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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 "muscle".
Found 47 matches in 21 Q&A's.


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

QUESTION: Would physical therapy ever be prescribed for the lower back pain associated with Addison's symptoms? How can you differentiate a spinal injury from Addison's-type muscle pain?

ANSWER: Back pain is seen in some people with untreated Addison's disease or during an adrenal crisis. It should not be considered a chronic feature of Addison's disease. Therefore, if persistent back pain is present in an addisonian who is on appropriate replacement steroids, other causes should be sought and treated, with physical therapy, pain management, etc.



2) Q&A from the March, 2006 NADF newsletter:

QUESTION: Is it common for Addisonian's to experience body aches, cramping and muscle spasms? What might be the cause? Is there any feedback data concerning successful treatment modalities from patients?

ANSWER: Untreated or poorly replaced Addison's disease can cause muscle spasms and cramps, especially in the abdomen. These symptoms usually resolve promptly with hydrocortisone because they are primarily due to the electrolyte abnormalities of untreated adrenal insufficiency (high potassium and low sodium). If a treated addisonian continued to have muscle cramps or aches when all the other symptoms have resolved, other causes should be sought, especially hypothyroidism which is very commonly associated with Addison's disease.



3) Q&A from the September, 2007 NADF newsletter:

QUESTION: I was diagnosed with Addison's Disease 14 year ago. Presently taking 40 mg Cortisol, 30 in the morning and 10 at noon, 1.5 mg Florinef, 88 mcg thyroid. Three months ago I started having double vision. I consulted an ophthalmologist who prescribed a prism on the affected eye. It helped some, but without the prism, the double vision continued. He had no other suggestions for the cause or treatment of the double vision . He felt it might be due to the Addison's Disease. I have looked on the Internet and found nothing to suggest this is the case. What is your take on this? Thanks you for your help.

ANSWER: Stable double vision that can be corrected with a prism is due to either swelling in an eye muscle or scarring in an eye muscle. Either could be related to autoimmune thyroid disease, not Addison's disease. As part of the evaluation, the ophthalmologist should do a CT of the orbits which will help to confirm the eye muscle distortion. If thyroid function is stable on the replacement dose of thyroid hormone, there may be no specific medical treatment. However, if the double vision remains stable for many months, corrective surgery on the affected eye muscle may be useful.



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

QUESTION: I have had Addison's disease since 1969 and I am 73 years old. I have always been active. This year, it is harder to do things and a lot of muscle and joint pain, which I take pain meds for. My question: Does age ever require an increase in steroids? I take 25 mg. cortisone acetate in the am and 12.5 mg pm. I also take 0.1mg fludrocortisone acetate and 0.1 mg. synthroid. Thank you.

ANSWER: There is no general tendency to need a higher dose of replacement glucocorticoid with aging. The aches and pain are more likely the normal symptoms of arthritis rather than adrenal symptoms. Discuss the symptoms with your doctor. You might benefit from a consultation with a rheumatologist.



5) Q&A from the December, 2009 NADF newsletter:

QUESTION: A member would like to know if it is typical to lose bone and muscle mass with Addison's. He is 73 and he has told me several times that he has lost all his bones and muscles.

ANSWER: One of the major problems in the treatment of Addison's disease is to balance the necessary replacement steroid dose for good health and well-being against the negative effects of excess steroid use. In excess, glucocorticoid hormones can cause muscle wasting and weakness as well as osteoporosis, or bone thinning which can increase the risk of fracture. Therefore, these effects are not due to the Addison's disease itself, but from the treatment. That is one of the reasons it is important to adjust the steroid dosage to the lowest dose that keeps the patient comfortable and free of adrenal insufficiency symptoms. At the same time, it is vital to maintain good nutrition, with adequate amounts of protein, calcium and vitamin D. When osteoporosis is found, additional treatment with bisphosphonate therapy (Fosamax, Actonel or Boniva) can be useful.



