Hydrocortisone & Thyroid Hormone Use in ME/CFS + Misdiagnosing Rarer Hypothyroidisms as ME/CFS

[Hip]

@poppythecat

Well the fact that a flu-like illness started off your long term illness is suggestive of ME/CFS. It often starts this way.

If you had fully recovered within a few months of you thyroid hormone protocol, it would make sense to assume that your health problems were all caused by thyroid dysfunction.

But the fact that thyroid hormones improved you, but did not bring remission from your symptoms (since you still have an ME/CFS-like illness), suggests that you may have either ME/CFS, or some other condition that has ME/CFS-like symptoms.

A good list of diseases that can mimic ME/CFS is found here.

Also, the fact that your blood pressure drops when you stand indicates you might have orthostatic hypotension (OH) or neurally mediated hypotension (NMH). These are common in ME/CFS. Some info:

Orthostatic hypotension (OH) and Neurally mediated hypotension (NMH)

OH and NMH are conditions in which your blood pressure drops upon standing. In OH the pressure drop is immediate; in NMH the drop occurs after a long period of time standing, or also sometimes after having an unpleasant or upsetting experience.

Symptoms of OH or NMH include: dizziness or light-headedness, feeling that you are going to faint, blurred vision, confusion, weakness, fatigue, nausea. These symptoms appear within a few seconds or minutes of standing up after you've been sitting or lying down, and will disappear if you sit or lie down for a few minutes. 1

Patients with ME/CFS have a high prevalence of neurally mediated hypotension (NMH), 1 which is due to a dysfunction of the autonomic nervous system. In some cases ME/CFS patients can experience almost complete resolution of their ME/CFS symptoms once their NMH is treated. 1

Orthostatic hypotension is diagnosed when, on standing from a sitting or lying position, there is a fall in systolic blood pressure of 20 mm Hg or more, and/or a fall in diastolic blood pressure of 10 mm Hg or more. 1 These blood pressure measurements can be made with an ordinary home blood pressure meter. Note that a blood pressure reading is expressed as systolic / diastolic, for example: 120 / 80.

If we were to assume you have ME/CFS, then there are a number of avenues you could explore in terms of treatments. Treatments that people frequently find improve their ME/CFS symptoms include:

• Vitamin B12 methylcobalamin (as injections or as B12 sublingual tablets)
• Methylation protocol (requires certain supplements to be taken, including vitamin B12 and methylfolate)
• Low dose naltrexone (LDN requires you to take the drug naltrexone, which you can buy prescription-free online)

It may be an idea to look into these, just to see if they help. There's a lot of info about them on this forum.

 

[Hip]

Just my two cents worth on thyroid v M.E. I spent some time at the thyroid fourm and found lots of people claiming M.E is just fabricated and not a real illness, I believed this might be the case for me as my symptoms are very common in hypothyroidism.

I looked around for Dr recommendations and went to a private Dr in the UK who believed that all M.E was misdiagnosed thyroid disorder and unsurprisingly diagnosed me with hypothyroidism. I was given Armour thyroid after a trial of levo had not worked out with a previous private M.E doctor.

At first I felt a bit better - especially improved libido and mood and some more energy. I was told to up the dose, so I did and after just a few days developed severe dizziness, then severe fatigue, then all the old M.E symptoms became amplified. I stopped the Armour, although this doctor believed I needed to continue or indeed increase my dose further. It took approx. three months for the extreme dizziness to abate and my health slid backwards considerably and has never recovered to the level I was at before I saw the Dr.

I am just wondering how long you were taking the Armour Thyroid and feeling better at the original dose, before you were told to increase the dosage.

Also, any idea why are these thyroid gland extracts (which contain the T4 and T3 hormones) are taken, rather than taking T4 and T3 individually as tablets of levothyroxine (T4) and liothyronine (T3)? Wouldn't there be more control over individual hormone dosage if you took T4 and T3 as separate tablets?

