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Re: OT RE:ACTH stim testing

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>From: " cindi22595 " <cindi22595@...>

>if by " academic exercise " you mean " learning " , i guess so.

>cindi

I believe I asked you once before why you thought you had high cortisol -

iodine/message/7531

" I was a high cortisol gal when starting Armour...and was very stable on 4

1/2 grains of Armour until after taking a quinolone antibiotic. I thinnk

treating the hypo fixed the high cortisol for me. "

Did your cortisol actually test high, or was there some other reason you

believed it high?

Did you know low DHEA can be a sign of low adrenals?. Durrant-Peatfield

said if the adrenal insufficiency was of long standing, low DHEA was a

typical sign, since the tests for cortisol itself is not very good.

OTOH, it can just be the pathway can be messed up. IN those cases, DHEA

will actually be high in relation to cortisol, as pregnenonlone is converted

to DHEA at the expense of cortisol.

In other cases taking DHEA will actually lower cortisol. Atkins said this,

and so did Durrant-Peatfield. Somewhere in Lowe's Q & A he discusses why

taking DHEA doesn't always lower cortisol.

That discussion can be found at

http://www.drlowe.com/QandA/askdrlowe/dhea.htm

Skipper

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>From: " cindi22595 " <cindi22595@...>

>sorry the link didn't work...

>if you're interested in the article, just google " glucocortoid induced

>adrenal insuffiency " and it's the first PDF document you come

>too...written by Alan Krasner in 1999.

>cindi

The title explains the concept. Glucocortioid (hyrdrocortisone or it's

toxic synthetic analog, prednisone) induced adrenal insufficiency. That

means they suppress the HPA axis and the adrenals on purpose. In this case,

I guess to see if once the HPA is suppressed, if they can artificially

inject ACTH and see if the adrenals will still work.

As for the safety of hydrocortisone, they seem to be afraid of using it as

Jeffries descrbed in a dose not large enough to suppress the HPA, yet, see

how commonly they use the glucocortoids -

http://www.uspharmacist.com/NewLook/CE/glucocort/lesson.htm

" Glucocorticoids are among the most commonly prescribed agents in clinical

practice. Their varied physiologic effects make them ideal agents for

treating several disease states. "

Except, I'm thinking these many and varied uses refer to only suppressive

doses, and mainly of prednisone.

Skipper

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yes, when i was first diagnosed with hashi/hypo in 2004, i tested

high cortisol. DHEA was normal, but low in range.

this could have been slightly deceptive I guess...as my liver would

have been clearing cortisol at a slower rate when hypo. But it was

still pretty high. I suppose as I corrected hypo, low cortisol

could have made an appearance. I'm going to check it via saliva.

What I have noticed is adrenal reserve doesn't seem to replenish

fast after stressors (i meet the stress...but have a down period for

about a week or two)...and to me, this is a sign of weak adrenals.

Whether that warrants treatment with h/c or not...would be my big

question...which is why i have tried to learn so much about h/c and

all the finer points of replacement doses, hpa axis suppression,

etc. i'll see what the saliva test indicate.

yes, I know low DHEA or high DHEA (in stage 6) can be indicative of

adrenal fatigue...but so far, i've been in range, just low.

cindi

>>

> I believe I asked you once before why you thought you had high

cortisol -

>

> iodine/message/7531

> " I was a high cortisol gal when starting Armour...and was very

stable on 4

> 1/2 grains of Armour until after taking a quinolone antibiotic. I

thinnk

> treating the hypo fixed the high cortisol for me. "

>

> Did your cortisol actually test high, or was there some other

reason you

> believed it high?

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I didn't have any problem understanding the concept of the

article...however within the article was excellent information in

several areas...various tests, HPA axis suppression, etc.

My question to you earlier...was because I thought you had referred

to the ACTH stim test as a test for HPA axis suppression...you

clarified to me you meant an ACTH blood draw. thanks.

i totally agree that docs are afraid to use H/C in sub-replacemement

doses...but i do think it would be important to have agreement on

what a " replacement dose " is and how HPA axis can be affected by

even low dose H/c (as well as inhaled steroids and h/c skin

ointments) - before we talk about sub-replacement doses for CFS or

AF.

cindi

>

>

> The title explains the concept. Glucocortioid (hyrdrocortisone or

it's

> toxic synthetic analog, prednisone) induced adrenal

insufficiency. That

> means they suppress the HPA axis and the adrenals on purpose. In

this case,

> I guess to see if once the HPA is suppressed, if they can

artificially

> inject ACTH and see if the adrenals will still work.

