Question: I had an adrenalectomy in August 2007. I am down to 5 mg of cortisol in the morning and 5 at night. I find that my thumbs and fingers pop at the joint and hurt. I must take my other hand and pop the joint back in place. I cannot make a fist anymore or open a bottle. I was ill and had to increase my replacement dose and I noticed that I felt better and my fingers felt better. Can you explain this?

Answer: In general, in subjects who have undergone adrenalectomy, hydrocortisone doses of 15-25 mg daily are often necessary to provide adequate steroid replacement. Low doses often result in symptoms of adrenal insufficiency, including fatigue, dizziness, and muscle and joint aches. The fact that you feel better on higher doses is evidence that higher doses are often necessary. I have not seen the problem of the joint issues that you raised.

Dr. Laurence Katznelson (Winter 2008)