Adrenal Fatigue & Medical Ignorance

by Leisa on July 13, 2009

Adrenal fatigue or adrenal insufficiency is one of the areas I specialise in as a Naturopath – having experienced severe adrenal issues combined with a thyroid problem myself in the past.

In my own search for answers to my health problems, I became very experienced with all the different remedies for adrenal function – from food, supplements and herbs – to medication.

Adrenal fatigue occurs when the adrenal glands (perched on top of the kidney’s) become exhausted and fail to produce enough of the hormone cortisol.  Cortisol is produced in response to day to day stresses, and is one of our key stress hormones.  It regulates our immune system, energy production, protein breakdown for glucose, carbohydrate metabolism and insulin response and also regulates inflammation within our body.

In excess it is linked with many chronic illness such as heart disease, diabetes and cancers – but in some people, after a prolonged or traumatic stress, cortisol production becomes limited.

The symptoms of this can include low blood pressure, dizziness (especially on standing up quickly), anxiety, overwhelm, chronic fatigue, depression, salt cravings and immune issues.

When someone is suffering the symptoms of severe adrenal fatigue, shows very low cortisol results on a Saliva Hormone Test, and seems to be unresponsive to food, herbs and supplements – I have found that low dose hydrocortisone (cortisol replacement) can be a very effective remedy.

Yes, we are moving into the medical world here – but hydrocortisone is pretty much identical to the body’s own natural hormone – and for many people they are just not able to rest the way they need to for their adrenals to recover naturally.  There still may be financial pressures and the need to work full time, the stress that caused the fatigue still may not be resolved etc and this is where in my experience, I have found hydrocortisone to be life-saving.

It appears that used in low dose (20mg or less), it allows the adrenal glands to rest and recover.  When slowly weaned off after a period of months, if good food, herbs and supplements have been used during this time to support the healing process, then the adrenals can recover and function without support, and the patient can make a full recovery.

This was my experience, and I wholeheartedly support the use of low dose hydrocortisone when it is necessary.

However, I have also found that very, very few doctors understand using this medication in low dose amounts for the purposes of adrenal support and recovery.  Most know nothing about adrenal fatigue to start with and don’t recognise it as an illness at all, and certainly very few have studied the use of low dose hydrocortisone.

Just this week I have had two patients who clearly have severe adrenal fatigue, discuss with their doctors the possibility of using this treatment. Both doctors were horrified and expounded the dangerous side effects of this medication.  One even going so far as to predict my patient would develop “osteoporosis within a month”.  How ridiculous.

It amazes me how ignorant the medical profession is at times, and that they continue to spout the party line without doing any of their own investigations.

Like everything, there is a safe dose and an unsafe dose and hydrocortisone is one of those medications that in high doses does have many undesirable side effects.  But replacing a deficient hormone in amounts that the body would naturally produce were it functioning properly – is entirely safe, and was proven so in extensive research done by Dr. William McK Jefferies in the 1950’s.

He used low dose hydrocortisone to help hundreds of patients recover their health, and wrote a book discussing this very topic, called “The Safe Uses of Cortisol“.  In this book he laments the fact that so many doctors dismiss this treatment out of hand, citing the side effects associated with high dose treatment.  And it looks as though nothing has changed in the 50 years since.

All we can do is arm ourselves with knowledge and try to encourage our medical practitioners to research this controversial topic.  Then we may see more people who are suffering with adrenal fatigue, have this issue recognised, and treated appropriately.



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18 commentsAdd comment

Jacqueline July 31, 2009 at 4:26 pm

Really interesting post and the first I’ve heard of hydrocortisone being used for AF. I am about to start treatment with a bioidentical progesterone cream for some hormonal issues and was told it would help my thyroid and adrenals as well, though I’m not sure just why that is. I will ask my practitioner about hydrocrotisone. Also, here is an article I just read before stumbling on your blog. From Women to Women, it discusses how to time meals and snacks throughout the day to support the adrenals (scroll about halfway down for the meal chart and cortisol production patterns). Eating to support your adrenal glands — small choices can make a difference

Leisa August 20, 2009 at 11:32 pm

Hi Jacqueline,
Thanks, that was a good article, “Eating to support your adrenal glands”. What she talks about there is great in mild to moderate adrenal fatigue, but for more severe issues it can come to the point where low dose adrenal replacement may be required. Bioidentical can have a positive effect on thyroid and adrenal function in many ways – it offsets or balances oestrogen dominance when can effect thyroid function, the progesterone is a precursor to cortisol production, so it can boost cortisol reserves in the body and support adrenal function, as well as balancing the mood. There are quite a number of different areas that progesterone can help if your levels are low in menopause.