>

> As for the safety of hydrocortisone, they seem to be afraid of

using it as

> Jeffries descrbed in a dose not large enough to suppress the HPA,

yet, see

> how commonly they use the glucocortoids -

>

> http://www.uspharmacist.com/NewLook/CE/glucocort/lesson.htm

> " Glucocorticoids are among the most commonly prescribed agents in

clinical

> practice. Their varied physiologic effects make them ideal agents

for

> treating several disease states. "

>

> Except, I'm thinking these many and varied uses refer to only

suppressive

> doses, and mainly of prednisone.

>

> Skipper

>

> _________________________________________________________________

> Get today's hot entertainment gossip

http://movies.msn.com/movies/hotgossip

>

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>From: " cindi22595 " <cindi22595@...>

>yes, when i was first diagnosed with hashi/hypo in 2004

Since you had Hashi's, did they also test your adrenal antibodies? (That's

just a rhetorical question, as just because you are more likely to have

adrenal antibodies if you have Hashi's, I've never actually heard someone

say their doctor tested them.) I guess if you have ovarian failure, it's

good to test for it, though maybe it would be better testing before the fact

-

http://www.findarticles.com/p/articles/mi_m0CYD/is_19_37/ai_92938820

An adrenal-antibody test is the best way to screen for adrenal insufficiency

in women with premature ovarian failure.

" The adrenal antibody test was, by far, the most efficient way to screen, "

said Dr. , who is head of the gynecologic endocrinology unit at the

institute.

Its positive predictive value was 67%, and its negative predictive value was

100%. Although the ACTH stimulation test is best for confirming a diagnosis,

as a screen it produced two false-positive results. Measurement of morning

serum cortisol levels missed three of the cases.

**************************************************************

The value of this might be the fact they say the antibody test is the best

predictior of low adrenals.

, i tested

>high cortisol.

Ray Peat said, that in many who had high heart rate when hypothyroid, it was

because the body was trying to compensate for low thyroid by producing

adrenaline. (YOu can find that on Shomon's site.) Do you know what

follows high adrenaline? High cortisol, of course -

http://en.wikibooks.org/wiki/Demystifying_Depression:The_Stress_System

" Just as your levels of adrenaline start coming down, so rises the amount of

cortisol flowing through your veins. Moreover, cortisol has a much larger

momentum than adrenaline, which means that even though it builds up slowly,

it also takes a long time to go back to normal. And should you constantly be

engaging in activities which require adrenaline, so will your levels of

cortisol slowly increase. "

So, the adrenals trying to compensate for low thyroid can cause adrenal

exhaustion, which is why high cortisol is sometimes only a sign that the

adrenals will be crashing before long.

>DHEA was normal, but low in range.

Did you know lab reference ranges follow the mathematical definition of

" normal. " That is the range which is two standard deviations from the

mean. Or, easier to understand is that if your DHEA actually shows up as

low on a lab, your in the same range as 2.25% of the population (i.e. 97.75%

of the population have a higher DHEA than you.) That has nothing to do with

optimal or well, especially if their lab range contains 80 year olds. Some

labs actually give an age and sex adjusted level.

>

I'm going to check it via saliva.

>What I have noticed is adrenal reserve doesn't seem to replenish

>fast after stressors (i meet the stress...but have a down period for

>about a week or two)...and to me, this is a sign of weak adrenals.

That makes sense. And may be why Jeffries claimed the adrenal reserve was

actually strengthened by taking HC, because it took away the two week down

time after stress.

It makes a huge difference. I actually quadrupled my dose of HC when going

to the dentist once before substantianl work. First time I ever came home

happy afterward.

>Whether that warrants treatment with h/c or not...would be my big

>question...which is why i have tried to learn so much about h/c and

>all the finer points of replacement doses, hpa axis suppression,

>etc. i'll see what the saliva test indicate.

>

>yes, I know low DHEA or high DHEA (in stage 6) can be indicative of

>adrenal fatigue...but so far, i've been in range, just low.

So are you at the 3rd percentile, the 10th percentile or the 50th

percentile? They don't tell you that on the lab tests, but all those

percentiles would be " normal. " Actually since numbers are sometimes skewed

on the curves, there's no telling what percentile you are really at just by

hearing the range. For example, the range for TSH is usually .5 - 5.5. So,

if your TSH is 3, you would think you were mid range. Yet, in large studies

85% of those tested without thyroid problems have a TSH below 2.35.

