My Life With Adrenal Insufficiency

Stress Dosing For Adrenal Insufficiency

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Stress Dosing For Adrenal Insufficiency

For the past 3 days I have been really unwell. I really didn’t know why. You see with Adrenal Insufficiency I don’t produce enough Cortisol -the stress hormone- and therefore when something unknowingly causes the body stress, I begin to suffer Hypo-adrenal symptoms.

stress dosing


I have felt weak, too weak to walk around once again. I have got up for the odd thing but I’ve felt dizzy, had a major headache and body pain. In fact on Monday night I cooked some Japanese noodles with my daughter and although the Photo looks lovely, the reality is I collapsed on the floor and my body just gave up.

noodle man

So, I knew there was something going on effecting my Cortisol levels. My chest has been feeling funny and I’ve been needing my asthma inhaler a lot, which is unusual. I woke up today and have a very sore throat, runny nose and I certainly have a VIRUS.


Well, when the body is under added stress, the brain will produce a hormone called ACTH which in turn tells the Adrenal glands to make more Cortisol. Whether you have Addison’s Disease of Secondary Adrenal Insufficiency the result is that the Adrenal glands don’t make the Cortisol needed each hour or day so you have to have Cortisol replacement therapy for life.

So, when you have a Virus and you don’t know it, you can get low Cortisol symptoms without really knowing what’s causing it. In my case, I was unsure why I felt so bad for the last two days. I knew my chest was funny but today waking up with a Virus I now know that it has ben developing over the past few days.

So what happens when the body is under extra stress to usual? The body makes extra Cortisol to cover the stress. Not in my case! I have to give myself extra Cortisol medication and working out the amount and doing so correctly is called Stress Dosing.

Stress Dosing Rules

Generally you stress dose (double your Hydrocortisone/steroid Medication for three days when you have a Fever, Infection or hypo-adrenal Symptoms.

I also have to stress dose for my period (because I get severe pain) and severe pain requires stress dosing. Although your told to stress dose for 3 days, sometimes an illness, infection or serious virus can last longer and so it would be silly to stop doubling the Cortisol if the illness lasts longer than 3 days. 3 days is a guideline.

Sometimes I will just need a top up rather than a double dose. For example, if i feel dizzy and pain in my body, I may try taking an extra 2.5mg rather than the 5mg and see if this is sufficient. It’s really a trial and error situation and slowly over the months and years an individual will come to know what they need for certain situations.

Stress dosing however will always be met with difficulties. There is no measuring stick, no way to know your levels. Your always to some extent guessing whats wrong, guessing how unwell you are and guessing how much extra medication you need.

I don’t think I will ever master this. Especially because when the Cortisol levels do go down, it causes a brain fog and difficulty concentrating to figure things out like just how much medication you need. That’s why I need support from my husband daily to take my medication because on a day when something happens that uses up my Cortisol faster than expected, I may get too unwell and need support.

I have also noticed recently (during a few car travel journeys) when my husband has had to slam on the breaks because of dangerous drivers on the road, that my cortisol was knocked out of me in an instant. That’s what it felt like. My body got weak and I felt dizzy and unwell suddenly. I guess that’s the sudden shock type of situation which can make me feel very unwell. It happens when I hear a loud bang or get a fright and I need a little extra medication.

One issue is however Cortisol tablets take an hour to kick in, which means one needs to be careful and if you lose too much Cortisol at once, a tablet wont be sufficient, you’ll need the emergency injection and potentially IV fluids etc.

If I were in a sudden car crash or something unexpected suddenly happened such as a shock, a death of a loved one or for me something highly emotional or a sudden physical stress, I am at risk of an Adrenal Crisis which can without treatment result in death.

In those circumstances, I have an emergency injection and need to go to the hospital for treatment. June was the first month in a long time I have not been in hospital. I did spend 8 days in hospital in May – due to adrenal crisis, but for now I am managing my illness at home with stress dosing.

I feel I need to stress dose again, due to how unwell I am. Hopefully my body can fight this virus and the extra Cortisol will help my body to get through. I will have my husband staying close by in case anything happens but for the next three days, I will be resting up in bed- I cant do anything much physically anyway as I’m simply too weak.

