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Please enter your search term and hit the search button. This will search 333 Question and Answer items published in the NADF newsletter between January 2004 and Present.

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Your search was for "cortef".
Found 34 matches in 17 Q&A's.


1) Q&A from the December, 2004 NADF newsletter:

QUESTION: Four years ago I had an operation for colon cancer that took 37 inches of my colon out. Since then it has traveled and is now in my lungs and may be in other places. I have talked with the cancer doctors who want me to take chemotherapy. I have studied the booklets they gave me and I have determined that I will be worse off if I get these treatments. There is Emend for controlling vomiting, then there is Eloxatin and Avastin for the chemo tube. I have been to the ER quite a few times with Addisonian problems and I simply cannot face this awful intrusion into my system. I was diagnosed with Addison's disease when I was 40 and could hardly walk. I am 73 now and get along pretty well. I have secondary Addison's and take 20 mg. of cortef daily. Could you please advise me what I should do? I am strongly tempted to take the time I have left and enjoy it.

ANSWER: The decision you have to make regarding your quality of life with chemo is a difficult one. The coincidence of adrenal insufficiency should not be much of a factor in your decision, however. You will probably need to increase your dose of hydrocortisone to handle the stress and nausea, but that is the easy part. Doubling or even tripling the dose will have marginal side effects compared to either the chemo or the cancer. I have had many adrenal insufficiency patients undergo chemo and get through quite well. Good luck.



2) Q&A from the March, 2005 NADF newsletter:

QUESTION: How long do you have to be off cortisol before you can get an accurate ACTH stimulation test result? Example: A patient is on cortef. His doctor takes him off the cortef and prescribes dexamethasone. How long should they wait before doing the ACTH stimulation test?

ANSWER: I assume the work-up is to rule out Addison's disease. In that case, I would wait at least two weeks after the switch to dexamethasone, hold the morning dose and then give the standard ACTH stimulation test. There is no journal article to quote regarding my recommendation for two weeks on dexamethasone. It reflects my bias from many years of clinical practice during which patients were sometimes referred to me on unknown doses of various steroid preparations, sometimes including intramuscular and topical steroids, and I was asked to determine if there really was underlying adrenal insufficiency. The point is that all cortisone or any other glucocorticoid that might be measured as cortisol in serum or urine assays must be totally cleared from the body before performing the stimulation test. In addition, one would like to allow the pituitary to readjust to a reasonable dose of glucocorticoid that avoids severe suppression of ACTH that might have occurred while on high dose cortisone. This will allow measurement of baseline plasma ACTH before the administration of the Cortrosyn, enhancing the value of the test. By the way, in cases where autoimmune Addison's is suspected, I recommend adding a blood test for 21-OH adrenal antibody for confirmation.



3) Q&A from the June, 2005 NADF newsletter:

QUESTION: Recently, my endocrinologist, while on a routine visit, lowered my cortef (10 mg) to a total of 15mgs a day. I am 76 years old and have taken 30 mg of cortef for the entire 38 years I have been diagnosed with Addison's. She states that ALL Addisonians are being similarly lowered to these levels. Do you know of any research that is ongoing concering this drop in corticosteroid level? I am not doing well on the low dose and must grab a 10 mg tablet many times over the course of a week.

ANSWER: Although it is true that 30 mg of hydrocortisone is probably more than enough for most otherwise healthy Addisonians, I think it is important to slowly change the dose on any stable patient with adrenal insufficiency. The symptoms that you have certainly suggest that you need more than 15 mg. I think it is a mistake to put all people in the same basket. There is a wide range of steroid requirement, from as little as 10 mg per day to as much as 50 to 60 mg. I find that most do well with 20 to 25 mg per day. I suggest that you talk to your endocrinologist about your response to the change in dose and try 25 mg for now.



4) Q&A from the June, 2005 NADF newsletter:

QUESTION: I have a question regarding possible interference of methotrexate with cortef. I was put on methotrexate (7.5 mg once a week) for rheumatoid arthritis about early October. It didn't help; in fact I began to feel worse, but we were finishing a new house, moving in, etc. and I attributed this to stress. Early December the dosage was increased to 10 mg per week. I began to feel REALLY HORRIBLE. Weak, upset stomach, weepy—it's hard to describe how awful I felt. My normal dose of cortef was 25-30 mg per day (10- 10-5). I had gone to 60 mg per day and it didn't seem to help. I started going through my files regarding Addison's and came across a short blurb about drug interference with cortisone. I discussed it with my PCP (not an endocrinologist as none are available in this area). We decided to drop the methotrexate about mid- December. I began to feel better as of early February. I am wondering if the methotrexate is indeed the culprit, how long it should take to get this out of my system and if there is something I could take in place of it. I would prefer not taking anything at this time if I can avoid it. Too many pills.