 

[justy]

I am just wondering how long you were taking the Armour Thyroid and feeling better at the original dose, before you were told to increase the dosage.

Also, any idea why are these thyroid gland extracts (which contain the T4 and T3 hormones) are taken, rather than taking T4 and T3 individually as tablets of levothyroxine (T4) and liothyronine (T3)? Wouldn't there be more control over individual hormone dosage if you took T4 and T3 as separate tablets?

Its hard to remember now exactly...I took if at a very low dose to begin, which he wasn't happy with, but I am very sensitive to everything. I was on a low dose for a couple of months, then gradually increasing every month or so - it was not miraculous, I didn't feel much better straight away, but did start after a couple of months to notice some cautious improvements.

I started seeing him in May, then in late August we went camping for the weekend at a friends and I did lots of walking (for me) and even swam in the sea and felt good - I had a glass or two of wine - I told myself I would never stop taking the Armour - it felt like I was re awakening - then it all fell apart in the September and I haven't even gpot back to where I was BEFORE I saw this doctor.

I had tried Levothyroxine in the past, but it had no effect on me at first at all and then on upping the dose I felt horribly hyper, but my labs where still well in the normal range - Dr Myhill who prescribed it to me said she sees this commonly in her M.E patients.

I don't understand all the theory/politics behind the T4/T3 combo natural v synthetic stuff, it is complex and im sure someone else can chime in and explain.

 

[A.B.]

Thyroid hormone causes adrenal reserves to be used up faster. If thyroid hormone brings energy and activity levels closer to normal, but then results in a crash a few days to weeks later, that could be exactly what is happening.

A good endocrinologist will check adrenal function before starting thyroid hormone therapy.

It seems that many people with chronic health problems that are difficult to explain are in a state of mild hypothyroidism and hypoadrenalism. I would say that I fall in this category, and in my case there are signs of partial hypopituitarism too. It is not clear whether this is a consequence of some other pathology, or if this problem has been underestimated by medicine.

 

[justy]

Thyroid hormone causes adrenal reserves to be used up faster. If thyroid hormone brings energy and activity levels closer to normal, but then results in a crash a few days to weeks later, that could be exactly what is happening.

A good endocrinologist will check adrenal function before starting thyroid hormone therapy.

It seems that many people with chronic health problems that are difficult to explain are in a state of mild hypothyroidism and hypoadrenalism. I would say that I fall in this category, and in my case there are signs of partial hypopituitarism too. It is not clear whether this is a consequence of some other pathology, or if this problem has been underestimated by medicine.

Yes this is exactly what happened to me - the Dr I saw believed that adrenals need not be treated firsta s they would 'come on line' once thyroid function was running correctly again.

Unfortunately the treatments for adrenal insufficiency are not tolerable by me. On a side note both myself and one other member here that I know have may actually have sheehans syndrome - mine caused by two post partum haemorrhages, but I have not been able to interest a mainstream endocrinologist in this at all and there is little help and support anywhere for this condition - the only person who mentioned this was Dr Myhill and she seemed unable to treat for this 9it is complex nd requires a myriad of finely tailored hormonal treatments)

 

[poppythecat]

@poppythecat

Well the fact that a flu-like illness started off your long term illness is suggestive of ME/CFS. It often starts this way.

If you had fully recovered within a few months of you thyroid hormone protocol, it would make sense to assume that your health problems were all caused by thyroid dysfunction.

But the fact that thyroid hormones improved you, but did not bring remission from your symptoms (since you still have an ME/CFS-like illness), suggests that you may have either ME/CFS, or some other condition that has ME/CFS-like symptoms.

A good list of diseases that can mimic ME/CFS is found here.

Also, the fact that your blood pressure drops when you stand indicates you might have orthostatic hypotension (OH) or neurally mediated hypotension (NMH). These are common in ME/CFS. Some info:.

I hear you, I really do. But why do you want my BP dropping when I stand to be ME, when it's a classic adrenal symptom, even the cardiologist admitted that, and it has stopped happening now I'm on adrenal support (HC and glandulars).

