Hydrocortisone & HPA axis suppression

[amethyst1969]

Hi, could anyone clarify if a daily dose of Hydrocortisone @ 20mcg per day for a prolonged period (say 6 months) would result in suppression of the HPA axis? Many thanks in advance.

[radd]

amethyst,

I haven't medicated HC but 20mcg (?)  seems quite a low dose for the HPA axis to become suppressed.. 

Cortisol secretion is controlled by ACTH (pituitary) which in turn is regulated by a hypothalamic hormone CRH. Both ACTH and CRH are controlled by cortisol through a feedback mechanism, i.e.- the more cortisol, the less ACTH and CRH are released, and the less cortisol, the greater ACTH and CRH that is released. These can be influenced by the addition of HC.

Every one is different due to kinetics, the efficiency of transport proteins and the variance in clearance rates. Ensure your doctor is aware of that HPA axis activity may need to recover, encouraged by gradually reducing HC dose.

[amethyst1969]

Oops - that should read 20mg (not mcg!)

[galathea]

Suggest you  have a look at this book......   There are excepts all over the web... It might even be in the thyroid uk library?    amazon.co.uk/Safe-Uses-Cort...

Xx. G

[galathea in reply to galathea]

I took hc for two years...  I did a saliva adrenal test and found my levels mid moning and mid afternoon were very low.....  So i supplimented throughout the  day...  I  started at 25 mcg  (or mg). And  weaned off over the two years.      It made a massive difference..... Much more noticable than any tweaking of my thyroid meds ever did.....      If i needed to do it again i would have no hesitation.

I got most of my info and a dosing schedule from the yahoo adrenal site.   They now have a website....  At.....

 rt3-adrenals.org       

G xx

[galathea in reply to galathea]

rt3-adrenals.org     Have just added this as missed it off my earlier reply..

Xx

[jennygrigg]

Hi amethyst69,

My daughter is on HC, has been now for 3 years.  My understanding is that when using HC therapy  you need to use the minimum physiological replacement dose of 25mg, and stress dose when ill or under extra stress. Any dose of HC will suppress your adrenals and doses smaller than 25mg will leave you feeling terrible. The idea of HC therapy is to suppress your own cortisol production in order to rest the adrenals and allow them to recover, then after a while you wean very slowly hoping adrenal activity is picked up and then will resume full working capacity. If your adrenal insufficiency is due to Addison's disease then HC therapy is lifelong.  The stage of your adrenal fatigue will dictate how long you are on HC therapy. Dosing should follow your natural diurnal curve of higher in the morning and lower in the afternoon. You should wear a Medicalert bracelet stating you are on HC in case of emergency treatment.

Good luck

Jenny

[HIFL]

Yes, 20 mg per day will suppress your HPA axis, for as long as you take it.  Have you been tested to be sure that your cortisol levels are truly low and flat-lined?  Is a doctor advising this, or another forum?  I only ask because I've read horror stories, and many wish they'd never gotten on this protocol.  On the other hand, others truly need to supplement the HC.  Have you read this?  Some good info on the pros and cons: tiredthyroid.com/hc.html

[determined56]

Please do not go the HC route without dr confirming necessary.once on it your adrenals are suppressed and have to fight hard to recover...

I am a lifelong steroid replacement user since a baby when adrenals did not work but know enough to increase when necessary but to decrease very slowly.

You do not want to go this route before proper blood tests taken / day curve to confirm the need for HC. Steroids are to be respected.......

From someone with nearly 60 years use .the other warning sign from HC over use is Cushing syndrome from over medication or long term use...

