Adrenal fatigue: The best methods to increase cortisol naturally

[Nelson Vergel]

FYI, at the moment I am off the cortisol completely (3 months now) and seem to be doing fine. Process of weaning was way easier than imagined. It seems that these years of cortisol replacement have somehow kickstarted my HPA again instead of suppressing HPA-function (as one would assume)

Good for you!!

Recovery of Adrenal Function after Long-Term Glucocorticoid Therapy for Giant Cell Arteritis: A Cohort Study


Abstract
Objectives
Giant cell arteritis (GCA) is a chronic systemic vasculitis of large and medium-sized arteries, for which long-term glucocorticoid (GC) treatment is needed. During GC withdrawal patients can suffer adrenal insufficiency. We sought to determine the time until recovery of adrenal function after long-term GC therapy, and to assess the prevalence and predictors for secondary adrenal insufficiency.

Subjects and Design
150 patients meeting the ACR criteria for GCA between 1984 and 2012 were analyzed. All received the same GC treatment protocol. The low-dose ACTH stimulation test was repeated annually until adrenal recovery. Biographical, clinical and laboratory data were collected prospectively and compared.

Results
At the first ACTH test, 74 (49%) patients were non-responders: of these, the mean time until recovery of adrenal function was 14 months (max: 51 months). A normal test response occurred within 36 months in 85% of patients. However, adrenal function never recovered in 5% of patients. GC of >15 mg/day at 6 months, GC of >9.5 mg/day at 12 months, treatment duration of >19 months, a cumulative GC dose of >8.5 g, and a basal cortisol concentration of <386 nmol/L were all statistically associated with a negative response in the first ACTH test (p <0.05).

Conclusion
Adrenal insufficiency in patients with GCA, treated long-term with GC, was frequent but transitory. Thus, physicians’ vigilance should be increased and an ACTH test should be performed when GC causes the above associated statistical factors.

 

[Nelson Vergel]

Recovery of steroid induced adrenal insufficiency

Abstract
Secondary adrenal insufficiency can result from insufficient stimulation of the adrenal glands due to inadequate secretion or synthesis of adrenocorticotropic hormone (ACTH). This can be caused by hypopituitarism, central nervous system injury (tumors, radiation, and surgery) or long-term glucocorticoid therapy. Glucocorticoids were introduced in the 1950s, and have been used for their anti-inflammatory and other pharmacological effects, and also as replacement therapy for adrenal insufficiency. However, chronic glucocorticoid use may lead to suppression of the hypothalamic pituitary adrenal axis through negative feedback. This may lead to secondary adrenal insufficiency. Typically, the hypothalamic pituitary adrenal axis recovers after cessation of glucocorticoids, but the timing of recovery can be variable and can take anywhere from 6–12 months. Understanding the effect of exogenous glucocorticoids on the hypothalamic pituitary adrenal axis, recovery of the axis, and tests used to assess the recovery, are crucial to avoid prescribing unnecessary steroid replacement or missing a critical diagnosis with detrimental consequences.

Keywords: Adrenal insufficiency, glucocorticoid use, stimulation test, adrenocorticotropic hormone (ACTH)

 

[Hormetheus]

Recovery of steroid induced adrenal insufficiency

Abstract
Secondary adrenal insufficiency can result from insufficient stimulation of the adrenal glands due to inadequate secretion or synthesis of adrenocorticotropic hormone (ACTH). This can be caused by hypopituitarism, central nervous system injury (tumors, radiation, and surgery) or long-term glucocorticoid therapy. Glucocorticoids were introduced in the 1950s, and have been used for their anti-inflammatory and other pharmacological effects, and also as replacement therapy for adrenal insufficiency. However, chronic glucocorticoid use may lead to suppression of the hypothalamic pituitary adrenal axis through negative feedback. This may lead to secondary adrenal insufficiency. Typically, the hypothalamic pituitary adrenal axis recovers after cessation of glucocorticoids, but the timing of recovery can be variable and can take anywhere from 6–12 months. Understanding the effect of exogenous glucocorticoids on the hypothalamic pituitary adrenal axis, recovery of the axis, and tests used to assess the recovery, are crucial to avoid prescribing unnecessary steroid replacement or missing a critical diagnosis with detrimental consequences.

Keywords: Adrenal insufficiency, glucocorticoid use, stimulation test, adrenocorticotropic hormone (ACTH)

Thanks for the info! For me though, likely as I was using much lower doses, recovery was almost "instant", without any transient period of (symptomatic) hypocortisolism.