Therefore you'd be in the highest 15%. The halfway point for TSH is

actually 1.5, but you'd never know it from looking at a lab slip.

Skipper

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lol on the rhetorical. of course they didn't test antibodies...but

yes, i know i'm at higher risk because of the hashi's...and i do

have some vitiligo (associated with autoimmune thyroid...and

adrenals).

i did tell an endo in about my concerns about adrenal

dysfunction...even pointing out my mom's autopsy findings which

showed adrenal hyperplasia (adrenal struggling to maintain balance

in the body so i've read - swells up)....and so the endo did a

cortisol draw at 3:00.

the range was 3-17 i think...and I was an 8.

In retrospect....that doesn't look that great to me...and yet the

high saliva cortisol was after that.

I have a history of 15 years of undiagnosed hypo symptoms (TSH was

just 2.something for all those years)...and it's hard for me to

believe that I don't have exhausted adrenals with that history.

As for H/C..i've actually played with 2.5 in the AM..and feel that

small amount with a marked lift in energy. I add another 2.5 4 hrs.

later...and I also notice that. For some reason, that doesn't sound

so good adrenal wise to me...to actually feel that small of an

amount. what do you think?

If I test low on saliva (test should be here this week)...I'm

thinking at this late stage of the game (I'm 51)...I will first go

on h/c at a dose that is 1/2 what my 's replacement would be

as calculated by body surface. I'm a thin gal (adrenal perhaps?)

and 20 mg. is just about my full replacement dosage according to the

standard formulas. So for me, I think that's too much if I'm really

trying to be cautious about HPA axis suppression. I'd rather not

make myself into an addison's patient and since i'm responding to

2.5 mg...i'm thinking I don't need 20 mg. Hard to say, huh?

The last DHEAS test I had...I was 5.1 in a range of 3-10...but

that's an old test..i may have really changed since then...since

that was with high cortisol...and i'm certain i'm no longer high.

cindi

cindi

>

>

> Since you had Hashi's, did they also test your adrenal

antibodies? (That's

> just a rhetorical question, as just because you are more likely to

have

> adrenal antibodies if you have Hashi's, I've never actually heard

someone

> say their doctor tested them.)

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yes, the SSTM is excellent in many many ways...I helped on the start-up

of the site and used to moderate the Mental Health forum there. To

make a long story short, I'm no longer there because of (to the best of

my knowledge) my disagreements with the adrenal info presented there

and disagreements behind the scenes on the h/c subject. Yes, they have

been very pro H/C...and lots of it.

It's actually not so much that I disagree with all the SSTM adrenal

info though. Hypo folks very often need H/C in order to even get

thyroid hormone into them. And using Peatfield's guidelines (which

they mostly do) of giving 20 mg. for a couple of months while someone

gets optimized on Armour will probably not hurt anyone. As much as I

admire and respect Peatfield, his information on 's replacement

dosages (he says 40 mg. in a resting state) is incorrect according to

everything I can find on the subject. I suppose he is going by the

older info as he is an older doctor. But he clearly indicates

correctly, adrenal suppression shouldn't be a problem unless it is

prolonged. But my question always was..shouldn't his 20 mg. 1/2 a

replacement dosage be adjusted downward? And how long is too long to

be on h/c? I mean too me..it's a little too easy to tell someone they

must have needed it for life..when you were recommending they take 30

mg. with no weaning info...and caused them to have permanent

suppression.

And then we never even got to discussion about what stages of Adrenal

Fatigue actually need h/c? I'm not so sure it's Stage 2 for

example..and yet that has been advocated by those moderators.

Where the big problem came in (or perhaps where they had a problem

with me) is we could even never agree on what an 's replacement

dosage is...they go strictly by Peatfield ...and I go by everything

else. I suppose there was also disagreement in that I feel like folks

should understand the risks of adrenal suppression with doses of 20 and

30 mg. and the risk of being on H/C for life.