6) Q&A from the December, 2010 NADF newsletter:

QUESTION: In January 2010 I had surgery for Lichen Sclerosus (autoimmune). I was increased on my high potency topical steroids for about 3 months prior to surgery, then told I needed to stop after surgery to heal. I crashed. 3 different specialist have said in conversation (not diagnosis) that I have Addisons disease, after telling what happened. I have felt this is true since 2006 after a different surgery. Since I cannot seem to get referred to an endocrinologist, I have used Dessicated Adrenal for 2 years now. I had also tried stopping the dessicated adrenal when they told me no steroids after the surgery. That also contributed to my crashing (severe muscle weakness, salt cravings, extreme fatigue, vomiting, confusion). My question is, does anyone know if this supplement can give false normal cortisol levels, as it has some steroidal effects. I do know I cannot function without it. I am afraid when I finally have my endo appointment in Feb. that my levels may be false normals, and I will not get proper treatment. I also take Rehmannia periodically, as it has an immune suppressing activity to it. Thank you.

ANSWER: Over the counter dessicated adrenal extract is unregulated. The FDA has inadequate resources to monitor ingredients. It is not legally allowed to have any significant hormonal activity, but who knows? I do not recommend it for anyone at anytime.



7) Q&A from the September, 2011 NADF newsletter:

QUESTION: Several years ago my doctor prescribed a statin drug to bring down my cholesterol. I started with Simvastatin that caused instant muscle and joint soreness. My doctor switched me to Pravastatin, 20 mg, which seemed to work for about a year. Eventually my joints and muscles gradually became so sore that I had difficulty moving my legs and arms and it got progressively worse. I stopped taking the statin about three months ago, on my own, and have improved 90%. As an alternative, I am taking two fish oil cap’s per day on my own. I will make an appointment with my doctor (endo) soon for a blood test and routine physical and discuss the statin side effects with him. I have discovered many other people with similar problems with statins through my research on the internet. Do you have any knowledge of side effects of statins on Addisonians?

ANSWER: The muscle cramps from statins are quite common and have nothing to do with Addisons’s disease. I see this frequently in all patients, with no increase in incidence in people with adrenal insufficiency. It is appropriate to try other statins, as you have done. The adjunct use of coenzyme Q-10 has been advocated for several years for those people who do develop muscle symptoms. In my experience it works some of the time, but not always. It seems very safe, so there is no reason not to try it. As far as fish oil versus statins, they are not equivalent. Statins are used primarily to reduce elevated LDL, the bad cholesterol. Fish oil does not do this. It can be useful for people with elevated triglycerides and low HDL, the good cholesterol. Fish oil lowers triglycerides while raising HDL. It is commonly used in conjunction with statins when both effects are desired. But if high LDL is a real issue as a risk factor for vascular disease, fish oil alone will not be adequate.



8) Q&A from the June, 2013 NADF newsletter:

QUESTION: I’ve been on prednisone non-stop for about 20 years for asthma. I was very slowly weaned to 7.5 mg every other day, a level I’ve been on for 3-5 years. Periodically I have to bump up the levels, and in the past 4 months I’ve had to bump them up and return to every day usage 3 times for asthma flares related to bronchial/lung infections. About 6 weeks ago I had a flare which required me to take the prednisone every day, in doses as high as 60 mg. It took about a month to get back to the 7.5 mg every other day. (I also have ulcerative colitis, but my primary medication for that is immuran.) Then I saw a new pulmonolgist. She asked me to reduce prednisone by 2.5 mg per week, becoming steroid free in a month. Her only warning about adrenal insufficiency regarded lightheadedness upon rising from a supine position. However, I wonder if that reduction is too fast, and if I should have blood tests to help guide the weaning. I am using 5 mg every other day now, but I have noticed weakness in my knees that I have associated with changes in steroid use in the past. I also have noticed new pain in my left hip, which I had not thought related, but now I wonder.

ANSWER: This is an example of the difficulty in tapering off long term steroids. I agree that the new pulmonary doctor may be too optimistic about your ability to taper and stop steroids after so many years of use and the frequent need to bump up to high doses. Going rapidly to every-other-day dosing in this situation is probably complicating the situation and contributing to the adrenal insufficiency symptoms (like the muscle weakness). Every other day dosing is useful in people who have been on steroids for a fairly short period of time, like a few weeks. In this current case, there is a great degree of adrenal suppression, so a slow taper of daily dosing has a greater chance of working. Once a dose of 5 mg is achieved, going down by 1/2 to 1 mg every 2 to 3 weeks may work better. Blood testing is not very useful, except for a morning ACTH once the dose is down to 2 or 3 mg, just to see if there is evidence of “awakening” of the pituitary. If ACTH is measurable, it is more probable that secondary adrenal insufficiency may resolve. Keep in mind that after 20 years of steroid use, many people have permanent secondary adrenal insufficiency and must settle on a baseline replacement dose of 4-5 mg of prednisone.