Why do you want the fact that I am still improving and still having some symptoms to be ME rather than showing I am recovering after years of endocrine neglect by my doctors. That doesn't make sense to me. People who take asthma medication still have symptoms. It doesn't mean they don't have asthma. People taking diabetes medication still have symptoms. Doesn't mean they don't have diabetes.

I think this isn't the forum for me. I was just trying to help members get the testing and treatment they need.

Anyone whose blood pressure drops when they stand almost certainly has adrenal problems. I'm sorry you don't want to see that, but maybe some other members do.

I'd like to think I've helped some of your members who don't want to have ME to see what might be their underlying problem(s) and start getting the testing and treatment they so desperately need. I nearly died before I found out. I'd like to prevent that from happening to others.

But those that don't want to find out, won't.

No need to ban me. I'm outta here.

 

[MeSci]

I hear you, I really do. But why do you want my BP dropping when I stand to be ME, when it's a classic adrenal symptom, even the cardiologist admitted that, and it has stopped happening now I'm on adrenal support (HC and glandulars).

Why do you want the fact that I am still improving and still having some symptoms to be ME rather than showing I am recovering after years of endocrine neglect by my doctors. That doesn't make sense to me. People who take asthma medication still have symptoms. It doesn't mean they don't have asthma. People taking diabetes medication still have symptoms. Doesn't mean they don't have diabetes.

I think this isn't the forum for me. I was just trying to help members get the testing and treatment they need.

Anyone whose blood pressure drops when they stand almost certainly has adrenal problems. I'm sorry you don't want to see that, but maybe some other members do.

I'd like to think I've helped some of your members who don't want to have ME to see what might be their underlying problem(s) and start getting the testing and treatment they so desperately need. I nearly died before I found out. I'd like to prevent that from happening to others.

But those that don't want to find out, won't.

No need to ban me. I'm outta here.

@Hip was only making helpful suggestions, @poppythecat. His reply was very nuanced and he wasn't saying that anything was definite.

 

[golden]

I hear you, I really do. But why do you want my BP dropping when I stand to be ME, when it's a classic adrenal symptom, even the cardiologist admitted that, and it has stopped happening now I'm on adrenal support (HC and glandulars).

Why do you want the fact that I am still improving and still having some symptoms to be ME rather than showing I am recovering after years of endocrine neglect by my doctors. That doesn't make sense to me. People who take asthma medication still have symptoms. It doesn't mean they don't have asthma. People taking diabetes medication still have symptoms. Doesn't mean they don't have diabetes.

I think this isn't the forum for me. I was just trying to help members get the testing and treatment they need.

Anyone whose blood pressure drops when they stand almost certainly has adrenal problems. I'm sorry you don't want to see that, but maybe some other members do.

I'd like to think I've helped some of your members who don't want to have ME to see what might be their underlying problem(s) and start getting the testing and treatment they so desperately need. I nearly died before I found out. I'd like to prevent that from happening to others.

But those that don't want to find out, won't.

No need to ban me. I'm outta here.

I am sorry you are leaving. I was reading with interest. I read Tears behind closed doors and the Nurse had been misdiagnosed including with M.E. until she treated her thyroid and was cured.

My BP was dropping upon standing. I just checked it this morning, I stopped checking it as I didnt like what it was sayin.

Lying down was 87/58 p73 and 88/50 p75

Standing still

105/77 p115
108/80 p104
111/55 p105
Error
Error
105/63 p87
73/57 p92
But then i was forced to stop as I couldnt catch my breath.

http://forums.phoenixrising.me/index.php?threads/pots-data.21673/

I have difficulty making sense of it all due to neurological probs. But this thread was last time i tried.

So its improved.

 

[bertiedog]

@golden I used to have readings like that but since being on full adrenal replacement my bp is now completely normal, around 127/78 and just goes up a bit on standing, pulse around 72. When it is hot I might need a small amount of Fludrocortisone to replace the salt that I loose but in general I don't need this when the weather is cooler.