ANSWER: I am not aware of any interference in cortisone metabolism from methotrexate. The fact that increasing the hydrocortisone dosage didn't help suggests that it was not the adrenal insufficiency that made you feel bad, it was the methotrexate. Many people can't tolerate it. I am not able to suggest other treatment for the RA. You need a rheumatologist to review your condition and your previous drug effects.



5) Q&A from the September, 2006 NADF newsletter:

QUESTION: A member with auto-immune Addison's disease was recently told by a psychiatrist that her depression is caused by her hydrocortisone. (She is on 30 mg. cortef a day, no Florinef.) She would like your opinion.

ANSWER: There is a complex relationship between cortisol and depression. Excess cortisol seen in Cushing's syndrome can cause mood changes including depression. Sharp and sudden excess cortisol from high dose steroids may cause dramatic mood changes including manic behavior and even psychosis. Low levels of cortisol in undiagnosed or inadequately treated Addison's disease will often contribute to a sense of depression along with the other symptoms of adrenal insufficiency. Restoring the glucocorticoid level to normal with hydrocortisone will usually improve mood substantially. Basically, aiming for “normal" with hydrocortisone treatment should include mood in addition to the typical physical features that are monitored. However, clearly some people with Addison's disease may have a coincidental clinical depression that cannot be managed by simply manipulating the hydrocortisone dose. Many Addisonians in excellent control with hydrocortisone and fludrocortisone also benefit from psychotherapy and antidepressant medication.



6) Q&A from the March, 2007 NADF newsletter:

QUESTION: I have been an Addisonian for seven years now and was diagnosed with Hashimoto's 12 years ago. Recently my endocrinologist decided to add Cytomel to my Synthroid (to help me with energy fatigue, etc.) and it really has helped me feel better. I used to struggle to get through a week of work, kids, family, house,etc. By Friday I was an absolute mess. My doctor thought this might help and it truly did! However, it appears to be causing problems with the absorption of my cortef/Florinef. She recently ran an ACTH level to make sure that I was not having a problem with that, and the ACTH should have been in the range of 4-58 and my test level was at 312! She wants to just increase my cortef/Florinef temporarily and see if that helps, but I am not comfortable with increasing it. I don't really want to stop the Cytomel because it has really made a large difference in how I feel, but do I need to be worried about my ACTH levels being so out of range? Do you have any information on Addison's patients taking Cytomel?

ANSWER: Cytomel is T-3, a form of thyroid hormone that the thyroid secretes in small amounts. Most of the thyroid hormone secreted is in the form of T-4. It turns out that there is adequate conversion of T-4 to T-3 outside the thyroid to keep the level normal in people given only T-4 (Synthroid). There has been a lot of research on the issue of whether hypothyroid patients benefit from adding T-3 to T-4, rather than just increasing the dose of T-4. In carefully controlled studies, it does not help. I do not use it myself. A major drawback to using T-3 is the short duration in the body, which can cause misleading blood test results.



7) Q&A from the September, 2008 NADF newsletter:

QUESTION: I have secondary adrenal insufficiency due to a depletion of ACTH. Should I take cortef or Prednisone and in what amounts? I am a 5'1" tall 49-year-old female. I was put on cortef two years ago because of subcutaneous inflammations and was told the Prednisone thins the layers of skin. Is this true. I've been taking 15 mg in the morning and 5 mg in the afternoon. I have been gaining weight on this med to the tune of 1/2 pound a month, steadily gaining 20 pounds. Any ideas as to what I should do?

ANSWER: Most people with secondary adrenal insufficiency have normal mineralcorticoid production (aldosterone) and lack only glucocorticoid production. Therefore, they can do very well with prednisone as their replacement steroid taken once every morning. cortef has some mineralcorticoid activity which can raise blood pressure, and it is usually taken in 2 doses. Thinning of the skin, bruising, stretch marks and “Cushingoid" weight gain are due to the total dosage of the glucocorticoid, not the preparation. So, if you need the blood pressure assistance or potassium suppression from the cortef, you can stay on it, but you may consider a smaller dose. Or, you can switch to prednisone and try a dose of 3 or 4 mg per day. All of these choices must be discussed with your own doctor.



