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Elsewhere in a post, Dr. M states:
“Note that the reference range for Cortisol has certain assumptions. The person is at rest, without excessive stress, without recent excessive exercise.”
My wife had a cortisol test done because I believe she has severe adrenal fatigue. She was on high dose prednisone for years trying to control Crohn’s disease.
She complained of fatigue, especially after exercising, and her doctor had her take the test after her typical one hour aerobic exercise.
Mistake?
It is my understanding that in some people that have low cortisol reserves to begin with exercising will cause you to burn it off rather quickly. Right now I am wondering if my cortisol levels are dumping because of just the slight 30 mgs of raise of armour I did. My temperature was 98 in the morning then 97.3 in mid afternoon. I am already on 20 mgs of cortef but temperatures are irradically. My labs last time where perfect but I felt like crap. I was wondering if a person with this issue should increase the cortef or back off the thyroid.
@chaos 389 wrote:
Elsewhere in a post, Dr. M states:
“Note that the reference range for Cortisol has certain assumptions. The person is at rest, without excessive stress, without recent excessive exercise.”
My wife had a cortisol test done because I believe she has severe adrenal fatigue. She was on high dose prednisone for years trying to control Crohn’s disease.
She complained of fatigue, especially after exercising, and her doctor had her take the test after her typical one hour aerobic exercise.
Mistake?
Not necessarily a mistake. When a doctor specifies certain criteria, then the doctor will look at that test with the criteria in mind.
For example, if I want to see how far a person’s cortisol production can go after stress, I would have them weight lift heavily the day before they took a morning cortisol level.
Without specifying the exercise level, then the usual cortisol level assumes a person is at rest.
@hardasnails1973 390 wrote:
It is my understanding that in some people that have low cortisol reserves to begin with exercising will cause you to burn it off rather quickly. Right now I am wondering if my cortisol levels are dumping because of just the slight 30 mgs of raise of armour I did. My temperature was 98 in the morning then 97.3 in mid afternoon. I am already on 20 mgs of cortef but temperatures are irradically. My labs last time where perfect but I felt like crap. I was wondering if a person with this issue should increase the cortef or back off the thyroid.
Temperature will always vary depending on a person’s metabolism at that moment. Thyroid alone does not determine temperature. Norepinephrine, for example, has a large input, as does Cortisol. Stress alone may cause a reduction in temperature should adrenal function become inadequate to compensate for the stress. Temperature may vary with thyroid levels, which will go down between doses. But thyroid hormone can’t be dosed continuously throughout the day. Achieving a fixed temperature is difficult, if not impossible to do. Thus, it is best to achieve a temperature range instead of a fixed temperature. This would keep one from being driven nuts by fluctuating temperatures from numerous factors.
Generally, I would be pretty happy if the temperature is over 97.2 degrees and below 98.2 degrees.
Once temperature in this range is achieved with thyroid treatment, thyroid dosing is usually minimally sufficient. I would then target the rest of the system for optimization before returning to consideration of further thyroid optimization.
Since, temperature also depends on norepinephrine signaling and other factors such as cortisol production, I would also have to take these into account. For example, when temperature is good in a high stress patient but thyroid hormone is grossly low, then much of this may be attributed to stress / norepinephrine signaling, if adrenal function is sufficient. The presence of an infection would also be suspected. Etc.
Once temperature in this range is achieved with thyroid treatment, the rest of the way toward a “normal” temperature and metabolism would be determined by functioning in the rest of the system, which I would then target for optimization. After improving functioning in those areas, I would reexamine thyroid dosing to see if it needs further optimization.
There is a back and forth adjustment in treatment until all areas are optimized.
Realize that the use of Cortisol is limited in long-term use to sub-replacement doses, unless one has a diagnosis of adrenal insufficiency or Addison’s disease. I wouldn’t want to fully suppress adrenal function by replacement or higher doses of Cortisol.