Please take care my friend

Hugs to all

[marigold22]

I was on hydrocortisone for 18 years.  My adrenals were very low from long term undiagnosed hypothyroid. Dr P put me on 5mg a day, but then he had his 'troubles' & I self medicated. While self medicating on hydrocortisone, my thyroid med from GP was much too low, unknown to me.  Certainly the hydrocortisone helped to get me through life.  Then 2 years ago I saw the best endo ever, who sadly has since gone to Oxford to do research on diabetes (of all things). He told me to come off the hydrocortisone 1mg a month.  I had doubted that I would ever be able to get off hydrocortisone but his advice was correct.   By the way, 8 years ago I was taking far too much hydro whilst self medicating- 10mg a day, & after a build up over a couple of years I ended up in hospital in an overdosed state.  I can tell you the hospital doctors were fuming with me, particularly when I had to admit I had been buying it on the internet.   Also now aged 65, I have osteoporosis & I believe it's from hydrocortisone,  So, please do take care.  

[amethyst1969]

Thanks to all for the helpful replies & informative links. Perhaps I should have given more personal info regarding my circumstances when posting my original question. Diagnosed Hypothyroid in June 2012 & given Levothyroxine 75mcg daily. Diagnosed Cushings Syndrome due to Adrenal tumour in Feb 2013. Adrenalectomy performed Aug 2013, leaving me with 1 Adrenal gland. Post surgery gradually weaned down from 40 mg to target daily dose of 15mg Hydrocortisone (HC). I really tried to tolerate this dose but found it too much of a physical (&  mental!) struggle, & definitely could not complete an 8 hour day at work, so Endo settled for me to raise to 17.5mg. This too is hard for me to cope with & I find that over the last 6 months I have relied on a 20mcg daily dose to enable me to get through. Still I have little quality of life & am too exhausted after working all week to have any social life. My weekends are spent catching up with housework I am too tired for during weekdays after work & resting, in preparation for work on Monday. Live alone, family live approx 300 miles away, do not generally enjoy others company when I feel so "unenergetic"........I think you can get my drift!. Anyway, returning to my original post : my regular 6 weekly 9am bloods have shown that my remaining Adrenal has yet to awake from its hibernation following the Cushings. My Endo has never explained to me that HC dose levels above a certain number would result in complete suppression of the HPA axis - I thought that increasing by 2.5mcg would maybe just delay the "wake up". So, I stumbled upon something on the web that said 20mcg would cause HPA suppression & was horrified to think that I may have put myself 6 paces backwards on the road recovery. But then again, what else could I have done to be able to work & pay the bills. Rock & a hard place??? Any helpful suggestions grateful, thanks again.

[galathea in reply to amethyst1969]

Well, no idea what you have been reading,  but in the book, "safe useage of cortisone"   Its said that 20mg wont mess up adrenal function...

Are you being given hydrocortisone  which needs multidosing throughout the day, or are you on prednisolone, which us a different thing altogether.....   20 mg of prednisolone is equivalent to something like 60mg or 80mg of hydrocortisone.  

A lot of the time prednisolone is called cortisone, but it is a synthetic version.....

Maybe time you had a saliva test to find out when you are short of cortisone and then multidose accordingly?

G xx

[greygoose in reply to amethyst1969]

Amethyste, I Don't know if my experience is going to be of any help to you, but I was put on HC by my doctor about 10 years ago. A very experienced hormone doctor who took HC himself.

He started me on 40 mg, which then went up slowly to 60 mg. And, he said that if I felt the need - stress, illness, etc - I could take more. But, he said, the golden rule was to never take it after 1 pm. One dose early in the morning, one at lunchtime - this is when the adrenals are at their busiest, and you just gave them a helping hand so that they weren't so over-loaded. But, after 1 pm you should leave them to cope for themselves. They didn't need to produce so much after that, production gradually wound down until bedtime. And that meant that they weren't struggling all day so that they finally managed to produce a decent amount of cortisol just at the moment that you wanted to go to sleep!

I took it for about a year and then gradually weaned off it. On a couple of occassions since then, I've felt the need to take it again, but just for short periods and a lower dose. Now, I think my adrenals are fine.

I know it's not quite the same case as yours, but I think the rule of not taking it after 1 pm is important. Worked for me, anyway.    

