Last updated April 2023.
Most people treat adrenal insufficiency with man made replacements for what their bodies would normally produce. This chart shows the levels of Cortisol through a 24hour period in a normal group of healthy adult males. Remember we are all different and age, gender and metabolism can make a difference.
Getting to this point can take a little time and may need adjusting over time. There is no such thing as a standard dose as no 2 bodies are identical. There is however a starting point but even that depends upon whether you have any adrenal function or not.
For an adult with no adrenal function and no other underlying conditions this link shows how Imperial College would start you on Hydrocortisone Dosing and this link shows how you would start on Prednisolone Dosing . All of these doses may change depending on your particular needs and metabolism. If you have any concerns about the doses you have been prescribed, ensure you discuss your concerns with your consultant before making any changes.
Whether Prednisolone or Hydrocortisone is used as a replacement, Fludrocortisone may also be prescribed to regulate Sodium and fluids. A starting dose would probably be 100mcg (0.1mg) daily.
If you are under replaced you will start feeling tired and lethargic, whilst if you are over dosed you may feel well but may be building up some long term cardio-vascular problems. This is where a day curve test is useful to establish the correct dose and timing of that dose. A day curve will measure how long steroids stay in your system, which allows for a reasonably accurate dosing regime to be established
Both of these regimes come close to mimicking the natural peaks and troughs that occur in a normal body. Do remember that emotional stress and physical stress often require an increase in cortisol levels to help your body cope.
This debate about the relevant pros and cons of Hydrocortisone vs Prednisolone
is worth watching. - Please note the date it took place was December 2016.