I have been asking myself a lot of question lately about adrenal fatigue and the best way to treat it:
I was diagnosed with adrenal fatigue in late 2011, by a so called Hertoghe doctor in Belgium who used blood and 24 h urine analyses to diagnose it. At the time, I had spent 11 years on thyroxine without seeing much improvement (diagnosed with Hashi's in October 2000). It kept me alive, but not much more.
I later read that adrenal fatigue should preferably be diagnosed using a saliva test.
I felt much better after being put on NDT and Medrol. The doctor explained to me that, since I had a tendency to retain fluid, HC would make that worse, which is why I should take Medrol instead (4-6 mg/daily). Prednisolone was an alternative, but Medrol was said to be longer-acting and result in more stable cortisol levels.
I spent several years on Medrol (most of the time, 4 mg/daily turned out to be enough), and the doctor whom I see once a year told me last summer that I'd need to take it for the rest of my life.
This would imply that adrenal fatigue is a chronic condition rather than a reversible one.
Against doctor's advice, I decided to wean off Medrol slowly, and take supplements for adrenal support (incl high doses of vits B and C) to see if I could live without it. Even if I take what the doctor calls physiological doses of Medrol, it's still a steroid and I wasn't comfortable with the idea of taking it for the rest of my life. After all, I've read so many times that adrenal fatigue and be reversed and that any kind of prescription drug (HC, Pred or Medrol) should only be taken for a limited period of time.
However, since stopping Medrol completely (I weaned off it slowly during the period July-October 2018), I have felt worse: more fatigue, NDT seems to work less well, I need more sleep but don't feel rested even after 10 hours of sleep and, worst of all: my salt and sugar cravings are back with a vengeance. That is a disaster for someone who gains weight by just looking at a bag of potato chips... I also tend to retain more fluid and my face looks more bloated off Medrol.
Has anyone else successfully weaned off a drug like Medrol (or HC or Pred)? If so, did you suffer similar side effects? Or can adrenal fatigue be a chronic condition like adrenal insufficiency, although not fatal? Or does the T3 in NDT make me need more adrenal support than would be the case if I were on T4 only?
I would not have a problem going back on Medrol if that made me feel much better. I have read so many times that steroids are bad for you, but I guess statements like that refer to supra physiological doses of the drugs said to shut your own adrenal glands down.
I know some people with rheumatoid arthritis taking high doses of Pred (40-60 mg/day) and they have gained 30 kgs, mostly around their waist, which they cannot lose, and have developed the typical moon face. However, that never happened to me on 4-6 mg of Medrol daily (the equivalent of 20-30 mg of HC or 5-7.5 mg of Pred), and I don't expect that to happen in the future either.
There is a supplement sold OTC which contains 5 mg of biological hydrocortisone: AdrenalMaxSupport Plus. I have considered giving it a try, but then thought: if I do indeed need adrenal support and Medrol works for me, why switch drugs? The obvious disadvantage of HC to me is that it needs to be multi dosed.
I'd love to hear about other people's experiences when it comes to adrenal fatigue (a diagnosis many doctors won't even recognise).
I have been off and on 5 mg prednisolone, which is equivalent to 4 mg of medrol approximately.
I weaned off with no problem but I was a marginal case and may not have needed it anyways. I just had a lot of symptoms and didn't want to waste time. I wasn't concerned with suppression personally.
If you have a condition like addison's, then no, it will likely never come back. If you were 'exhausted,' then I don't know, and I'm not sure if anyone else does either. Testing seems the only way to find out. Have you tested since going all-natural?
From what I've read, thyroid will lower transcortin (the cortisol binding protein) and accelerate the use of free cortisol. So, I have always wondered if pre-thyroid therapy, if the cortisol numbers are that useful for determining if you will have enough cortisol once you ramp up metabolism with more thyroid hormone. It seems very tough to test. It seems to fluctuate a great deal each day too.
Also, in the studies I read, I did notice that the traditional doses (5 mg pred, 4 mg medrol, 30 mg hydrocort) seemed to be more suppressive for women than for men. There is a meaningful surface area difference and average weight between men and women, so perhaps the doses are too high for women. Maybe 3-4 mg prednisone or 3 mg medrol, for example. This is not only meaningful for suppression but also for when symptoms (long term and short term) might kick in.
Some of the weight gain from higher therapeutic doses could be from deteriorating insulin sensitivity. At higher doses, it can raise blood sugar some and personally, I've always wanted to know if it raises insulin - as I view that as the more important question. Merely testing blood sugar is often insensitive for marginal cases IMO.
