Adrenal Hormone Therapy
The adrenal glands produce three categories of hormones. The first category is the Glucocorticoids. The most important hormone in this group is cortisone. This group of hormones is important for stress management, immunologic balance and metabolic balance. The next group is the Mineralocorticoids. The main hormone in this category is aldosterone. Aldosterone causes salt and water retention. This helps us maintain our fluid volume and prevents dehydration. The 17-Keto-Steroids are the sex hormone precursors and the sex hormones.
This is a discussion of the glucocorticoids and mineralocorticoids. The most extreme example of glucocorticoid deficiency is an illness called Addison’s Disease. This illness can present precipitously. Under such circumstances, the individual would be profoundly ill. If the cause were undetected, they would not survive. Addison’s Disease may also develop insidiously. It may be difficult to diagnose at first. As in other areas of medicine there is a continuum between serious illness and optimum health. The Integrative Medicine view is to identify the individual along this continuum and provide appropriate support to move the individual towards an optimal health level.
There is an important difference between the pharmacologic versus the physiologic use of Cortisone. Physiologic dosing is intended to supplement glandular function without impairing it. Pharmacologic dosing is intended to treat a disease or symptom of a disease. The potential for impairing glandular function is accepted because of the severity of the disease that requires treatment. Physiologic dosing does not have the same potential for side effects as pharmacologic dosing.
Proper adrenal gland function is an important factor in the way that we manage acute and chronic stress. The adrenal gland interacts with the brain via the hypothalamus and the pituitary gland. Chronic stress can cause Hypothalamic-Pituitary-Adrenal (HPA) Dysfunction. Chronic stress can be due to many causes; psychosocial factors, toxins from the environment, toxins produced within our gastrointestinal tract, toxins produced in our bodies, chronic illness, chronic sleep disturbance and hormonal imbalance. There are many effective strategies to support HPA function. The use of cortisone as hormone replacement should be considered when there are clear indications from laboratory testing. The physician may suggest a trial of cortisone therapy when other strategies to improve HPA function have failed and the patients’ distress warrants a therapeutic trial.
Symptoms and Signs of Adrenal Dysfunction that may suggest the need for further evaluations:
- Marked fatigue associated with low blood pressure, which worsens with standing
- Muscle aching and stiffness
- Intermittent fever
- Poor appetite
- Inability to concentrate
- Sweet craving
- Inability to recover from exertion/exercise
- Low serum sodium, elevated serum potassium and calcium
- Increased allergy symptoms
Borderline adrenal insufficiency is often associated with hypothyroidism. In patients with hypothyroidism who fail to respond to treatment with thyroid, I will test for adrenal insufficiency.
Our body can make antibodies against our adrenal tissue. This is believed to be a common cause of Addison’s Disease. One should be suspicious of this phenomenon in a person who has other autoimmune diseases.
Testing for Adrenal Insufficiency:
- A morning serum cortisol is often used for screening. Unfortunately, it rarely picks up those patients with low adrenal reserve.
- A 24-hour urine collection for cortisone and other adrenal metabolites is a very effective way to look for adrenal insufficiency.
- A provocative test that looks at adrenal reserve is the ACTH stimulation test.
- Salivary hormone assays for cortisol can be an effective screening test for either excess cortisone production or inadequate production. It is not useful for following patients who are being treated with cortisone.
- Testing for adrenal auto-antibodies may be valuable in identifying individuals with early adrenal dysfunction.
Strategies for Improving HPA Function:
- Attending to the psychological and social issues that are creating negative stress is very important. Pills do not fix everything. Consider counseling to help in identifying the issues and developing a plan for dealing with them.
- Improving the quality of sleep is very important in optimizing HPA function and relieving stress. See our information on sleep hygiene practices and herbal supplements that may improve sleep quality.
- Avoid recreational drug use. This includes legal drugs such as caffeine, alcohol and tobacco as well as illegal drugs.
- Eat to support your health. Avoid foods that may create stress. This would include foods that are processed and foods that are rich in sugar. Another strategy for identifying foods that are stressing the individual is to do food allergy testing.
Supplements that may support healthy adrenal function include:
- Vitamin C
- Pantothenic Acid (Vitamin B5)
There are many herbal products that may support healthy adrenal function. They are referred to as Adaptogens:
- Siberian Ginseng
- Panex Ginseng
- American Ginseng
- Gotu Kola
The use of herbal preparations is best done under the supervision of a knowledgeable health care practitioner who can create and monitor an individualized program.
Herbal formulas that are very useful include Vital Adapt, Power Adapt and Botanabol.
When appropriate I prescribe Cortisone in physiologic doses. The dose must be individualized and its effects carefully monitored for therapeutic benefit and possible side effects. When indicated, the use of Cortisone is very rewarding.
We can reduce the risk of side effects by using supplements such as DHEA, Calcium, Vitamin D and Probiotics (acidophilus).
There are many strategies to support healthy adrenal function. The use of Cortisone can be a valuable therapeutic intervention for appropriate individuals.