Juliana Sanguinetti April 27, 2011 at 4:05 am

Hi Leisa,

Your story is wonderful news to me. I just started taking HC after a yr of feeling awful and its been about a mth, and there are so many people out there saying they couldn’t ween off, or when they did, that their adrenal function was just as weak as before. I want to feel hopeful about the HC but these stories are just so discouraging.

I was healthy before taking an SSRI for a yr, Effexor, which caused me to have high cortisol levels while on it, and I think it caused adrenal fatigue because once off of it, my energy level just crashed, and for a yr I’ve had low blood pressure, low body temp, adrenaline rushes, hypoglecemia, dry skin, weight gain, etc. Had detailed lab testing including thyroid and the only thing came up abnormal was slightly low sodium and a very low cortisol on saliva 24hr test.

I was wondering did you take the saliva test and were your results in the depressed range? And now after a course of HC your 24 hr cortisol levels are much higher/more normal? How long were you on the HC for? And what caused your low cortisol function in the first place?

I’m so glad that there is a person whose cortisol function came back after HC. Thanks so much for sharing your story.

Juliette January 17, 2012 at 7:59 am

Hi Leisa,
I have SLE and after a beautiful holiday in Greece for a month in the sun (UV rays are bad for lupus) I flipped from hypo to hyperthyroidism and my doctor told me my adrenal glands were in overdrive, so I could not tolerate my thyroid medication for 3 months afterwards. Now my hair is falling out in large amounts. Does this mean I need cortisol? Does liquorice work as well as hydrocortisone to combat adrenal exhaustion?

Leisa January 29, 2012 at 6:57 am

Hi Juliette,
This is a complex issue that needs more than just a short answer here… The adrenals and thyroid are very linked and too low or too high cortisol will effect how your thyroid medication is utilised. My first suggestion would be to have a Comprehensive Saliva Hormone Test done so that you can see exactly where your adrenals are up to. Then, if you have autoimmune issues as well, you need to be on a program to tackle those – so it is multi-faceted and several areas need to be addressed. Hair falling out is a symptom of hypothyroidism and could mean that you have shifted towards that condition further. Liquorice can support cortisol, but no, its not equivalent to hydrocortisone. In cases of milder adrenal fatigue you can use herbal medicine very well to support and improve adrenal function, but we’d need to know where you were at first. Have a think about a saliva test, and then we do consulting through Embracing Health, so that could be an option as well.

Beth April 10, 2013 at 12:45 pm

I need help with HC dosing….. I am very very low in the morning… I have taken 2.5 mgs of HC and it leaves me tired 2 hours later… So I bumped it to 5 mgs…. It left me EVEN more tired two hours later….. I have no idea what to do…. I though HC was supposed to help?!?! Here are my test results from a saliva cortisol test:
Morning. 2.8 (3.7-9.5)
Noon 2.3 (1.2-3.0)
Dinner 1.3 (.6-1.9)
Night .5 (.4-1.0)

How much HC SHOULD I BE TAKING….. I’m not getting any feedback from compounding pharmacist!!!!! I’m at a loss… I’m severly depressed,no energy, no drive….. I’m flattened!!! So done please help me!!!!!

Margaret April 17, 2013 at 5:49 pm

I am currently experiencing the same problem Juliana described; after being on anti-depressants for 5 years, I have very low cortisol. I am currently under the supervision of an MD specializing in functional medicine and taking Adren-All (bovine cortex, rhodiola, schisandra, ginseng), which is helping a lot. Do you have any thoughts on the possible connection between antidepressants and low cortisol? How does one know when HC is necessary? Any thoughts on supplements for this condition? I’m interested in how you responded to Juliana’s question as well, regarding your own recovery using HC. Thanks!

Brianna Thompson June 17, 2013 at 7:04 pm

Doctors look at the difference between your blood pressure readings during the last two hours before retiring and your morning levels during the first
two hours after rising to assess whether you have morning hypertension.
But, I did manage to control my glucose level pretty good for several years by watching what and the amount that
I ate. These are prepared from the natural herbs and thus do
not cause any side effect in your body.