To Read more on Adrenal Insufficiency visit The Adrenal Diaries


  1. This is the medication I need right now. By reading what others are going through , I can learn how to take better care of myself. I would love to walk again, cooking is what I miss the most. I am force feeding myself due to being in the 80 to 90 pound range . It has been four years since I had this stomach surgery for a ulcer and it stopped my glands from working. Most of the time I am to weak to sit up. I use a potty by my bed and do not make it sometimes. I cry everyday and night in pain. I do not sleep at night at all. In the day time I may sleep twenty minutes . My body is so tired and weak. I have no husband to help me, I do have a daughter that I live with, she works all the time so she does her best to get me what I need. I try so hard and feel like I am getting no where. I am calling my doctor this morning and see what we can do because the only thing I have to take for this is Florine’s 0.1 mg. I take them faithfully. My hair has all come out also. This is a horrible thing and I want to get better. So please keep writing so we can learn. Thank you!

    1. Dear Sheila, Please find an endocrinologist that can help you with the hormones you are lacking. If you feel I do not know where you are located, but maybe your Primary Care Physician can make a referral . I think that your medicine is able to be used with hydrocortisone, but not sure. Please find you a good Endo to help you. I feel awful for you as I do for all the Addy people.

  2. Great post. I felt like you were talking about me. I’ve had times where I have felt so weak that I have to sit on the floor of the kitchen. I think the hard part is changing the mindset that you can take more meds than written on the bottle of tablets when feeling unwell. My GP gets frustrated with me about that.

  3. Oh, pants! I just wrote quite a lengthy comment, but the page reloaded and all was lost.

    Top and bottom was this: what dose of hydro are you on? I was dx’d with adrenal insufficiency and the inability to convert thyroid hormone T4 to the active form, T3, in 2000, and was on the standard physiological replacement dose of 20mg/d until I got breast cancer in 2007. The treatments made everything an awful lot worse, and during radiotherapy, I was forced to take 160mg before I could literally get out of bed and be driven to the next session.

    I’m on less now, but have hardly ever been able to get it below 45-50mg as my baseline.

    I also put on around 6st (actually, tbh, I went from 8st 7 at my mastectomy (usual weight then 9-9.7, but the cancer made me lose weight rapidly) to over 15st, so I know how you feel.

    So what dose of hydro do you take?

    I struggle with the rules when it comes to my big doses, because as you know, too high a dose can squash your immune response. I get chalazion cysts, infected styes, eye infections because of my dose. However, from the amount of times you’ve been in crisis and in hospital this year, and from what you said about sudden car braking wiping you out, it sounds to me as though your maintenance dose is too low. Having said that, you have to trust your endo team, and I’m not qualified except by dint of experience, so I wouldn’t expect you to take my word for it without discussing it with your team.

    Anyway. I’ll stop before the page reloads again! Only felt well enough to find your blog and write a comment because I double dosed this morning.

    I’m worried about ending up in hospital with an adrenal crisis, and the other thing I’d like to know is how long they have kept you in when you’ve been hospitalised following your emergency injection.

    Thanks, Angela,

    Kindest regards,

    1. Before I went onto the pump I was on 20mg a day at 10 5 5 . I have had day curves to know what rate I should be at but these can always be inaccurate. Last time I went to hospital I was in for 8 days.

  4. I have the exact same thing you describe when something startled me! I can’t tell you how many times I’ve been put into a downward spiral of scary symptoms just because my husband hit the brakes too hard or because of a loud noise or one of my kids falling or choking or ANYTHING! I can’t believe how sick I get in an instant! I’ve known it must be related to my SAI but it’s good to hear someone else back that up!

  5. I see your replies to everyone are quite short, but wanted to say thank you anyway for the adrenal blogs. If nothing else it made me feel less alone if only for the time it took to read it. Seeing other stories of life with adrenal insufficiency hit home and are all too familiar. I’m unfortunately not one of the lucky ones that run marathons. I do occasionally get to cook or do some laundry or perhaps go out then rest for 3-4 days. After nearly 10 years with this and no improvement I’m tired and depressed and honestly don’t know how long I can go on. If only my family could read your blogs and see that this is how life is…

    1. Well I reply the best I can with my limited time and health. Yes as you say Adrenal Insufficiency can make us really tired and doing something can knock us out for days. It does for me. Share a link on your FB page and maybe yur family will read one or two of the posts on what it’s like to have this illness.

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