9) Q&A from the December, 2013 NADF newsletter:

QUESTION: I have had secondary pituitary adrenal insufficiency for the past 10 years. I have severe weakness in all extremities; the left worse than the right. My base dose of steroids is 6.5 mg of prednisone. I have had bilateral hip replacements and other orthopedic problems. My left fibula will dislocate from no trauma. My ankle strength is fair (3/5) and never seems to get any stronger. I was a physical therapist and was very active before my adrenal glands failed. I fall frequently. I cannot exercise heavily due to the Addison’s fatigue, severe asthma, and I am morbidly obese. Due to exacerbations from the asthma, I am on a roller coaster with the prednisone. Is it possible to increase strength through exercise taking a steroid for life?

ANSWER: The array of medical problems presents a challenge for you. The need for steroid replacement therapy itself does not prevent you from exercising and improving your strength. However, higher doses of steroids like prednisone can contribute to muscle weakness, so it is important to work with your doctor on finding the lowest dose that keeps you comfortable. The obesity is also a major issue. It exacerbates the arthritis and makes it harder to exercise. With less exercise, there is more weight gain. There is no magic formula, but try to reduce the dose of prednisone if possible, diet as well as you can, and try to find some form of exercise that will not cause further injury.



10) Q&A from the September, 2014 NADF newsletter:

QUESTION: Since I was diagnosed with Osteopena, I have learned that DHEA and testosterone are needed for strong bones and muscles. Is this true?

ANSWER: I am not in favor of this type of treatment. First of all, osteopenia is not at high risk for fracture. Osteoporosis is high risk. I recommend adequate vitamin D levels, good nutrition, and regular exercise to slow the gradual loss of bone mineral. There is good evidence that estrogen replacement will help in menopausal women, but that is not a good enough reason to prescribe estrogen. Low DHEA and T levels in menopause are normal. DHEA can be taken orally in women with Addison’s disease for its general improvement in sense of wellbeing, but its effect on bone is probably very minor. I see no reason to give any form of progesterone - orally or skin cream except to balance any extra estrogen treatment. By itself, progesterone has no benefit.



11) Q&A from the December, 2014 NADF newsletter:

QUESTION: Is taking 5 milligrams of oral prednisone comparable in our body to having a split dose of 2 milligrams of prednisone, and 12 milligrams of hydrocortisone? What is your opinion of using two different steroids as a replacement dose, rather than just one? And effects would this have on bone and muscle?

ANSWER: I generally do not use a combination of prednisone and hydrocortisone, but I have resorted to doing so on 2 occasions when I needed to significantly step up the glucocorticoid dosage for a short time, and did not want to add the additional mineralocorticoid effect that would come with a high dose of hydrocortisone. In the question posed, the total glucocorticoid effect would be similar to 5 milligrams of prednisone, but the total effect would be different. Since prednisone has a longer duration of action and much less mineralocorticoid than hydrocortisone, combining the two will have a smaller effect on blood pressure. The downside effect of glucocorticoids on bone and muscle should be roughly equivalent with the two regimens.



12) Q&A from the September, 2015 NADF newsletter:

QUESTION: I am a 27 year old Addisonian male, and was diagnosed at the age of 13. Since then, I have been really skinny. I am currently 6 feet tall, and weigh 135 lbs. I have tried almost everything to put on muscle, but have not been able to. I read that when diagnosed at a young age, there should be testosterone and growth hormonereplacement therapy. But I never had this. Both my father and brother are much heavier with muscle than I am. I was wondering if this could be caused by low testosterone, and if so, would my Addison’s have anything to do with that?

