Question: I am on cortisol replacement medication and just had a large ulceration in my stomach. Can cortisol replacement cause this? For those on replacement, what is the best pain medication for arthritis that will avoid stomach problems? Answer: One of the potential side effects of cortisol replacement (using prednisone or hydrocortisone, most commonly) is… Continue Reading
Category Archives: Doctor’s Answers
Replacement Steroid Dose After Menopause
Question: Does one require less hydrocortisone replacement after menopause? Answer: Female hormones (estrogens) do affect cortisol metabolism by increasing the binding of cortisol to carrier plasma proteins. When the estrogen levels decrease after menopause cortisol binding also decreases. In people with intact pituitary-adrenal function, cortisol secretion decreases and levels adjust automatically. However, if a person… Continue Reading
Replacement Steroid After Surgery and Tapering
Question: What medication is given following successful surgery for Cushing’s syndrome and is there a proper procedure for weaning a patient from replacement medication? Answer: During and immediately following surgery, the patient is usually placed on high doses of hydrocortisone, 200 to 300 mg/day. Beginning the day after surgery, I normally decrease the dose by… Continue Reading
Rapid Heartbeat During Tapering
Question: I am trying to taper my replacement dose of hydrocortisone, but I am having difficulty tapering due to a rapid heartbeat which happens when standing and during stress. My AM cortisol is 9nmol/L. Is this normal during tapering? Should I increase my dose? Answer: Your very low cortisol levels indicate that your hypothalamic-pituitary-adrenal (HPA)… Continue Reading
Permanent Steroid Replacement and Nelson’s
Question: I had unsuccessful pituitary surgery and then had a bilateral adrenalectomy. I am feeling better, but have not been able to lose any weight. My maintenance dose is 37.5 mg per day of Cortef, which I understand is on the high end of replacement doses. My endocrinologist doesn’t think it is wise to decrease… Continue Reading
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