Question:
I have had Addison's disease for over 25 years. Are there any side effects of the replacement dosage of cortisol I have been taking? If so, what can I do to mitigate them?
Answer:
Addison's disease (sometimes called chronic adrenal insufficiency) is a rare disorder that leads to diminished or absent production of the hormone cortisol (and sometimes the hormone aldosterone as well) by the adrenal glands. Treatment includes replacing the hormones that are not being made, and must be tailored to each person individually. You can replace the missing cortisol by using cortisone, cortisol (hydrocortisone), or longer-acting medications such as dexamethasone or prednisone. If aldosterone is also lacking, it is replaced with fludrocortisone acetate (Florinef). Treatment must be modified during times of stress and illness. If untreated, Addison's disease can be fatal.
Cortisol-type medicines are often used in high "anti-inflammation" doses to treat a variety of diseases including asthma and rheumatoid arthritis. At these doses, they can have many serious side effects, including high blood pressure, high blood sugar levels, and thin bones. In Addison's disease, however, only small "replacement" doses of the medications are needed, just enough to supply the missing amounts of the hormones. With these low "replacement" doses, side effects are usually minimal. Too high a dose of replacement cortisol can definitely have side effects.
A few studies have suggested that patients with Addison's disease may develop thin bones earlier than other people, probably in part a result of taking cortisol medication. In high doses, cortisol medicines may bring on diabetes and cause elevation of blood fats, including cholesterol and triglycerides; these complications should not happen with the lower doses used for Addison's disease. High doses of these medications can also cause changes in the eyes, such as cataracts or high pressures in the eye. A regular eye examination would detect any of these changes.
