The adrenal glands produce three categories of hormones. The first category is the Glucocorticoids. The most important hormone in this group is cortisone. This group of hormones is important for stress management, immunologic balance and metabolic balance. The next group is the Mineralocorticoids. The main hormone in this category is aldosterone. Aldosterone causes salt and water retention. This helps us maintain our fluid volume and prevents dehydration. The 17-Keto-Steroids are the sex hormone precursors and the sex hormones.
This is a discussion of the glucocorticoids and mineralocorticoids. The most extreme example of glucocorticoid deficiency is an illness called Addison’s Disease. This illness can present precipitously. Under such circumstances, the individual would be profoundly ill. If the cause were undetected, they would not survive. Addison’s Disease may also develop insidiously. It may be difficult to diagnose at first. As in other areas of medicine there is a continuum between serious illness and optimum health. The Integrative Medicine view is to identify the individual along this continuum and provide appropriate support to move the individual towards an optimal health level.
There is an important difference between the pharmacologic versus the physiologic use of Cortisone. Physiologic dosing is intended to supplement glandular function without impairing it. Pharmacologic dosing is intended to treat a disease or symptom of a disease. The potential for impairing glandular function is accepted because of the severity of the disease that requires treatment. Physiologic dosing does not have the same potential for side effects as pharmacologic dosing.
Proper adrenal gland function is an important factor in the way that we manage acute and chronic stress. The adrenal gland interacts with the brain via the hypothalamus and the pituitary gland. Chronic stress can cause Hypothalamic-Pituitary-Adrenal (HPA) Dysfunction. Chronic stress can be due to many causes; psychosocial factors, toxins from the environment, toxins produced within our gastrointestinal tract, toxins produced in our bodies, chronic illness, chronic sleep disturbance and hormonal imbalance. There are many effective strategies to support HPA function. The use of cortisone as hormone replacement should be considered when there are clear indications from laboratory testing. The physician may suggest a trial of cortisone therapy when other strategies to improve HPA function have failed and the patients’ distress warrants a therapeutic trial.
Symptoms and Signs of Adrenal Dysfunction that may suggest the need for further evaluations:
Borderline adrenal insufficiency is often associated with hypothyroidism. In patients with hypothyroidism who fail to respond to treatment with thyroid, I will test for adrenal insufficiency.
Our body can make antibodies against our adrenal tissue. This is believed to be a common cause of Addison’s Disease. One should be suspicious of this phenomenon in a person who has other autoimmune diseases.
Testing for Adrenal Insufficiency:
Strategies for Improving HPA Function:
Supplements that may support healthy adrenal function include:
There are many herbal products that may support healthy adrenal function. They are referred to as Adaptogens:
The use of herbal preparations is best done under the supervision of a knowledgeable health care practitioner who can create and monitor an individualized program.
Herbal formulas that are very useful include Vital Adapt, Power Adapt and Botanabol.
When appropriate I prescribe Cortisone in physiologic doses. The dose must be individualized and its effects carefully monitored for therapeutic benefit and possible side effects. When indicated, the use of Cortisone is very rewarding.
We can reduce the risk of side effects by using supplements such as DHEA, Calcium, Vitamin D and Probiotics (acidophilus).
There are many strategies to support healthy adrenal function. The use of Cortisone can be a valuable therapeutic intervention for appropriate individuals.