Valerie June 30, 2013 at 12:37 pm

I have been taking 20mg (split 4x/day) of cortisone but it doesn’t seem to be enough. My symptoms (abdominal cramps, diarrhea) break through within 3 hrs, sometimes less, of taking the dose.
I was under EXTREME stress for more than 20 years, so I am not surprised that my adrenals basically quit. I feel better when I take 30, so it it OK for me to do that? Thanks.

Lara July 3, 2013 at 3:08 pm

Hi Valerie- I have the exact same symptoms! No doctor has understood the correlation but I have just started cortisol as well. The bowel issues are tied to an adrenaline rush from low cortisol I believe. What about trying 10mg and 10 mg? That was my doctors recommendation.

Ramee November 27, 2013 at 1:13 am

I am a CFS sufferer and have been going to a Naturopath for several years. My health was decent until last Christmas when I came down with severe eczema. Since then I’ve been trying to get my health back on track. I’ve cut out everything I am allergic to (including gluten) but I was on isocort (my main adrenal support) and now the company will not be making it any more. My doc suggested a low dose (5mg) of hydrocortisone to help my adrenals recover. I have a history of Addisons disease in my family and my Dad has taken hydrocortisone for more than 50 years but he wants me to be cautious and use it as a last resort. Any thoughts?

Leisa December 18, 2013 at 3:54 am

Hi Ramee,
Without knowing your full history, it would be uwise of us to comment on the specifics of your case, however, we do a lot of work with patients who have very poor adrenal function and we do what we can naturopathically to restore adrenal function. In extreme cases replacement cortisol may be required and as you have said, your doctor is looking at prescribing this for you. A combination of both natural medicine and adrenal replacement can work well, with most patients weaning off their cortisol over a period of time as their adrenal glands strengthen. Just going on cortisol though, is not necessarily the answer for most patients as it doesn’t really help the recovery, but just replaces what the adrenals are not able to produce properly. Saliva hormone testing ( is recommended and then an assessment can be made of how poor your adrenal function is and strategies put in place to help their recovery. If you would like to know more or want to make an appointment for a review, just go to and we’d be happy to help!
Warmest regards

Samuel Claiborne April 28, 2014 at 10:35 pm

I have read in several places that saliva tests (which I recently had) are NOT reliable, and that only a STIM test is.

Care to comment?


Leisa May 1, 2014 at 1:04 am

Hi Samuel,
Saliva testing has been used for many years now and is approved by the World Health Organisation as a valid test for active hormone levels. I’m not sure where you were reading that the tests are not accurate, but they are reliable and give very good information to the practitioner about the status of a person’s hormone levels. As with any test, the interpretation of the results is one of the most important factors. Having a practitioner that can take the results and use them in conjunctions with a person’s history, health status and other relevant tests is always going to give a better outcome for the patient. Relying on any one test as the only determination of health is not a good practice. The STIM test is a very accurate one as well and one that is very useful in conjunction with other tests. Many people however are not offered this tests until they have further evidence that shows that adrenal fatigue is likely – so saliva tests are a great option for most people.
Thanks for your interest!

jean August 6, 2014 at 11:26 pm

Started taking this 3weeks ago and have to say, for the first time in years I feel normal, I used to sleep every day and lost interest in life. Felt ill all the time, was forever taking infections and the list goes on…. I had never heard of this, i was prescribed it in hospital after tests. All i know is i have started to feel positive about my life.

Leisa August 8, 2014 at 1:41 am

Fantastic result! Such a good thing that you could get the help you needed :-)

mary March 9, 2015 at 4:03 pm

I have been prescribed 5mg four times a day after years and years of adrenal support through herbs, glandular and vitamins, etc.
I am having a difficult time acclimating to the hydrocortisone.
I have been taking 5mg in the morning, 2.5 at lunch and half that at 4pm. It makes me feel racy and uncomfortable when I up the dose, but I am more tired since being on this, excessively tired. Taking 3 pills the first day I did not sleep and have experimented, with much loss of sleep, but not getting where I need to be.
I want it to work because I do feel like my adrenals need the rest.
Any suggestions? I am about 10 days in.

Julie November 20, 2017 at 3:59 am

Eeek using hydrocortisone (for me) I felt was all wrong. It may have been from the doctor over using it because it made me feel really good at first then eventually I felt terrible. Read this to see some of the important cautions when dealing using steroids-

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