I do think their HypoPit forum Moderator, Chris...gives excellent info

here - keeping in mind he has mostly worked with hypopit folks:

http://www.stopthethyroidmadness.com/community/viewtopic.php?t=1404

I reference this..because one thing he does...is point out the need for

testing before going on H/C...and the real possibility that smaller

doses may not suffice...and a person may be on it for life - and he

gives his theory why. I guess with H/C - because of the risk of

adrenal crisis and death and the need to know about stress dosing - I

think extreme caution is needed - and enough information given -

before recommending H/C to folks so easily. But i'm more the

conservative type...they may have the right idea. dunno. some folks

investigate what they read and make their own decisions...I just worry

about the folks who are desperate and blindly follow.

But don't let anything I say about their adrenal info take away from

the greatness of that site...okay? I do disagree with some of the

adrenal info...but that site is saving lives and folks' sanity. IF

they find they've gone overboard on the h/c...they'll fine tune the

message i am sure.

And yes, I take Armour. I've ordered a saliva test through clymer

clinic which is a diagnos-tech test. and I've also ordered a test

through ZRT lab. I'm going to do both one day after the

other...because i'm curious as to how they will compare from lab to

lab.

Cindi

>

> Cindi,

> I am curious (as I can certainly relate to the adrenal issues.) Are

you

> taking Armour? Do you ever go to _www.stopthethyroidmadness.com_

> (http://www.stopthethyroidmadness.com) ? There is a huge amount of

adrenal info there and

> they are very pro HC. What saliva test did you take?

> Thakns,

>

>

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>From: " cindi22595 " <cindi22595@...>

>I didn't have any problem understanding the concept of the

>article...however within the article was excellent information in

>several areas...various tests, HPA axis suppression, etc.

I couldn't link to the article, and I couldn't find the particular article

in the search engine, but that's OK.

>

>My question to you earlier...was because I thought you had referred

>to the ACTH stim test as a test for HPA axis suppression...you

>clarified to me you meant an ACTH blood draw. thanks.

>

>i totally agree that docs are afraid to use H/C in sub-replacemement

>doses...but i do think it would be important to have agreement on

>what a " replacement dose " is and how HPA axis can be affected by

>even low dose H/c (as well as inhaled steroids and h/c skin

>ointments) - before we talk about sub-replacement doses for CFS or

>AF.

>cindi

>

And you're convinced that Jeffries is wrong? It sounds like you think you

need it, but the doctors who are afraid of you have convinced you there's

good reason, those same doctors who prescribe Prednisone for a lot of

different conditions in suppressive doses.

You won't know if it can help you until you try it.

Skipper

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you will have the greatest success on 5mg 4X a day. I think that is why Jefferies recommended it. I was told to take 5mg 3X a day and within a week I had stopped H/C, thinking I didn't need it. ONE WHOLE YEAR LATER!!! I started on 5mg 4X a day and it was perfect. It's really counterproductive to think you have to take the most minimal dose. Just like with Armour, you need enough. You aren't going to suppress your already struggling H-P-A axis.

gracia

lol on the rhetorical. of course they didn't test antibodies...but yes, i know i'm at higher risk because of the hashi's...and i do have some vitiligo (associated with autoimmune thyroid...and adrenals). i did tell an endo in about my concerns about adrenal dysfunction...even pointing out my mom's autopsy findings which showed adrenal hyperplasia (adrenal struggling to maintain balance in the body so i've read - swells up)....and so the endo did a cortisol draw at 3:00. the range was 3-17 i think...and I was an 8. In retrospect....that doesn't look that great to me...and yet the high saliva cortisol was after that. I have a history of 15 years of undiagnosed hypo symptoms (TSH was just 2.something for all those years)...and it's hard for me to believe that I don't have exhausted adrenals with that history. As for H/C..i've actually played with 2.5 in the AM..and feel that small amount with a marked lift in energy. I add another 2.5 4 hrs. later...and I also notice that. For some reason, that doesn't sound so good adrenal wise to me...to actually feel that small of an amount. what do you think?If I test low on saliva (test should be here this week)...I'm thinking at this late stage of the game (I'm 51)...I will first go on h/c at a dose that is 1/2 what my 's replacement would be as calculated by body surface. I'm a thin gal (adrenal perhaps?) and 20 mg. is just about my full replacement dosage according to the standard formulas. So for me, I think that's too much if I'm really trying to be cautious about HPA axis suppression. I'd rather not make myself into an addison's patient and since i'm responding to 2.5 mg...i'm thinking I don't need 20 mg. Hard to say, huh? The last DHEAS test I had...I was 5.1 in a range of 3-10...but that's an old test..i may have really changed since then...since that was with high cortisol...and i'm certain i'm no longer high. cindicindi>> > Since you had Hashi's, did they also test your adrenal antibodies? (That's > just a rhetorical question, as just because you are more likely to have > adrenal antibodies if you have Hashi's, I've never actually heard someone > say their doctor tested them.)

