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Do You Need Hydrocortisone For Low Adrenals?

Do you have an adrenal disease or adrenal dysfunction? If you do have low cortisol due to adrenal dysfunction is hydrocortisone something you should consider? Today, I’d like to break down everything that you need to know about your adrenals and their relationship with hydrocortisone.

Adrenal Disease & Dysfunction

There are various cases that can cause disturbances in cortisol output1, but let’s look at two specific adrenal patterns in which low cortisol is seen:

  1. Adrenal Disease – Low cortisol due to the disease state called Addison’s. Addison’s disease is very rare and is caused by the destruction of the adrenal gland itself1–3
  2. Adrenal Dysfunction – Adrenal fatigue is often used as a term for any stress on the adrenals but does not capture the more complex patterns of the adrenals. A better term would be HPA dysregulation (1). HPA dysregulation reflects that the cortisol rhythm has been altered. Cortisol can be simply high, normal, or low BUT it can also vary from an optimal pattern. Low cortisol due to HPA dysregulation is quite rare but it is possible, this is what we term the CRASHED state (2).

How to know which one you have? Chances are if you are feeling fatigued it probably isn’t Addison’s disease, but to confirm physicians run lab testing. This would include things such as:

Cortisol

Addison’s cortisol is always low1. Adrenal dysfunction/ HPA dysregulation cortisol can be low but it can also be high or normal.

ACTH

ACTH is a signal from the brain to the adrenal glands. ACTH is high in Addison’s, think of the brain as screaming at the adrenals to make more cortisol.

In adrenal dysfunction with low cortisol, the ACTH will also be low. This is because the adrenal gland itself is not broken and the body desperately trying to regulate itself.

Adrenal Antibodies4

These are present in Addison’s, but not in the case of adrenal dysfunction.

Key Insight: Now that we have ruled out Addison’s, how do you know what pattern of Adrenal dysfunction/ HPA dysregulation you have? A good starting point is taking the adrenal quiz (3).

Hydrocortisone For Adrenal Dysregulation

Now that we understand the difference between adrenal disease vs adrenal dysfunction let’s begin our discussion about hydrocortisone.

Hydrocortisone is a glucocorticoid, this means that it works by directly feeding the adrenals. In the case of true adrenal disease, prescribing hydrocortisone is imperative as your body is unable to make cortisol itself due to the actual gland being faulty1,5,6.

In adrenal dysfunction, the gland is not damaged, therefore it has the ability to make cortisol. Even if you are in “Crashed” state (with low cortisol) your body still has the ability to make cortisol.

Hydrocortisone does have side effects, though, like:

  • Skin thinning
  • Sleep disturbance
  • Acne
  • Mood problem
  • Weight gain7

Key Insight: More serious side effects on the heart, liver, and immune system can cause long-term damage to the body8.

Should You Take Hydrocortisone?

Taking hydrocortisone can also be counterproductive for adrenal health. When you have functional adrenals and you take hydrocortisone it tells your own adrenal glands that it doesn’t need more adrenal hormone because there is already cortisol in your system.

Daily Reset Shake - Dr. Alan Christianson

Adrenal suppression is a protective mechanism to stop overproduction of cortisol and damage to the body. This will never allow your own body to make adequate cortisol in an ideal cortisol rhythm, further contributing to poor health. Long-term suppression will eventually cause your own adrenals to shrink and be unable to produce cortisol effectively8.

Bottom Line: Therefore, no, you do not need hydrocortisone for adrenal dysfunction, not only is it dangerous it is counterproductive. There are other options to improve your own cortisol rhythm.

What Can You Do?

Here are some great options to help you get started:

  • The Adrenal Reset Diet (4)
  • Getting quality sleep (5)
  • Supplementation (6)

How Do You Get Off Hydrocortisone?

If you are currently on hydrocortisone for adrenal dysfunction, what you can do to taper off: First, do not stop taking hydrocortisone cold turkey, it is dangerous to do so8!

Instead, enlist the help of a qualified medical professional. It is possible and beneficial to wean off of hydrocortisone but it is important to have guidance.

Heal Your Adrenals Today

A hydrocortisone prescription is not needed for adrenal dysfunction, whether you’re in the stressed, wired and tired, or crashed state there are other simple tools to help balance cortisol.

If you are interested in safe and/or natural treatments, please contact us at Integrative Health today (7). Don’t forget: Before deciding on a treatment option, always make sure to speak to your doctor.

1. Charmandari E, Nicolaides NC, Chrousos GP. Adrenal insufficiency. Lancet. 2014;383(9935):2152-2167. doi:10.1016/S0140-6736(13)61684-0
2. Arlt W, Allolio B. Adrenal insufficiency. Lancet (London, England). 2003;361(9372):1881-1893. doi:10.1016/S0140-6736(03)13492-7
3. Husebye E, Løvås K. Pathogenesis of primary adrenal insufficiency. Best Pract Res Clin Endocrinol Metab. 2009;23(2):147-157. doi:10.1016/j.beem.2008.09.004
4. Petríková J, Pura M, Lazúrová I. Antibodies to Gonadal and Adrenal Tissue. Autoantibodies. January 2014:391-405. doi:10.1016/B978-0-444-56378-1.00047-2
5. Hahner S, Allolio B. Therapeutic management of adrenal insufficiency. Best Pract Res Clin Endocrinol Metab. 2009;23(2):167-179. doi:10.1016/J.BEEM.2008.09.009
6. Oksnes M, Ross R, Løvås K. Optimal glucocorticoid replacement in adrenal insufficiency. Best Pract Res Clin Endocrinol Metab. 2015;29(1):3-15. doi:10.1016/j.beem.2014.09.009
7. Curtis JR, Westfall AO, Allison J, et al. Population-based assessment of adverse events associated with long-term glucocorticoid use. Arthritis Care Res. 2006;55(3):420-426. doi:10.1002/art.21984
8. Nicolaides NC, Chrousos GP. Hypothalamic–Pituitary–Adrenal Suppression. Encycl Endocr Dis. January 2018:83-89. doi:10.1016/B978-0-12-801238-3.65817-8

Written by Dr. Tara Burke of Integrative Health. Dr. Tara Burke is a licensed Naturopathic Medical Doctor earning her degree at Southwest College of Naturopathic Medicine in Arizona. While attending SCNM, Dr. Burke gravitated to endocrinology and women’s health, focusing much of her studies on these topics.

Learn more about Dr. Burke here. 

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