ANSWER: You should get a thorough endocrine evaluation, as you raise some appropriate issues. If you have typical autoimmune Addison’s disease, it usually would not include growth hormone deficiency, and you are 6 feet tall. Testosterone deficiency is another matter, and should be investigated. Of course, your dosage of glucocorticoids could be the basic issue. Your endocrinologist should evaluate the adequacy of your dosage and consider a trial of an increase.



13) Q&A from the September, 2015 NADF newsletter:

QUESTION: Having been an Addisonian for 42 years, I have a question about fatigue. When I was working 40 hours a week, cooking and cleaning for a family of seven, I was taking 5 mg. of Prednisone a day and doing fine. After retiring I had increased the dose to relieve arthritis to the point my muscles became weak. Now that I am 80 years old and not real active, I am still taking the 5 mg daily and experience muscle weakness and fatigue. Could these symptoms be caused by more Prednisone than I need at this point? If possible, how should I proceed?

ANSWER: Yes, the use of higher doses of prednisone over many years to treat the symptoms of arthritis could have caused atrophy of the muscles, especially the proximal muscles such as the thighs, leading to difficulty getting up from a chair or climbing stairs. At this point, even 5 mg may be too much if your weight has diminished. It is possible that a slight taper may help with muscle strength, but it will be a slow process. Before reducing the dose, a full evaluation with your doctor is necessary, to make sure there are no other medical problems that might make a prednisone reduction inappropriate.



14) Q&A from the March, 2017 NADF newsletter:

QUESTION: My doctor has told me that dexamethasone is an adequate adrenal crisis care injectable, but you recommend hydrocortisone. Is there a reason one is better than the other?

ANSWER: Dexamethasone has no mineralocorticoid activity, and has a very long duration of action that misses the physiologic diurnal variation. It is only available as 0.5 mg in 5 ml. That is a very big injection if given into a muscle and the dose would be inadequate. I disagree with your doctor for the reasons stated.



15) Q&A from the March, 2018 NADF newsletter:

QUESTION: I have secondary adrenal insufficiency. My adrenal glands are small and produce cortisol with proper diet and care. Stress will put me into crises. When I go into crises I lose all muscle control so it is a race of time to get me to the ER. I was born with only the right thyroid, and now have nodules on it. I have hypothyroidism and tried armor and levothyroxine, which I’ve had allergic reactions to. My father had thyroid nodule cancer. If I need to have the right thyroid removed because of cancer, is their medication for me to take for the thyroid that will not damage my adrenal glands?

ANSWER: There are mistaken concepts about adrenal insufficiency as well as thyroid disease. The simple answer to the question is that thyroid hormone in the form of levothyroxine would be necessary if the remainder of the thyroid is removed. Levothyroxine cannot be allergenic. If allergic symptoms occurred in the past, it was to the inert ingredients in the tablet. One way to avoid that is to use a liquid form of levothyroxine in the brand Tirosint®. Thyroid hormone cannot damage the adrenals.



16) Q&A from the December, 2018 NADF newsletter:

QUESTION: I am a 63 year old female with SAI for 15 years. I developed it from being given high doses of steroids for sudden onset severe adult asthma, off and on for over a year. When diagnosed with SAI, I tried so hard to be weaned off the Prednisone without success. I just saw the pulmonologist as I was having shortness of breath, and he did an inspiratory/expiratory breathing test and it showed my inspiratory muscles were only working at 50%. He felt this was due to steroid myopathy. Have you heard of this and is it reversible? He also did a chest x-ray which was normal and a 6 minute oxygen test which was also normal.

ANSWER: Steroid myopathy from long term use of high dose glucocorticoids primarily affects the proximal muscles of the arms and legs, but can cause weakness in any muscles. Chronic obstructive lung disease itself does weaken the respiratory muscles and the steroid use may be contributing as well. Unfortunately, the treatment from the pulmonary specialist may require continued use of steroids. If they can be weaned, whatever contribution to the shortness of breath that may be due to the myopathy may improve. There is no other specific treatment to improve the muscle tone.



17) Q&A from the March, 2020 NADF newsletter:

QUESTION: I was diagnosed with Addison’s disease in 1988. I was wondering if anyone has tried CBD (cannabidiol) products to help with tiredness, joint pain, and muscle aches. If so, does it help, and are there any downsides to it? Thanks for any info you can give.