People become insulin resistant in western societies anyways and anything that'll raise blood glucose could accelerate the process. Perhaps adding in otc insulin sensitizers, like lipoic acid or chromium could make sure that isn't an issue.
I was told, back in 2011, that anything lower than a minimum replacement dose (4 mg of Medrol or the equivalent doses of Pred or HC) would partly suppress my own adrenals without the benefits of a full replacement dose (symptom relief), so that was never an option. I have never heard about that dose being even lower for women, but it's an interesting thought.
The information on adrenal fatigue is quite contradictory, with some experts claiming it doesn't exist while other say it's either a reversible or chronic condition. I have often wondered if the adrenal glands can become so tired after years of being hypothyroid that they never fully recover even after you're on optimal doses of thyroid hormone...
What you say about thyroid hormone decreasing the cortisone binding hormone and increasing the need for free cortisone makes sense, and I agree with you it would be very difficult to test. So maybe symptom relief is what we should go by...?
And no, I've been never been retested. I don't know how other doctors work, but the Hertoghe doctors only order a full hormone panel (blood + 24 h urine) between the first and second visit. After that, they only test blood, and not for cortisone but thyroid hormones and sex hormones.
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PS. I have also wondered if Medrol has a positive effect on my Hashi's, meaning that maybe it calms the inflammatory process down somehow...?
I know what you mean about the Hertoghe doctors. I got all the paperwork but didn't go in. I'm an american living in London, so I have lots of options, and went someplace more convenient.
I think 'adrenal fatigue' can exist. The acth stim test probably isn't that sensitive.
I wonder about the hypothyroid induced adrenal fatigue myself. Thyroid has a profound effect on maintaining blood sugar, so the adrenals definitely could be working overtime to keep blood sugar up and stable. So I definitely think it's possible.
What I ultimately decided for myself, was that if I ever have hypoglycemia issues or signs of inflammation, then I'll see about adding it back in. Many diseases seem to have an inflammatory component, and from what I could tell, those taking low dose corticosteroids do have lower systemic inflammation.
It never shut down my own production at all. The very next day, or even later the same day, my ACTH would be back up again and cortisol would be normal.
And what you say about it helping your Hashi's sounds reasonable to me. That's good to hear.
And about Hertoghe's approach to testing. I don't know specifically about the saliva vs urine cortisol test, but I do like his approach of testing multiple ways. The more I studied these things the more I started to realize how often they can be inconclusive. Binding proteins, rates or turnover, interaction with other hormones, and altered needs when you add in a single hormone, etc.
I doubt some of the urine measures as a MAIN test but find them useful as a secondary test. I've been to a few really ritzy doctors who have been known to get results, and the main diagnostic theme I've observed, is how thorough their testing is, followed by a 'let's try this and see.' That may be the best modern day endocrinology is capable of.
I just read this article by US osteopathic doctor Alan Christensen, a proponent of NDT, who claims that prescription cortisone will provide short-term relief but long-term side effects. Therefore, he advocates the use of adaptogens and supplements to support tired adrenals which, according to him, are not incapable of producing cortisone but rather UNWILLING to do so.
However, since he also sells his own expensive products in his webshop, I decided to take everything he says with a pinch of salt...
Thank you so much again for all your input and interesting ideas
I wonder as you have been taking steroids for many years your adrenal glands have given up producing cortisol because you have been supplementing it for so long? I have secondary adrenal insufficiency. I had a pituitary tumour which caused Cushing's disease, (the opposite of adrenal insufficiency) however once the tumour had been removed I needed replacement steroids to keep living. The idea is for the pituitary to wake up again & start to produce ACTH to simulate the adrenal glands to produce cortisol. It can take up to two years for this to happen, but after that period of time there is less chance of cortisol being produced. I wonder if this has now happened to you? In which case you need to have some tests done under an Endocrinologist to rule this out or in. If you do have it, it is now a life threatening condition in that as your body doesn't make enough cortisol you could go in "crisis" - you can die if you don't have an emergency injection of Hydrocortisone. I have to take steroids on a regular basis to live & function, I have to carry an emergency injection with me at all times & wear a medic alert bracelet to notify people I have a life threatening condition if in an accident or such.
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Yes, what you say may very well be true...I honestly don't know if long-term steroid supplementation can cause the adrenals to shut down, even if you only take physiological doses...it seems impossible to find an answer. The Hertoghe doctors seem to consider it a condition requiring life-long treatment with physiological doses of either HC or Pred/Medrol.
Other doctors will only use it short-term (8-12 weeks) while some recommend using adaptogens only and avoiding steroids altogether.