[janeofjungle in reply to greygoose]

Did you have low adrenal function when you were put on it? Or for other reasons?

[greygoose in reply to janeofjungle]

I had very low adrenal function.

[greygoose in reply to greygoose]

What other reason could there be?

[janeofjungle in reply to greygoose]

I read that hc can be given to those with other conditions like ovarian dysfunction or autoimmune diseases...

Im really at a loss of words right over my situation. I thought i had adrenal fatigue but my morning cortisol was pretty high and then normal/lower throughout the day.

But im having so many horrible low AI symptoms and thought I even had another adrenal crisis a few days ago because of terrible lower back pain abdominal pain and hypoglycemia and terrible fatigue plus have lost weight and my appetite and feel very lightheaded. The pain in my flank area makes me want to pass out because its so bad.

[greygoose in reply to janeofjungle]

Well, I've never heard of HC being given for those things - except that, having those conditions could cause adrenal fatigue, so, in the end, it all comes down to helping the adrenals.

The symptoms you describe could all be down to low thyroid.

[janeofjungle in reply to greygoose]

Did you have severe flank pain that radiates up back or abdominal pain?

God this almost like Addisons?!

[greygoose in reply to janeofjungle]

No, I didn't have that.

It can't be Addison's if your morning cortisol is high and the others are in range.

[janeofjungle in reply to greygoose]

What if I was in the process of developing it just now?

Its so strange because I have all the syptoms of adrenal fatigue and the heart palpitations and exercise intolerance ....

I do have an adenoma on my right adrenal gland..

[greygoose in reply to janeofjungle]

Well, it's probably that causing the pain, then. Heart palps can be symptoms of low thyroid, or high thyroid. Exercise intolerance is also a hypo symptom.

[janeofjungle in reply to greygoose]

But all this happened after I had my adrenal crash and it seemed ro weaken my entire body and now have medication and supplement intolerance and if i take for example progesterone cream my heart literally beats out of my chest

Its like it cannot tolerate it

[greygoose in reply to janeofjungle]

Perhaps you don't need it. What makes you think you had an adrenal crash?

[janeofjungle in reply to greygoose]

Oh what I experienced was sheer terror. I had abrubtly stopped eating gluten and was having severe pancreatic pain and then BOOM I ended up with horrendous low blood sugar body shaking slurred speech severe chest pain extreme intolerance to all the stuff I was taking before meds supplements very bad heart palpitations it was horrendous...i seemed to he getting a little better a few months later but now im gettting worse than ever before and the lower back and flank pain is so horrendous it feels like im going to die

[greygoose in reply to janeofjungle]

I'm sure it was horrendous! But why do you think it was your adrenals causing it?

What does your doctor say about all your symptoms?

[janeofjungle in reply to greygoose]

Because after I was asked to to an ACTH stimulation test and all it showed was that they were hyperfuncrioning and I felt a doom and gloom and so sick after doing that test.

But again now my symptoms point to adrenal fatigue and im so baffled and scared. I was back in hospital the other day due to what seemed another crash with similar symptoms to what I had 3 months ago and low blood sugars and chest pain flank pain low back pain....and I read that is what an adrenal crisis is

[greygoose in reply to janeofjungle]

OK But, high cortisol is Cushing's, not Addison's. And you wouldn't take HC for Cushing's. I'm not sure how you would treat that.

[janeofjungle in reply to greygoose]

But im losing weight not gaining and have low blood sugar and cushings seems to be the opposite of that?

Im lethargic and feel like fainting terrible headaches intolerance to meds and that I read comes after an adrenal crash or fatigue type situation

Im so scared

[greygoose in reply to janeofjungle]

Yes, I can imagine you are. But, losing or putting on weight in and of itself proves nothing.

I've got to go out now, but sometime later, I will read through your past posts and see if anything jumps out at me.

