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ACTH Stimulation Test to Determine Discontinuation of Steroid Replacement

Question: What is an ACTH Stimulation Test and what is it used for? Answer: An ACTH stimulation test is most commonly used in patients with Cushing’s Syndrome many months after surgery to determine whether their hypothalamic-pituitary-adrenal axis is recovering and whether it is therefore safe to discontinue their steroid medications. It is a 1 hourContinue Reading

Adrenal Insufficiency When Discontinuing Replacement Steroids

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 understandingContinue Reading

Age and Replacement Dose

Question: I have been on permanent replacement hydrocortisone for many years. Is there a need to increase or decrease my replacement dose as I age? Answer: This is a very good question. There is no literature that I am aware of that has addressed this specifically. However, as we age, we are at higher riskContinue Reading

Colonoscopy and Stress Dose Replacement Need

Question: I am on cortisone replacement and am scheduled for a colonoscopy. Do I need to tell my doctors that I need a stress dose of hydrocortisone? Answer: I recommend that my patients be given intravenous hydrocortisone, usually 50 mg, just before the colonoscopy to cover the stress and light anesthesia for the procedure. ByContinue Reading

Determination of Replacement Steroid Dose

Question: How is the proper dosage of maintenance medication determined? Answer: Your endocrinologist begins with a “standard” dosage of steroid, which lies within a very narrow range. For an average adult, the usual daily dosage for glucocorticoid replacement would be .5 to .75 mg of dexamethasone taken as a single dose, 5 to 7.5 mgContinue Reading