Adrenal Insufficiency Support Group

and I don't think it is extra HC that I need. Most days I drink a mug of broth in the morning with 1/2 tsp salt and then salt my food throughout the day - I thought that was enough. Skipped it yesterday though b/c we were out in the morning and I forgot later in the day. Felt horrible all afternoon but still dragged myself to a yoga class where I just about passed out. Luckily I was still thinking clearly and asked for salt - had two big handfuls of it and after awhile felt better. Had my broth when I got home and some potato chips Later that evening I felt great, and this morning still feeling so much better than I have in a long time. So, I'm pretty sure that my biggest problem right now is my salt levels (biggest problems right now are low BP and feeling weak - but I've been foggy so just didn't put the two together - I feel kind of dense now).

At my last blood work my renin/aldosterone were still in the normal range, but I also wasn't feeling as bad then so endo didn't put my on fludrocortisone then. My next appt. is in June and I'll be asking for it then.

In the meantime anyone have any suggestions for keeping my sodium level in check? I've heard licorice can help - I was thinking a licorice root tea? How much? How much more salt should I be consuming in a day? If I can feel better without the extra HC I would be really happy. With summer/heat coming I really want to get my sodium levels in check!

Mamame,

Please be careful with the licorice, this is an alternative self-treatment for adrenal fatigue and not used for adrenal insufficiency. You are already on cortef, according to your signature, so I would not mess the two together. Also, if you are on the right dosing for the cortef, your sodium should balance itself out unless you were sweating a lot, etc. I do not think you are on a very high dose of cortef - any of you who are on that want to chime in here? It may be that you are not optimally replacing what your body needs. You need to find the right "fit" or daily dose of maximizing your body's need to the hormone replacement. This is never easy! But well worth the time and attention. Most endos start you on a minimal dose - I am on prednisone but started with 5 mg. You have to consult with them with ongoing symptoms and they then up it - I am now on 7.5 but when very physically active (more than one hour spinning for ex) will go up to 10. Those of us with SAI (that is, adrenals still work) usually do not need aldosterone replacement (fludocortisone).

For me, my symptom of being low is muscle pain, blurry vision, fatigue, cold intolerance.

Deb

Mamame

Opinion...

Remember that HC is a "combined" gluco and mineralo corticoid. In a lot of situations the mineralo content is enough that you don't need extra salt. If it isn't this is when you need florinef and is commonly given for PAI. It would seem your renin/aldosterone "normal" is not good enough for your body UNLESS you don't take enough HC in general. How do you know you are on too much?

Its best not to rely on tested levels for dose setting, but analyze your symptoms and QOL. Feelings of salt cravings may come from the gluco or low BG side. You have to figure out which and adjust accordingly. (Blood serum BG tests are not much help in this regard because it will fluctuate widely under HC dosing)

Sorry this doesn't answer your direct question. I think it important to cover the wider possibilities though. ie what causes the salt craving, not just how to fix it the fastest way. Salt in large quantities really is only a temporary workaround. The base system needs fixing instead.

Bob

I completely understand what Deb and Bob are saying, but I also have btdt with exactly what Mamame is experiencing. However, maybe because I've yet to find a doc who could tell me exactly why I feel like I feel, I've learned/am learning to handle symptoms as they crop up. Almost exactly like Mameme, I was on 15mg cortef and 75mcg synthroid (for exactly the same reasons, well, except I'm supposedly SAI). There are times when I am shaky, feverish, or weak, and salt helps me. When I tested this out 2ys ago, it was while I was seeing a cardiologist and had a holter monitor on, and set off a crisis. The cardio said it was dysautonomia and told me to salt load. I don't know-it seemed a bit like hand-waving (and over-doing salt makes me feel hyper-startleable, so there's a fine line for me), but the simple fact is that there are times when salt works better than anything else, and it's a pretty quick (ie 10-15 minutes rather than hours) effect. I also struggle with low bp and postural hypotension (on and off; I've also been on and off florinef for this, but don't like it so don't stay on it); salt and or 2x electrolyte packages work better than food for me. In fact, I have problems with sugar so the more I can avoid food to regulate my feelings, the better. A strange example....the other week when I had to go 24 hrs without food, I was nervous because I get shaky when I don't eat (many ys ago was told it's "reactive hypoglycemia"). But it was noon and I was getting shaky, so I made some chicken broth (high sodium). Tada, shakes were gone! Otoh..I was drinking it slowly so I could watch out for any side effects and sure enough started feeling startle-y, so stopped and drank water....and must've found a balance because then felt fine. I was shocked that I didn't need any sugar (yeah, body, for apparently doing what it's supposed to be doing)!

I don't know why this is, so this is in no way a medical opinion, just what I do. In the last two days I've completely identified with two of you on here, but am worthless as far as contributing any knowledge. In some ways, feeling pretty useless....but please know that you're not alone in what you're going through.

Footprints - that sounds like EXACTLY what I go through. I get weak and shaky and I test my blood sugars and they are find - but eating some salt always makes that feeling go away - and fairly quickly. Within 15 minutes I can feel really good.

I have BAD postural hypotension - like pretty much constantly. If I stand up I automatically hold onto something for tht few seconds of blackness. When sitting though BP is not dangerously low - just a low normal.

I generally eat a low sugar diet and as a result my reactive hypoglycemia has pretty much disappeared. I frequently test my blood sugars and they are usually pretty normal (hard exercise can sometimes bring on really low blood sugars for me).

I don't tend to swell, but do unrinate frequently (at least every hour and 2 or 3 times at night). I really only drink water and a mug of broth daily and not huge quantities of either.

I've considered that maybe I need more cortef, but am reluctant to go higher than 20 mg right now. I've been as high as 40 mg while stress dosing, and honestly feel worse the higher my HC dose goes (I get very weak and feel almost like I can't move). I just don't get that feeling of energy that everyone says they get when they updose. 15/20 mg doesn't really feel like quite enough either, but I anything higher and I feel like I can barely get out of bed. My thought is that the higher doses are suppressing the little bit of natural cortisol production that my body still has.

Wow, you folks have given me something to think about and try out. I've been feeling much better, in general, on my 7 mg/day prednisone. I have SAI, but my adrenals are fairly weak (cortisol only reached 3 after one hour at my ACTH stim test). My endo says I only need to take my prednisone, and nothing else.

But, although my BP and body temp have normalized, I've been experiencing periods of being very weak and shaky. At that time, if I stand up, my pulse shoots up to 120-130. I picked up a glucose meter, and have been checking my blood sugar levels. They've been normal to a little high - no low blood sugar. I drink plenty of water (6-8 cups/day), but usually eat a low salt diet.

So now I'm going to try to use some salt when I get shaky again, and see if that helps at all. If it makes a big difference, I think I'll need to talk with my endo again.