One problem would be finding a knowledgeable doctor as I suspect many endos won't recognise the diagnosis "adrenal fatigue" nor have no idea how to treat it...the impression I get from reading other people's stories is that most doctors will not react as long as your cortisol levels are anywhere in range, just like many doctors won't be able to diagnose hypothyroidism until your labs are clearly out of range even though symptoms usually occur much sooner as your levels are simply "in range" but no longer optimal. I would expect my cortisol levels to be lowish but still in range, so not sure how many doctors would agree to prescribe treatment.
Since weaning off Medrol, although I've felt slightly more sluggish and been craving salt and sugar more than I used to, I have also had a couple of bad colds which I survived without problems, and I'd expect a person with insufficient cortisol production would have a much harder time coping with that. Or did I get this all wrong...?
Thanks again, appreciate your input!
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Then there is the question whether HC is better/more gentle on the body than Pred/Medrol, mainly used to treat inflammation? After all, HC is bio-identical which is why some doctors treating adrenal fatigue will only use HC, not Pred/Medrol. Of course, HC needs to be multi dosed which can be a hassle, but healthy adrenal glands also secrete cortisol throughout the day so maybe that is simply a more natural way of supporting the adrenal glands...?
HC needs to be multi-dosed if you have adrenal insufficiency. If you have adrenal fatigue, you should not take it more than twice a day - never after 1 pm because that way you would shut your adrenals down.
I took it for a couple of years - I can't remember doses because they varied. In fact, my doctor prescribed me extra so that I could always increase it if I felt the need. But, said only to take first thing in the morning, and at lunchtime. Leave the adrenals to work for themselves the rest of the time.
After about two years, I was able to wean off safely. But it's not something I would recommend to anyone unless they absolutely needed it. The water-retention is terrible, and difficult to get rid of, afterwards.
Thanks, GG, very interesting and helpful input! Yes, the doctor who put me on Medrol did say that HC can worsen fluid retention (a problem I already had after being hypothyroid for years on T4 only with FT3 levels below range), which is why I should take Medrol instead...but I really think it's a good idea to wean off prescription steroids if at all possible as I worry about long-term side effects. Now that I'm finally off Medrol, I'd hesitate to go back on it or any other prescription drug.
What you say about people with adrenal fatigue needing to take HC only twice daily unlike patients with adrenal insufficiency makes a lot of sense!
Hi there I too went to Hertoghe was put on 4 mg Medrol in 2006 - but as I had been put on Levo tablets by the NHS and was suffering with dreadful adrenal issues because they did not have the capacity to help with the uptake needed by the metabolism speeding up - it helped stabilise the issue. However got Sepsis 2017 and the hospital said we 'don't do Medrol' here and put me on HC - I came out on 200 mg !!! It took me 18 months to get down to a lower dose - but got to 30mg and my legs swelled up twice their size and phoned my NHS consultant who said you will have to switch back to Medrol because the anti inflammatory part of HC was not enough for me any longer. I am now down to 4 mg again (equivalent of 20 mg of HC) - when I was in hospital I asked the Drs who were looking after me - I feel really good on HC - he said it is a much better product for the adrenals as it controls water levels better - I have to agree.
I came off NDT a couple of years ago due to side effects - excessive sweating etc. - as too much T3 for me. Now on Levo liquid as I am lactose intolerant - so a lot of my previous issues were more than likely exacerbated by me losing levo thyroxine down the loo - ie malabsorption - so got that sorted but still not able to get off the Medrol - funny thing is that when I try to take it down to 3 mg - my blood pressure goes sky high - then take it back to 4 mg - and blood pressure goes down - my consultant does not understand that because it should go down as you put pressure on adrenals - but I think I have worked it out - the adrenals are responsible for blood pressure together with kidneys generally - and I have an issue with the kidneys - so I think the steroid is keeping inflammation down and when I try to drop it - they become inflamed again.
If you need adrenal hormone such as Medrol - then you should not worry because you are just replacing a deficiency - i.e. Addison's - however I am now Adrenal Insufficient II as you are - but having been diagnosed with Low DHEA and Pregnenalone and Progesterone and Testosterone for many years but I have never been able to take tablets or creams in relation to these deficiencies - not realising until recently that I probably had side effects because my thyroid was not being helped by the Levo tablets lactose content as previously stated - so I have started researching DHEA again and have just started taking 10 mg - DHEA makes testosterone and cortisol and oestrogen - so I came off my HRT which I was not told to do previously when I tried - so had an issue with sweating - have been off HRT for about 3 months - so thought it OK to have another try - unfortunately DHEA does not make Pregnenalone which makes all the adrenal hormones including Progesterone which I am severely deficient in - my levels are 0.1 and range 0-10. So far so good and I know DHEA is used in Lupus patients to help them get off steroids - and I feel after it gets into the system for a few months or weeks I should be able to drop down - in my case I firmly believe all my issues have been adrenal related but sex hormones within the adrenals - hence why higher doses via creams and tablets did not work - it is a marginal amount I need via the correct pathway. It has taken me 25 years to get to this stage - all by a process of elimination - so hope this helps. I also need to add that when I mentioned to a Professor in Endo recently about progesterone he said we dont deal with that it is a gyney problem - you could not make it up.