ANSWER: CBD products are now available without prescription because they contain no THC, the active cannabinoid in marijuana. Unfortunately, since the products are over the counter, manufacturers and distributers can make claims about benefits and purity that are unsubstantiated. We need controlled studies and better verification on the potency of these products. I am not an expert in the use of CBD oil or other products, but some of my patients without adrenal disease have reported short term help with anxiety and stress with the oil. I have no experience with CBD in Addison’s disease. I would express caution until there is more research and more consistency in the available products.



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

QUESTION: Should individuals with adrenal insufficiency stress dose prior to receiving the COVID-19 vaccine?

ANSWER: I do not advise using extra glucocorticoids on the day before or on the day of vaccination. I suggest the individual with adrenal insufficiency wait to see if significant side effects occur, usually the day after the vaccine. If there is fever, significant muscle aches and pains, and especially nausea or any typical adrenal insufficiency symptoms, I would then add stress dose steroids in addition to treating any fever with acetaminophen or ibuprofen. I have spoken to many of my patients about their experiences, and many report no side effects at all. Those that did have significant symptoms were individuals who had a history of acute Covid-19 infection earlier in the year, and then had the vaccine.



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

QUESTION: I have Addison’s and Type 1 diabetes, in addition to Hashimoto’s. I have always had an emergency kit to inject dexamethasone in case of a crisis. Now I have glucagon for an emergency injection for low blood sugar. I asked my endo - if I am found unconscious with no other clue - give dexamethasone injection, then check if low blood sugar, give glucagon? My endo said just give the glucagon, and let the ER provide the steroids when I get to the hospital. But my recent crisis was a good example of what many of us know - if we don’t know to give ourselves the emergency injection, we may not get it at all. I did not get admitted to ER in North Carolina for many hours and was too out of it to give myself the injection. That did not go well. Any advice welcome.

ANSWER: With the combination of Addison's disease, Hashimoto's thyroiditis and type 1 diabetes, the most likely cause of loss of consciousness would be hypoglycemia. Therefore, if found unconscious, I would recommend that someone give sc glucagon immediately. An adrenal crisis generally takes hours to develop, with significant symptoms, including nausea, vomiting, diarrhea, muscle cramps and fatigue. IM or SC steroids (usually hydrocortisone rather than dexamethasone) can be self administered or given by someone else if vomiting prevents the retention of the oral steroids. I basically agree with your endocrinologist. The issue of getting appropriate emergency management of your adrenal crisis is another matter. NADF strongly recommends wearing a MedicAlert bracelet or necklace indicating adrenal insufficiency, carrying a NADF wallet card giving instructions, and most importantly, loudly insisting to the ER medical staff that you have adrenal insufficiency and are in an adrenal crisis.



20) Q&A from the March, 2023 NADF newsletter:

QUESTION: My endocrinologist told me that I’m unable to build muscle tissue and get stronger from disciplined exercise. Is that true?

ANSWER: Glucocorticoids do contribute to wasting and atrophy of muscles, especially the proximal muscles (closer to the body) in the arms and legs. This is called steroid atrophy. It will occur when there is prolonged exposure to doses above the normal physiologic dose. In treating adrenal insufficiency, we try to keep the replacement dose below that level, so there is a smaller risk of atrophy. If there is atrophy from previous exposure, but the dose is now stable, there is the potential to regain strength in these muscles over time. If there is a lot of atrophy, it can take many months to regain the strength with exercise and good nutrition, including adequate protein. There may be other factors in your situation that may contribute to a lack of muscle recovery, such as other diseases or medications and age. Older people have a much harder time regaining muscle. Discuss this with your endocrinologist.



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

QUESTION: I have had almost constant painless muscle twitching/Spasms on my upper abdomen where my stomach is. Does this have anything to do with Addison’s disease?

ANSWER: Addison's disease can cause muscle cramping, especially in the abdominal area. Painless twitching is probably not related. It is worthwhile trying an extra dose of hydrocortisone at a time when the symptoms are worse to see if it subsides. If it doesn’t help, consider a neurology consultation.





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
not a medical authority, nor does it claim to have medical
knowledge. In all cases, NADF recommends that you consult your
own physician regarding any course of treatment or medication.





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