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.