Maybe looking at deficiencies in micronutrients, like vitamin D, selenium and zinc along with possible hormone or thyroid issues would help? I don’t suffer from fatigue. Is that from my disease being very well controlled or the micronutrients I take along with trying to balance my hormones, or exercise? I don’t know, but I’m betting on all three.

  • Have you been tested for Lyme Disease? There aren’t many Lyme literate doctors in the world and it often goes unchecked but perhaps it’s well looked after in Denmark?

    Just a thought.

  • I have a very up to date and enlightened Rheumatologist here in Western Australia.

    I have had Rheumatoid Arthritis for 28 years now. I haven't worked since 2004.

    He Diagnosed Adrenal Exhaustion five years ago and told me how to order DHEA tablets online. If I run out my energy slumps accordingly.

    In the same period he diagnosed dry mouth syndrome and dry eye syndrome, I learned later from my own reading that it is Sjogrens Disease. For the past four to five years my teeth are breaking in halves sometimes under the gumline.

    Eight years ago he diagnosed Underactive Thyroid and now I am on three tablets a day 50mcg, I started on one.

    For the past twenty years I have been afflicted with Angina, I have not had a heart attack and two Angiograms showed heart fine.

    I take heart medications every day and have Nitroglycerine spray and tablets.

    I have been led to believe that the CRP part of the monthly blood test that shows inflammation affects the heart, and as my disease has been out of control due to family stress, I don't know which comes first, the Angina from stress and/or the inflammation.

    It is a rotten disease and joint mobility is only part of the overall picture.

    I had early osteoporosis fifteen years ago which was treated immediately and calcium tablets have restored bone density. I have regular bone density tests every two to three years

  • Just another quick note, my Rheumatologist picked up Adrenal Exhaustion because I said I was so exhausted but although I had a sweet tooth, I was craving licorice all sorts out of the blue, I could eat a pack a day! He said that was enough for a diagnosis, licorice was a good source of energy and my body desperately needed it

    He started me on DHEA and the craving stopped. I know Hypothyroidism makes you gain weight too.

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