DEAR DR. GOTT:
I have been diagnosed with iatrogenic secondary adrenal insufficiency. I have searched the internet for information on this but have not been successful.
Can you please explain ways that might help me to get off oral cortisol? I am currently taking 22.5 mg daily. Almost every time I drop the dose, even by as little as 1.25 mg every other day, I get the beginning symptoms of an adrenal crisis (sweating, nausea, vomiting, abdominal pain, diarrhea, extreme fatigue and profound weakness). I take extra cortisol when this happens and I usually start to feel better within 30-45 minutes.
During one of these episodes, I noticed that my skin looked tan even though I had not been out in the sun. What was this from and what does it mean? I want my adrenal glands to work on their own. I have been on oral cortisol for four years.
P.S. I was given large quantities of high dose prednisone for treatment for a back problem. I don’t know if this will help you.
DEAR READER:
The adrenal glands, which are next to the kidneys, produce steroids, notably cortisol, that are vital for normal metabolism. Yours adrenal glands are deficient therefore you need to take supplemental cortisol.
Iatrogenic secondary adrenal insufficiency (reduced function of the adrenal glands caused by medical treatment) is one of the most common forms of adrenal insufficiency. It is caused by excessive or chronic use of glucocorticoid medication (such as prednisone) which essentially reduces adrenal function or shuts down the adrenal glands. I suspect that you are now having issues because of your use (by doctor’s orders) of prednisone. Your doctor should have known and told you about the possible risks of long-term prednisone use and offered ways to reduce the risk of adverse effects.
To the best of my knowledge, your adrenal glands will not likely resume normal function, necessitating supplemental cortisol for the rest of your life. Without normal levels of cortisol, your body cannot function properly (as you know by your symptoms). This can lead to serious consequences, including death if proper amounts of cortisol are not given. Your endocrinologist is the best person to answer your concerns. He or she will know more about the condition, treatment and outcome of your disorder better than I.
As for your tan skin, that is due to the lack of cortisol present in your body. It should have disappeared after taking the extra cortisol. It is one of the symptoms of adrenal insufficiency.
For my other readers, there is some good news. Iatrogenic adrenal insufficiency is somewhat preventable. If you must take glucocorticoid medication such as cortisone or prednisone, use the lowest dosage possible, take it on alternate days or use a topical or inhaled form. Your physicians are the best source for information.
To give you related information, I am sending you a copy of my Health Report “Consumer Tips on Medicine”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.