PS. Can I ask why you opted for DHEA instead of pregnenolone?
Very interesting story, thanks for sharing! Yes, I was told Medrol is better if you tend to retain fluid. Also, I don't think physiological doses such as 4 mg daily will suppress my own adrenals completely; I think you'd have to take supra physiological doses for that. I was told by the doctor who prescribed Medrol that I could go as high as 8 mg daily (equivalent of 40 mg of HC) in case of severe illness such as the flu or pneumonia, but not for more than five days. I was also told doses of up to 6 mg/daily are considered a safe replacement dose. However, most of the time, I did fine on 4 mg a day.
I have been trying to find out if steroids should be considered a short-term treatment for fatigued adrenals of if the condition could be life-long. Your experiences suggest treatment could indeed be permanent or at least long-term...which is what I suspect is true for me as well.
I did feel much better on Medrol and, almost six months after weaning off it, I still don't have the same energy levels as I did while on it. For instance, on Medrol, I took 5 grains of NDT daily and felt great. I even managed to lose weight for the first time in years. What's even better: I managed to keep my new, lower weight. After going off Medrol, I've had to lower NDT to 3 grains daily to avoid hyper symptoms such as sweating and racing heart. However, it's clear to me that 3 grains daily are not nearly enough for my body's needs. I've regained the weight lost and put on a few extra kilograms in the process (in total ca 20 kg weight gain in six months). So it would seem that, without the Medrol, my body cannot handle the onslaught of T3. At the same time, I seem to need a lot of T3. Another reason to reconsider the decision to wean off Medrol...
HI I did go on Pregnenalone but unfortunately for me my blood pressure which is a little high at the moment (steroids raise blood pressure) went up to 200/150 or similar and it frightened me - so taking DHEA does not seem to raise blood pressure so much and that is because Pregnenalone promotes aldosterone which is the hormone that raises blood pressure in the body when it falls low. The ideal scenario is that you take both together but I am too frightened to take Preg again for the moment until I get down off the steroids as it is preg I am also low on. It is the master steroid hormone that supplies all of the adrenal hormones needed including cortisol that our steroid supplies. Even better that it supplies all of the adrenal glands hormones - it knows exactly where to place the hormones that are deficient or low automatically which is a fantastic response.
Yes hopefully I believe my issues were low progesterone/high oestrogen all along - looking at the symptoms of low progesterone it affects thyroid - I had fibroids at 33 - fibrocystic breasts - can cause autoimmune disease which I have - I cried when I read the list of symptoms because I realised all my issues were adrenal gland related but via the sex hormones which supply oestrogen progesterone testosterone cortisol etc. - but in those days there would not have been anyone to take on this information - it took me years to get on thyroid hormone because it was sub clinical. If only someone had known this in those days I would not have needed to go on thyroid hormone at all I daresay. Such a shame but there you go. But for oestrogen dominance you should really read progesterone deficiency which causes oestrogen dominance - although I dont believe it is oestrogen that causes breast cancer I believe it is progesterone so perhaps better I didn't go down that route at the time.
Here is the list
ESTROGEN DOMINANCE SYMPTOMS
The symptoms and conditions associated with estrogen dominance are:
• Acceleration of the aging process
• Allergies, including asthma, hives, rashes, sinus congestion
• Autoimmune disorders such as lupus erythematosis and thyroiditis, and possibly Sjoegren's disease
• Breast cancer
• Breast tenderness
• Cervical dysplasia
• Cold hands and feet as a symptom of thyroid dysfunction
• Copper excess
• Decreased sex drive
• Depression with anxiety or agitation
• Dry eyes
• Early onset of menstruation
• Endometrial (uterine) cancer
• Fat gain, especially around the abdomen, hips and thighs
• Fatigue
• Fibrocystic breasts
• Foggy thinking
• Gallbladder disease
• Hair Loss
• Headaches
• Hypoglycemia
• Increased blood clotting (increasing risk of strokes)
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a question to those of you who have successfully recovered from adrenal fatigue