I have a question for you, as you seem incredibly experienced and knowledgeable: I have heard recommendations to try small doses of pregnenolone or progesterone quite a few times now. Some (select) people seem to do amazingly well on small doses of pregnenolone (10-50mg) or progesterone. Likely, because these steroids are converted into neuroactive metabolites (neurosteroids).

Personally, I have never done proper experiments with these in isolation, however, as more people keep telling me about their beneficial effects, I might do a 10mg pregnenolone experiment soon.

What is your take on pregnenolone and/or progesterone? Who would benefit? Are there risks? I´d be interested in your take on this matter.

 

[Nelson Vergel]

Please let's stay on topic

@Hormetheus We have a lot of discussion here:

Pregnenolone and Progesterone for Men: Pharmacokinetics and Studies

"Pregnenolone can be administered orally, subcutaneously, intravenously, intranasally, and topically/transdermally. Oral pregnenolone has high metabolism and low bioavailability.28 It is lipophilic and readily crosses the blood brain barrier. There is very limited data on the pharmacokinetics...

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pregnenolone

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[Spoony Luv]

Great article! Its been a battle for me for many years..... just started TRT and its been very up and down. I went from feeling great to completely becoming overcome with anger and hyer fight or flight. I had to completely stop and and in just a few weeks already lost the 10 lbs I managed to gain....

How do yall do on TRT?

 

[Hormetheus]

Great article! Its been a battle for me for many years..... just started TRT and its been very up and down. I went from feeling great to completely becoming overcome with anger and hyer fight or flight. I had to completely stop and and in just a few weeks already lost the 10 lbs I managed to gain....

How do yall do on TRT?

Hey, the more I follow all of this and people on TRT it seems it is a very common experience that people feel great for some time but then many return to feeling shitty again... Many try thyroid and adrenal replacement. Same thing. The honeymoon period does not last (at least for many). To me, it seems, that it has to do just as much to do with hormones but also neurotransmitters, which many seem to neglect

 

[Gianluca]

Thanks for the info! For me though, likely as I was using much lower doses, recovery was almost "instant", without any transient period of (symptomatic) hypocortisolism.

I have a question for you, as you seem incredibly experienced and knowledgeable: I have heard recommendations to try small doses of pregnenolone or progesterone quite a few times now. Some (select) people seem to do amazingly well on small doses of pregnenolone (10-50mg) or progesterone. Likely, because these steroids are converted into neuroactive metabolites (neurosteroids).

Personally, I have never done proper experiments with these in isolation, however, as more people keep telling me about their beneficial effects, I might do a 10mg pregnenolone experiment soon.

What is your take on pregnenolone and/or progesterone? Who would benefit? Are there risks? I´d be interested in your take on this matter.

HI @Hormetheus, what was your HC replacement dose at base line? did you need to stress dose?

thanks

 

[Gianluca]

Good for you!!

Recovery of Adrenal Function after Long-Term Glucocorticoid Therapy for Giant Cell Arteritis: A Cohort Study


Abstract
Objectives
Giant cell arteritis (GCA) is a chronic systemic vasculitis of large and medium-sized arteries, for which long-term glucocorticoid (GC) treatment is needed. During GC withdrawal patients can suffer adrenal insufficiency. We sought to determine the time until recovery of adrenal function after long-term GC therapy, and to assess the prevalence and predictors for secondary adrenal insufficiency.

Subjects and Design
150 patients meeting the ACR criteria for GCA between 1984 and 2012 were analyzed. All received the same GC treatment protocol. The low-dose ACTH stimulation test was repeated annually until adrenal recovery. Biographical, clinical and laboratory data were collected prospectively and compared.

Results
At the first ACTH test, 74 (49%) patients were non-responders: of these, the mean time until recovery of adrenal function was 14 months (max: 51 months). A normal test response occurred within 36 months in 85% of patients. However, adrenal function never recovered in 5% of patients. GC of >15 mg/day at 6 months, GC of >9.5 mg/day at 12 months, treatment duration of >19 months, a cumulative GC dose of >8.5 g, and a basal cortisol concentration of <386 nmol/L were all statistically associated with a negative response in the first ACTH test (p <0.05).

Conclusion
Adrenal insufficiency in patients with GCA, treated long-term with GC, was frequent but transitory. Thus, physicians’ vigilance should be increased and an ACTH test should be performed when GC causes the above associated statistical factors.

to mention, in this study prednisone was used, not hydrocortisone

 

[Nelson Vergel]

Webinar - Adrenal Hormone Therapies by Thierry Hertoghe

in the webinar: Cortisol, DHEA, Pregnenolone and Aldosterone diagnosis and treatment. I thought the explanation on low cortisol symptoms was excellent, simple to understand.

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