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>From: " cindi22595 " <cindi22595@...>

>As for H/C..i've actually played with 2.5 in the AM..and feel that

>small amount with a marked lift in energy. I add another 2.5 4 hrs.

>later...and I also notice that. For some reason, that doesn't sound

>so good adrenal wise to me...to actually feel that small of an

>amount. what do you think?

I think HC is a powerful hormone. The 10 mg a day you're talking about may

be adequate for you. Just be aware that if you are on too low a dose of a

particular hormone, it can also cause problems. The Synthroid lit mentions

too low a dose can cause or worsen hypothyroid symptoms, and I don't think

that's so uncommon with hormones in general.

Skipper

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Not exactly.

What i think he was wrong about was hydrocortisone being equal to

cortisone acetate.

if we make the adjustment on that...hydrocortisone is stronger...

Jefferies would be saying that 32 mg. is a full replacement

dosage...and that is more in line with all the research that came

after him.

not sure if you were saying I'm afraid of docs (sorta wrong - i hate

docs mostly...and only afraid of them because they have harmed me)

or the docs are afraid of me (hehe - well maybe a few of

them)....but i have no problem at all taking H/C if it's indicated.

and speaking of suppressive prednisone doses...that may well have

been my downfall. I had one in april or may...and was very

reluctant to do it because i feared the suppression effect to my

adrenals...and honestly, i haven't been quite the same since that.

Now...it could have been that i should have lowered my armour dose

to compensate for the hit to the adrenals...don't know. But i'm not

afraid of H/C. I am afraid of being uninformed.

Cindi

>

> >From: " cindi22595 " <cindi22595@...>

> >

> >

> And you're convinced that Jeffries is wrong? It sounds like you

think you

> need it, but the doctors who are afraid of you have convinced you

there's

> good reason, those same doctors who prescribe Prednisone for a lot

of

> different conditions in suppressive doses.

>

> You won't know if it can help you until you try it.

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It's ironic isn't it? I was on the NTH list and the first person there to take H/C, and they were hearing none of what I had to say about it!

You should also be investigating iodine b/c I think it is very helpful too. I can't figure out why you care how much H/C s patients should take! Who cares?!

Gracia

yes, the SSTM is excellent in many many ways...I helped on the start-up of the site and used to moderate the Mental Health forum there. To make a long story short, I'm no longer there because of (to the best of my knowledge) my disagreements with the adrenal info presented there and disagreements behind the scenes on the h/c subject. Yes, they have been very pro H/C...and lots of it. It's actually not so much that I disagree with all the SSTM adrenal info though. Hypo folks very often need H/C in order to even get thyroid hormone into them. And using Peatfield's guidelines (which they mostly do) of giving 20 mg. for a couple of months while someone gets optimized on Armour will probably not hurt anyone. As much as I admire and respect Peatfield, his information on 's replacement dosages (he says 40 mg. in a resting state) is incorrect according to everything I can find on the subject. I suppose he is going by the older info as he is an older doctor. But he clearly indicates correctly, adrenal suppression shouldn't be a problem unless it is prolonged. But my question always was..shouldn't his 20 mg. 1/2 a replacement dosage be adjusted downward? And how long is too long to be on h/c? I mean too me..it's a little too easy to tell someone they must have needed it for life..when you were recommending they take 30 mg. with no weaning info...and caused them to have permanent suppression. And then we never even got to discussion about what stages of Adrenal Fatigue actually need h/c? I'm not so sure it's Stage 2 for example..and yet that has been advocated by those moderators. Where the big problem came in (or perhaps where they had a problem with me) is we could even never agree on what an 's replacement dosage is...they go strictly by Peatfield ...and I go by everything else. I suppose there was also disagreement in that I feel like folks should understand the risks of adrenal suppression with doses of 20 and 30 mg. and the risk of being on H/C for life. I do think their HypoPit forum Moderator, Chris...gives excellent info here - keeping in mind he has mostly worked with hypopit folks:http://www.stopthethyroidmadness.com/community/viewtopic.php?t=1404I reference this..because one thing he does...is point out the need for testing before going on H/C...and the real possibility that smaller doses may not suffice...and a person may be on it for life - and he gives his theory why. I guess with H/C - because of the risk of adrenal crisis and death and the need to know about stress dosing - I think extreme caution is needed - and enough information given - before recommending H/C to folks so easily. But i'm more the conservative type...they may have the right idea. dunno. some folks investigate what they read and make their own decisions...I just worry about the folks who are desperate and blindly follow. But don't let anything I say about their adrenal info take away from the greatness of that site...okay? I do disagree with some of the adrenal info...but that site is saving lives and folks' sanity. IF they find they've gone overboard on the h/c...they'll fine tune the message i am sure. And yes, I take Armour. I've ordered a saliva test through clymer clinic which is a diagnos-tech test. and I've also ordered a test through ZRT lab. I'm going to do both one day after the other...because i'm curious as to how they will compare from lab to lab. Cindi>> Cindi,> I am curious (as I can certainly relate to the adrenal issues.) Are you > taking Armour? Do you ever go to _www.stopthethyroidmadness.com_ > (http://www.stopthethyroidmadness.com) ? There is a huge amount of adrenal info there and > they are very pro HC. What saliva test did you take?> Thakns,> >