[janeofjungle in reply to greygoose]

Yes but sudden weight loss and appetite loss and all the other strange symptoms are quite alarmimg

[amethyst1969]

Thanks galathea & greygoose. In reply, this is what I read (hope its ok to post the link?). Ignore 1st half of page, I realise they are talking in reference to skin conditions, & scroll down to "comparison of systemic steroids" table: dermnetnz.org/treatments/sy... ....Yes, it is definitely HC that I am taking - currently 10mcg at 6am so that I can get out of bed & get to work, & 10mcg around 2pm (any earlier & i'm almost asleep at my desk by 4pm & don't end shift until 5.30pm!) I think I will try the 1pm method & see if I can still function adequately long enough (don't hold ya breath tho'!!) Re saliva test : I'm not due to see Endo until Sept now -  think I may have pushed him a bit too far last time by begging him for T3 to accompany my Levothyroxine (to which he finally gave in). Sept I am also due for a check on the state of my Pituitary microadenoma by way of MRI. In the meantime I think I will have to bite the bullet once again, & try for 15mcg HC a day (again - don't hold ya breath there either ! ). I just so want my Adrenal to wake up so that I may have more of a chance of getting my "life" back on track & me out of this "on hold" state of existence X

[Hidden]

Taking your last HC at 1pm leaves you  very long period without any cortisol in your body, have a look at at the CAHISUS website on Circadian dosing,   cahisus.co.uk/pdf/CIRCADIAN...  although its aimed at children with adrenal insufficiency it relates to adults as well. That's bad luck if you've had an adrenal tumour & you've got a pituitary tumour! I've got secondary adrenal insufficiency due to a pituitary tumour surgery & am on 20mgs of HC. I've experimented with doses & times to try to get the best dose for me, don't be afraid of trying within the parameters of your prescribed dose. So I take 2.5mgs at 3am (yes that's right) I've got RA as well & find this helps to reduce the stiffness; 5mgs at 7am; 10mgs at midday (I was finding that it was feeling nauseous & heady with lack of appetite late afternoon if i took less)  & 2.5mgs at 4pm.  There is research coming out that suggests there is no real difference on sleep if taken later in the day - you just have to try to see what works for you. There some good groups on FAcebook if you are on there.  Good luck!

[amethyst1969 in reply to Hidden]

Thanks PaulineS, the cahisus link/website makes some interesting & informative reading. Re my dose times : the reason my Endo put my last dose at 2pm, was so that there would be a longer cortisol "starvation" period which would, hopefully, help in kick starting the remaining Adrenal...........................Yep, after almost 3 years, I'm still waiting for that magical moment !! Happy for you that you seem have have worked out a completely unique & unorthodox HC dosing regime that is a success for you - well done ! Take care & best wishes x

[JacquelineR]

Do you mean 20mg? 20mcg is a tiny amount!

[amethyst1969 in reply to JacquelineR]

Yes, of course I mean 20mg !! Doh - got my mcg's & mg's mixed up as I was writing about my Levo dose in the same thread. Why? Do you have useful info for me ??

[amethyst1969 in reply to JacquelineR]

If you read on, I had corrected this further down the thread.

[JacquelineR in reply to amethyst1969]

So my experience with hydrocortisone is that taking 30mg or less is a physiological dose so it will not cause your body to stop making cortisol. hormonebalance.org/userfile.... I was taking 7.5mg daily for crashed adrenal glands and I started seeing a new doctor who suggested increasing it to 30mg.

[amethyst1969 in reply to JacquelineR]

Thank you for the info & the helpful link. Take care x

[JacquelineR]

Sorry, I didn't read the entire thread, I only had a few minutes! I do have some info, I'll reply with it as soon as I can!

[janeofjungle]

Im currently dealing with severe adrenal fatigue and had a very bad crash a few months ago.

From what Ive read, such small doses like 20mg of HC will NOT cause adrenals to shut down.

What doses are these people taking?? And is it bioidentical cortisol or the more potent synthetic stuff??