At higher doses of Cortisol, the loss of the other adrenal hormones becomes a significant factor. For example, the loss of progesterone may result in increases stress, anxiety, irritability since progesterone is calming and mood stabilizing. Cortisol treatment may need to be augmented by treatment with Pregnenolone, progesterone, DHEA (and progesterone, testosterone, and estrogen in women) to help prevent problems from suppressing adrenal response with Cortisol. This is what makes cortisol treatment complicated and tricky. This is why some people do not do well on treatment with Cortisol alone.
If one is reaching the endpoint in regard to an adrenal support treatment with cortisol and other adrenal hormones, I would consider a psychiatric medication to address the nervous system side of the equation, depending on the person’s preference. Otherwise, I would keep working on the other parts of the system or on metabolic-nutritional factors.
@DrMariano 459 wrote:
Temperature will always vary depending on a person’s metabolism at that moment. Thyroid alone does not determine temperature. Norepinephrine, for example, has a large input, as does Cortisol. Stress alone may cause a reduction in temperature should adrenal function become inadequate to compensate for the stress. Temperature may vary with thyroid levels, which will go down between doses. But thyroid hormone can’t be dosed continuously throughout the day. Achieving a fixed temperature is difficult, if not impossible to do. Thus, it is best to achieve a temperature range instead of a fixed temperature. This would keep one from being driven nuts by fluctuating temperatures from numerous factors.
Generally, I would be pretty happy if the temperature is over 97.2 degrees and below 98.2 degrees.
Once temperature in this range is achieved with thyroid treatment, thyroid dosing is usually minimally sufficient. I would then target the rest of the system for optimization before returning to consideration of further thyroid optimization.
Since, temperature also depends on norepinephrine signaling and other factors such as cortisol production, I would also have to take these into account. For example, when temperature is good in a high stress patient but thyroid hormone is grossly low, then much of this may be attributed to stress / norepinephrine signaling, if adrenal function is sufficient. The presence of an infection would also be suspected. Etc.
Once temperature in this range is achieved with thyroid treatment, the rest of the way toward a “normal” temperature and metabolism would be determined by functioning in the rest of the system, which I would then target for optimization. After improving functioning in those areas, I would reexamine thyroid dosing to see if it needs further optimization.
There is a back and forth adjustment in treatment until all areas are optimized.
Realize that the use of Cortisol is limited in long-term use to sub-replacement doses, unless one has a diagnosis of adrenal insufficiency or Addison’s disease. I wouldn’t want to fully suppress adrenal function by replacement or higher doses of Cortisol.
At higher doses of Cortisol, the loss of the other adrenal hormones becomes a significant factor. For example, the loss of progesterone may result in increases stress, anxiety, irritability since progesterone is calming and mood stabilizing. Cortisol treatment may need to be augmented by treatment with Pregnenolone, progesterone, DHEA (and progesterone, testosterone, and estrogen in women) to help prevent problems from suppressing adrenal response with Cortisol. This is what makes cortisol treatment complicated and tricky. This is why some people do not do well on treatment with Cortisol alone.
If one is reaching the endpoint in regard to an adrenal support treatment with cortisol and other adrenal hormones, I would consider a psychiatric medication to address the nervous system side of the equation, depending on the person’s preference. Otherwise, I would keep working on the other parts of the system or on metabolic-nutritional factors.
I was completely normal till i switch the armour brand 5 weeks ago then my whole system started taking a nose dive. I know that low thyroid can stress adrenals so it was hard to distinguish what was causing the problem. I assumed it was the thyroid because cortisol has been constant for over 2 years. Was it going hyper or hypo because I just increased by 1/2 grains which before previous dosage was held for 6 weeks or was it the armour not strong enough. Stress wise that has not changed and as a defensive mechanism my brain is very laxed in a “what ever” mood. Now I switched to nature thyroid with same dosage and i feel alittle bit more balanced, but I am going to get blood test monday to see exactly what is going on.
Hard I thought you were going to do labs before you switched meds. Now you will not know what happened.