8) Q&A from the March, 2009 NADF newsletter:

QUESTION: Recently my Solu-cortef injections expired. Per NADF's e-mail of July 6, 2007, Dexamethasone Sodium Phosphate was recommended as a substitute for solu-cortef. So last week I got my prescription renewed with Dexamethasone, because it doesn't need complicated mixing like solu-cortef. However, last evening I was going through old NADF newsletters. In a 2003 Q&A to Dr. Margulies, he replied that Dexamethasone is not a great substitute for hydrocortisone because: “it contains no mineralcorticoid activity (the only reason to take an injection of steroids) it would not provide enough stimulation to blood pressure." Should I get a new prescription for solu-cortef? Is there any injectable solution that is good for Addison's emergency that does not need mixing: this is a very difficult process for lay persons. I would appreciate your reply. Thanks for all the years of NADF and it's support!

ANSWER: I haven't changed my mind about dexamethasone. For emergencies, Solu-cortef and/or the other brand of hydrocortisone are superior because it contains mineralocorticoid and well as glucocorticoid activity and therefor helps to maintain blood pressure.



9) Q&A from the March, 2009 NADF newsletter:

QUESTION: My 20 year old son is a member of NADF because he has Addison's. His endo of 11 years died and he has a new one now. He is 165 pounds and she recommends he injects 200 mg of solu-cortef if there is an emergency. His previous endo rec 100mg. What is the dosage used by adult Addisonians? I fear that if he uses too much, it will be detrimental instead of helpful. I would appreciate any help you can give us with this question.

ANSWER: A stress dose of 100 mg of hydrocortisone (Solu-cortef is hydrocortisone) is adequate for emergencies while waiting for transportation to a health care facility. Keep in mind that the average human produces about 20 to 35 mg of cortisol per day. When stressed, we will produce more. The typical suggested stress dose of 100 mg every 8 hours IV or IM given in hospitals for medical emergencies or surgery is purposely an exaggeration of the normal physiologic response, but is generally safe. Although there is no significant long term ill effect of giving an acute dose of 200 mg in an emergency, it is much more than necessary, and might temporarily raise blood sugar and lower potassium.



10) Q&A from the March, 2013 NADF newsletter:

QUESTION: I have secondary adrenal insufficiency, and for the last 10 years I have found that in a pinch, squirting the hydrocortisone solution of my crisis care injection into my mouth and swallowing it works if I can't inject myself with the hypodermic needle. Is this a good way to treat an Addisonian crisis?

ANSWER: I do not recommend this approach. Since the purpose of an emergency injection is to provide a high dose when oral medication would be ineffective (especially if the person is vomiting), giving the injectable form into the mouth is not more effective than taking more pills by mouth. I suppose the injectable forms, like Solucortef would be absorbed, since it is a solution of hydrocortisone in sodium succinate. But if the individual is vomiting, the amount absorbed would still be uncertain. I would still suggest increased oral steroids for stressful events, IM hydrocortisone for emergencies when oral cannot work, and ER visits for IV saline and hydrocortisone when those treatments do not work. It is possible that squirting Solucortef into the mouth may help if there is no other steroid available, but it is not the ideal treatment.



11) Q&A from the September, 2013 NADF newsletter:

QUESTION: I was diagnosed as adrenal insufficient due to very low levels of cortisol in saliva and urine tests, and also have a hypothyroidism. I was on only a fourth of a pill of Nature’s Thyroid for 6 years. I could never raise it any higher without going into what I now know was adrenal crisis. Now that I am on cortef, when I tried to take an eighth more, I went into crisis again. I asked my doctor to switch me to T3 only. He did it, but said that it isn’t good, because it will eat up all my cortisol and mess up my adrenals. What should I do?

ANSWER: First, I suggest a more accurate diagnosis of adrenal insufficiency than just salivary and urine cortisol levels. An ACTH stimulation test is the best way for most Addisonians. Second, I never use desiccated thyroid or pure T3 to treat hypothyroidism. The best therapy is levothyroxine (T4) with the dose appropriately adjusted based on symptoms as well as TSH levels. It is important to remember that the proper TSH level to aim for varies from person to person, so personal comfort and symptoms count. We don’t stop with a “normal TSH” because some will feel best with a TSH in the low normal range and others will feel best with a TSH in the mid or high normal range. Work with your endocrinologist!



12) Q&A from the March, 2021 NADF newsletter:

QUESTION: Humana is my insurance provider for Medicare Part D benefits. When I refilled my prescription recently, I learned that Solu-cortef is not included in the drug formulary for my plan. Instead, they would cover methylprednisolone acetate. I talked to my endocrinologist and he was reluctant to recommend the substitution. I’m curious about a second opinionI thought I might not be the only person to encounter this issue.