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>From: " cindi22595 " <cindi22595@...>

>Not exactly.

>

>What i think he was wrong about was hydrocortisone being equal to

>cortisone acetate.

I can't locate my book right now, but I thought he specifically mentioned

Cortef.

>not sure if you were saying I'm afraid of docs (sorta wrong - i hate

>docs mostly...and only afraid of them because they have harmed me)

You should be afraid. By their own admission, their errors are the fourth

leading cause of death in the USA.

>and speaking of suppressive prednisone doses...that may well have

>been my downfall. I had one in april or may...and was very

>reluctant to do it because i feared the suppression effect to my

>adrenals

Depending on the reason, normally they simply want to give you a high dose

of 60 -80 mg of prednisone, wihout first trying lower amounts to see if

they'll suffice. But, ask for a low dose to help your adrenals and they

panic.

.....and honestly, i haven't been quite the same since that.

>Now...it could have been that i should have lowered my armour dose

>to compensate for the hit to the adrenals

No. If you are having a hyperthyroid storm, some doctors will give you

prednisone because they know it interferes with the ability to convert T4 to

T3 and stops the emergency.

Skipper

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good point...and that's why i've researched this all so diligently.

it's interesting to me that there is research out there with CFS

using 5 and 10 mg. with benefit and no suppression...and then you

have this middle ground of 15-20 mg. with big " ifs " about the degree

of suppression (some docs using 20 and some docs staying at 12 mg.

for adrenal fatigue) and then 25-30 mg. basically being full

replacement. of course it bears repeating...that suppression isn't

a problem as long as it is not prolonged.

I'm thinking this is also like Armour Thyroid...in that you can take

just a little bit (one grain or less?) and you actually supplement

with a very small amount...but if you take much more than that, you

interfere with the HPT feedback loop and end up needing full

replacement to feel good.

I'm also interested in the data that talks about When you take doses

(and this is probably for pharmalogic - but still has application) -

and how that affects suppresssion:

ACTH and cortisol are normally secreted with a diurnal rhythm; with

cortisol levels highest in the morning and lowest in the late

evening. Some studies show that when steroids are given at 8am

glucocorticoid secretion is suppressed at 4pm and midnight but

insignificantly so at 8am the next morning. Given at 4pm, the same

dose suppresses glucocorticoid secretion totally at midnight,

partially at 8am, and insignificantly at 4pm the next day. When

given at midnight however glucocorticoid secretion is suppressed for

24 hours6.

cindi

>

> >

> I think HC is a powerful hormone. The 10 mg a day you're talking

about may

> be adequate for you. Just be aware that if you are on too low a

dose of a

> particular hormone, it can also cause problems. The Synthroid lit

mentions

> too low a dose can cause or worsen hypothyroid symptoms, and I

don't think

> that's so uncommon with hormones in general.

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I think Jefferies recommended it because he used cortisone acetate

which is shorter acting in the body.

I still like Lowe's protocol on this....3x a day dosing, with the

biggest dose in the AM. just makes more sense to me when looking at

the body's rhythm and the longer acting action of h/c in the body.

h/c I thought has a half-life of 8-12 hrs...although i keep seeing

folks say in some places it's used up in 4 hours.

