Question: My last ACTH was normal at 19.6 and I was taken off cortisone. I had severe adrenal insufficiency and was put back on small doses of cortisone for two months. It has now been almost a year and I suffer symptoms such as generalized pain/aches/soreness, loss of appetite, lack of energy, etc. My understanding is that once the ACTH level is normal, one should no longer suffer from adrenal insufficiency. Is this correct?

Answer: The symptoms that you mention resemble relative adrenal insufficiency, which occurs frequently when the cortisol levels go down from very high to normal. We do not know what the mechanism is for symptoms of steroid withdrawal but the treatment may require supraphysiological doses of cortisol replacement for some time. While a normal ACTH level suggests recovery of pituitary ACTH secretion, it does not insure a normal cortisol response. It would be important to measure urinary free cortisol to be sure that the cortisol levels have indeed returned to normal.