ANSWER: I suggest that your endocrinologist ask the insurance company for an exception to their formulary. Solu-cortef isstandard of care and they should approve it off formulary.



13) Q&A from the June, 2021 NADF newsletter:

QUESTION: I have never seen any guidance on what to do if we have a severe allergic reaction (anaphylaxis) to something. My guess is that we would need both Solucortef (or equivalent) and epinephrine. Would there be a problem if we were given only epinephrine without the Solucortef?

ANSWER: The immediate treatment for anaphylaxis is epinephrine. If this were to occur in a person with adrenal insufficiency, I would recommend adding a stress dose of hydrocortisone 20 mg to cover the stress. IV or IM hydrocortisone would be appropriate only if there is a sustained allergic reaction after the use of epinephrine.



14) Q&A from the September, 2022 NADF newsletter:

QUESTION: What could be advice for someone who has experienced many adrenal crisis incidents over just the past 3 years (I've had it for 6 years this month.) I've been on hydrocortisone, prednisone, and am currently on a high dose of dexamethasone and have been on that high dose for two years. even with that, stress dosing when needed and doing other preventative measures my cortisol still hits the floor (.4 on average) to put me in the hospital.

ANSWER: It is difficult to determine what factors make you more prone to acute adrenal crises. Many factors could be involved, including occupation, family status that might expose you to more infections, other coexisting diseases, and the need for early recognition of the signs and symptoms that indicate that stress doses should be started immediately. I would recommend that you have an emergency Solu-cortef vial and syringe, which might prevent the need for an ER visit in some situations. I am a bit puzzled about the switch to prednisone or high dose dexamethasone. If you have primary adrenal insufficiency, prednisone and dex have no mineralocorticoid activity. I assume you are taking adequate fludrocortisone. If not, your blood volume may be chronically low, keeping you too close to the threshold where blood pressure can drop and precipitate a crisis. Also, since you mention very low serum cortisol levels, keep in mind that when you are taking dexamethasone, the serum cortisol will be suppressed, so it will not be a useful test. Much better to go back to hydrocortisone.



15) Q&A from the September, 2022 NADF newsletter:

QUESTION: With regards to the Solu-cortef injection, if vomiting is occurring, would that be sufficient to try to stay at home or would an ER visit be necessary due to possible dehydration?

ANSWER: If a person with Addison's disease is vomiting and can't hold down oral hydrocortisone, the Solu-cortef injection may be sufficient if the vomiting stops and you can start to keep oral fluids and then hydrocortisone down. However, if the vomiting persists, or there are signs of low blood pressure or fever, a trip to the ER may still be necessary. Either way, the injection provides some immediate relief and reduces the overall risk of the acute adrenal crisis.



16) Q&A from the September, 2022 NADF newsletter:

QUESTION: My doctor is prescribing Paxlovid for COVID. When I check it out online, I read that it alters the absorption of cortef and Fludrocortisone. My doctor does not understand Addison’s, so he may not be aware of how crucial that absorption is. What is NADF advising regarding Paxlovid with cortef and Fludrocortisone? I just read NADF article “FDA Approves Antiviral Pills……” along with its links. It does not address this issue.

ANSWER: Paxlovid is appropriate for individuals with adrenal insufficiency who have Covid. It has a minor effect on glucocorticoid metabolism, especially dexamethasone and prednisone, but not hydrocortisone or fludrocortisone. Even then, the effect is to raise the level, which is beneficial in the setting of symptomatic Covid. Individuals with adrenal insufficiency should increase their dosage of glucocorticoids to handle the stress of the acute illness. Any effect during the 5-day course of Paxlovid is helpful, not harmful. Since there are many other drugs that can interact with Paxlovid, they should be reviewed by the physician and pharmacist.



17) Q&A from the June, 2023 NADF newsletter:

QUESTION: I am having trouble obtaining Greenstone hydrocortisone, and my doctor is prescribing prednisone instead. What are your thoughts?

ANSWER: Before switching to prednisone, I suggest trying to get cortef brand hydrocortisone while waiting for the Greenstone supply. Prednisone can be used, but it has a different duration of action and has very little mineralocorticoid activity. If you do use it, you may need to increase the dose of fludrocortisone.





Questions are normally submitted by NADF members.
Answers are from NADF's Medical Director Paul Margulies, M.D., FACE, FACP.

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NADF does not engage in the practice of medicine. It is
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knowledge. In all cases, NADF recommends that you consult your
own physician regarding any course of treatment or medication.





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