I think little doses (as used in CFS) versus larger doses...depends

on many factors. I don't believe in a one size fits all for H/C and

adrenal fatigue protocol any more than I think all folks needs the

same amount of Armour. I do agree however that Peatfield's protocol

(20 mg. - 40 mg.) of H/C when getting someone optimized on thyroid

hormone has the benefit of them not needing to stress dose during

that time...and simplifies the whole thing....but I'm not sure he

really intended everyone to take 30 mg. of h/c for an extended

period of time. but i've been wrong before.

cindi

>

>

> you will have the greatest success on 5mg 4X a day. I think

that is why Jefferies recommended it. I was told to take 5mg 3X a

day and within a week I had stopped H/C, thinking I didn't need it.

ONE WHOLE YEAR LATER!!! I started on 5mg 4X a day and it was

perfect. It's really counterproductive to think you have to take

the most minimal dose. Just like with Armour, you need enough. You

aren't going to suppress your already struggling H-P-A axis.

> gracia

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>From: " cindi22595 " <cindi22595@...>

>I think Jefferies recommended it because he used cortisone acetate

>which is shorter acting in the body.

I thought he mentioned Cortef by name. (Can't find my book right now.)

>

>I still like Lowe's protocol on this....3x a day dosing, with the

>biggest dose in the AM. just makes more sense to me when looking at

>the body's rhythm and the longer acting action of h/c in the body.

Seems to make sense. However, the AM is when it's easiest for the body to

produce cortisol on its own, so do you want to supress the ACTH at that

time? Because your body is producing the cortisol, you will have higher

levels at that time, just like the circadian rhythm. Plus the larger any

single dose the more likely to have weight gain from the timing of the

dosage. In " Adrenal Fatigue " vaguely explained how those with

adrenal insufficiency could have weight gain because of the timing of the

cortisol production. I'm assuming he meant all at once, instead of spacing

it out but I could be wrong.

>h/c I thought has a half-life of 8-12 hrs...although i keep seeing

>folks say in some places it's used up in 4 hours.

And 12 hour " half-life " means in your system for 24 hours.

...but I'm not sure he

>really intended everyone to take 30 mg. of h/c for an extended

>period of time. but i've been wrong before.

He saw it as s couple month issue. Don't have his book in front of me, but

this is what he published to the Internet first. 1/2 of a tablet 3 or 4

times a day is 15 - 20 mg. And he says it's normally stopped in 3 to 4

months, except those people who's adrenals aren't fixed by the thyroid

treatment -

<Quote>

Low Adrenal ReserveCORTISONE REPLACEMENT IN THE LOW ADRENAL RESERVE SYNDROME

© 1994 Dr. Barry Durrant-Peatfield

M.B., B.S., L.R.C.P., M.R.C.S.

All rights reserved. This copyright must not be removed.

You will be given hydrocortisone 10mgm, which is the natural form, to take

in a dose appropriate to your needs. Half a tablet three or four times a day

is usual, later to be increased, if required.

Adrenal insufficiency related to low thyroid function corrects itself, as

the thyroid levels improve, and usually after, two, three or four months,

have recovered sufficiently for the cortisone therapy to be stopped.

<UNQuote>

Skipper

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>From: " cindi22595 " <cindi22595@...>

>good point...and that's why i've researched this all so diligently.

>it's interesting to me that there is research out there with CFS

>using 5 and 10 mg. with benefit and no suppression...and then you

>have this middle ground of 15-20 mg. with big " ifs " about the degree

I don't think those of us taking the 5 mg 4 times daily are too concerned

about it. Of course, I " m a 230 pound male, and I'm sure there are 115 pound

females taking the same dosage.

of course it bears repeating...that suppression isn't

>a problem as long as it is not prolonged.

>

>I'm thinking this is also like Armour Thyroid...in that you can take

>just a little bit (one grain or less?) and you actually supplement

>with a very small amount...but if you take much more than that, you

>interfere with the HPT feedback loop and end up needing full

>replacement to feel good.

A very limited amount of people do well on small doses. However, Synthroid

lit says that too low a dose can worsen or cause hypothyroid symptoms. It

does work for some,but not many, and those on small doses if they understood

low thyroid would generally start to see more symptoms than they had when

they started. Not all, but many patients.