@DrMariano 459 wrote:
At higher doses of Cortisol, the loss of the other adrenal hormones becomes a significant factor. For example, the loss of progesterone may result in increases stress, anxiety, irritability since progesterone is calming and mood stabilizing. Cortisol treatment may need to be augmented by treatment with Pregnenolone, progesterone, DHEA (and progesterone, testosterone, and estrogen in women) to help prevent problems from suppressing adrenal response with Cortisol. This is what makes cortisol treatment complicated and tricky. This is why some people do not do well on treatment with Cortisol alone.
If one is reaching the endpoint in regard to an adrenal support treatment with cortisol and other adrenal hormones, I would consider a psychiatric medication to address the nervous system side of the equation, depending on the person’s preference. Otherwise, I would keep working on the other parts of the system or on metabolic-nutritional factors.
Dr. M what you are saying is very logic, but what happens in addison’s patients you only get cortisol and aldosterone supplementation??? Why dont the doctors care about their pregnenolone/dhea/progesterone and the rest of the hormones in their case?? Hows is those people’s life ??
I would also want to ask what happens with adrenaline production in cases of addison’s ?? Doesnt the person without adrenals suffer from depressed drive and fluctuations in energy because of the medullary hormonal loss?? Plus all the other minor but significant hormones being produced, why arent they ever mentioned or restored?? Why dont doctors supply properly made glandulars instead of synthetics??? Wouldnt it be better for the patients??
@Shaolin 496 wrote:
Dr. M what you are saying is very logic, but what happens in addison’s patients you only get cortisol and aldosterone supplementation??? Why dont the doctors care about their pregnenolone/dhea/progesterone and the rest of the hormones in their case?? Hows is those people’s life ??
I would also want to ask what happens with adrenaline production in cases of addison’s ?? Doesnt the person without adrenals suffer from depressed drive and fluctuations in energy because of the medullary hormonal loss?? Plus all the other minor but significant hormones being produced, why arent they ever mentioned or restored?? Why dont doctors supply properly made glandulars instead of synthetics??? Wouldnt it be better for the patients??
When pregnenolone, DHEA, progesterone, testosterone, and estradiol are also not considered for replacement in hypoadrenal conditions where cortisol and aldosterone are replaced, patients may develop problems related to the missing hormones.
Doctors may not consider these other hormones because often the symptoms of deficiencies are behavioral symptoms. Some problems of deficiency are, however, recognized due to the physical symptoms they produce.
The missing hormones are very active signals in the brain.
In post-menopausal women, for example, estradiol can go down to zero if its adrenal output isn’t replaced. Estradiol is important in women for memory, energy, drive, mood. it is also important for bone development. Without it, one can see what can happen. The use of estrogen, however, in women is recognized often since menopausal symptoms are an indicator of a deficiency. Also, doctors these days are more cognizant of osteoporosis as an endemic problem.
Without DHEA, one can get depressed, become insulin resistant, develop abdominal fat, have impaired immune system activity.
Without progesterone, which is an anxiolytic and calming signal, which promotes maternal caring behaviors, one can expect an increase in stress, anxiety, insomnia, etc.
Etc. Etc. All one has to do is examine the functions of the missing hormones and determine what would happen. Women are more susceptible to problems since the adrenal glands after menopause is so important for the production of testosterone, progesterone, and estrogen.
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Although glandulars can be useful in cases of hypoadrenalism, the use of glandulars isn’t taught these days because of the availability of adrenal hormones themselves.
Also, since cases of hypoadrenalism outside of Addison’s disease are not recognized by endocrinologists, the use of glandulars also came to be viewed as not effective since they generally are too weak of a treatment for Addison’s disease.
I just read an abstract on another forum which concluded that the adrenal response to ACTH is impaired in people who suffer from chronic fatigue.
Is it possible that my wife’s adrenals could have atrophied, given the long term high dose prednisone she was on. We’re talking as high as 50 mg for years, which I would guess is more than physiologic and would have resulted in endogenous suppression.
Would an ACTH stim be more useful in diagnosis? Would conventional medicine recognize a substandard response to ACTH?
I understand conventional medicine only recognizes Addison’s and Cushing’s. But is there a textbook response to ACTH where, if one were outside of a range, would indicate a treatable condition?
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