>ACTH and cortisol are normally secreted with a diurnal rhythm; with

>cortisol levels highest in the morning and lowest in the late

>evening. Some studies show that when steroids are given at 8am

>glucocorticoid secretion is suppressed at 4pm and midnight but

>insignificantly so at 8am the next morning. Given at 4pm, the same

>dose suppresses glucocorticoid secretion totally at midnight,

>partially at 8am, and insignificantly at 4pm the next day. When

>given at midnight however glucocorticoid secretion is suppressed for

>24 hours6.

This may or may not be relevant. For one thing you say " steroids " cause....

Well, what kind of steroid? If we're talking about Prednisone, it's

irrelevant because no one should be taking prednisone for this. It's

different, it's a synthetic analog, and it has no mineralocortoid activity,

which many with AI need.

Skipper

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I think I have had it. I had a blood draw at 8a.m. and then waited an hour?

then was given an injection I think then another blood draw? All was

pronounced normal :((

Gracia

>

> I think she is worried it will suppress the HPA axis. Have you ever had

> your ACTH taken? (Just the ACTH level, which can be taken at the same

> time

> as your other labs, and I'm not referring to the ACTH stim test, only the

> ACTH level.)

>

> Skipper

>

> _________________________________________________________________

> Find a local pizza place, music store, museum and more.then map the best

> route! http://local.live.com

>

>

>

> Iodine

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hydrocortisone IS pretty much equal to cortisone acetate. It is just dosed differently. Cort acetate dose would be 37mg=20mg cortef. My BB doc asked me which one I liked best, and I said I guess I like cortef best. But they work the same.

Gracia

..

>> > I can't locate my book right now, but I thought he specifically mentioned > Cortef.if i remember correctly...take a look in the section "replacement doses" near the beginning...and he says cortisone acetate is the same as cortisol...let me know. > >

..

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>From: " Gracia " <circe@...>

>I think I have had it. I had a blood draw at 8a.m. and then waited an

>hour?

>then was given an injection I think then another blood draw? All was

>pronounced normal :((

>Gracia

That's the ACTH stimulation test. They actually inject you with ACTH. What

I'm wondering about is once you started cortisol, if you've had your ACTH

level tested. There's no injection involved.

This would be likely to tell if the HPA axis is suppressed, because ACTH is

to the adrenals what TSH is to the thyroid.

Skipper

>

> >

> > I think she is worried it will suppress the HPA axis. Have you ever had

> > your ACTH taken? (Just the ACTH level, which can be taken at the same

> > time

> > as your other labs, and I'm not referring to the ACTH stim test, only

>the

> > ACTH level.)

> >

> > Skipper

> >

> > _________________________________________________________________

> > Find a local pizza place, music store, museum and more.then map the best

> > route! http://local.live.com

> >

> >

> >

> > Iodine

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yea...it is ironical.

For me, Gracia...if i had a diagnosis of 's...the calculated

full replacement replacement dosage for me IS 20 mg. And if I took

the 30 mg. that is recommended to some folks (citing peatfield), I'd

soon be developing Cushing's from over replacement.

So in my case...and perhaps because i'm thinner...it really matters.

cindi

That

>

>

> It's ironic isn't it? I was on the NTH list and the first

person there to take H/C, and they were hearing none of what I had

to say about it!

> You should also be investigating iodine b/c I think it is very

helpful too. I can't figure out why you care how much H/C s

patients should take! Who cares?!

> Gracia

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>>

> Seems to make sense. However, the AM is when it's easiest for the

body to

> produce cortisol on its own, so do you want to supress the ACTH at

that

> time? Because your body is producing the cortisol, you will have

higher

> levels at that time, just like the circadian rhythm. Plus the

larger any

> single dose the more likely to have weight gain from the timing of

the

> dosage. In " Adrenal Fatigue " vaguely explained how those

with

> adrenal insufficiency could have weight gain because of the timing

of the

> cortisol production. I'm assuming he meant all at once, instead

of spacing

> it out but I could be wrong.

right..time of dose...amount of dose...are all variables that can

factor into suppression and whether we have side effects, etc. For

instance there's data that over 10 mg. in a the AM is more

associated with elevated eye pressure during the day. I think,

though....it is the nightime administration of H/C that would be

suppressive of the morning rise in ACTH. But i'm still figuring

this part out....

>

> He saw it as s couple month issue.

Well that the way I always read him too....but i think some folks

didn't see that part in his work until later.

I also am not sure if we can take his articles and apply them to all

other AF cases Without hypo. It would just seem needing to get

thyroid hormone in to you and needing the H/C for that might be a

little different protocol from non-hypo AF.

Cindi

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