I believe I had a mild Sheehan's syndrome that affected all my hormones but they were never at Addison's level, however I still needed 6 mg Prednisolone in order to feel better and to be able to tolerate the 2 grains of dessicated thyroid that I need.

Treating the adrenals and thyroid can make a massive difference to how one can feel and what one can do although I still have late stage Lyme to deal with which causes me many problems.

Pam

 

[Hip]

Why do you respond in this "I'm outta here" fashion to a discussion on possible diagnoses for your symptoms, a discussion which would normally be seen as being helpful?

Why do you want the fact that I am still improving and still having some symptoms to be ME rather than showing I am recovering after years of endocrine neglect by my doctors

First of all, nobody wants you to have ME/CFS; in fact that's the last disease I would wish that anyone had, given the lack of good treatment options.

But I was pointing out that when a hypothyroid patient is finally diagnosed, and gets their thyroid hormone replacement, it does not take long to get back to full health. A few few months at most. A family member experienced this: they were getting more and more fatigue, and it turned out they were hypothyroid. As soon as they got the T4 replacement therapy, they began to feel better, and got completely back to normal within a few months.

Anyone whose blood pressure drops when they stand almost certainly has adrenal problems. I'm sorry you don't want to see that, but maybe some other members do.

That sweeping statement is just not correct. There are many reasons why blood pressure can drop when you stand. Adrenal insufficiency is one of them, and indeed, the British Society for Endocrinology website says:

What is adrenal insufficiency?

Adrenal insufficiency is caused by failure of the adrenal glands to produce sufficient (or any) amounts of cortisol and aldosterone. Prolonged lack of cortisol leads to severe fatigue, chronic exhaustion, depression, loss of appetite and weight loss. Lack of aldosterone leads to a drop in blood pressure, particularly when standing up quickly, and to disturbed salt levels in the blood.

So if you were positive for the ACTH stimulation test that detects adrenal insufficiency, then that would explain your blood pressure symptoms. Were you so tested?

However, this article on orthostatic hypotension (OH) shows that there are several other causes of blood pressure dropping when you stand. Neurally mediated hypotension (NMH) also involves blood pressure dropping when you stand, but the pressure drop is delayed, not instant. One of the treatments for NMH is aldosterone replacement (using fludrocortisone).

I'd like to think I've helped some of your members who don't want to have ME

Or in other words: "If you don't want to have ME, then just put you faith in me". That's a bit messianic, isn't it?

Whether you want to have ME/CFS or not, that does not change your disease one iota. If you have real ME/CFS, no amount of wanting to go away will have any effect.


I appreciate the points made about hormonal problems sometimes being misdiagnosed as ME/CFS, but if you have to say "I'm outta here" as soon as someone mentions an alternative explanation (and quite possibly a very helpful one for you, in terms of treatments), well, it seems that these accusation of being close minded apply both ways.

 

[Hip]

@justy

So from your experiences, perhaps a bit of thyroid hormone may be helpful in ME/CFS, but too much might be counterproductive.

When I was taking the 15 mcg of T3 daily, I noticed an increase in energy, but I found things like my mental PEM were not improved. So the exertion from socializing would still whack me, and give me PEM symptoms of mental exhaustion. So my ME/CFS was certainly not cured by this thyroid hormone, at least not in short period that I took T3.



By the way, for anyone who wants to buy liothyronine T3 thyroid hormone at greatly reduced prices, I notice that the body building supplier websites sell very cheap liothyronine. See links below. I bought my T3 from the first one (www.researchliquids.com), at a cost of $20 for what would be the equivalent of 300 x 20 mcg liothyronine tablets.

Note however that these body building suppliers list their products as "not for human consumption," as this caveat allows them to sell this stuff legally. Lots of body builders buy and take these drugs sold "not for human consumption," and none have dropped dead as a result, as far as I am aware; but if you are uneasy about this, then use a regular prescription-free pharmacy which sells drugs specifically for human consumption (or ideally get a prescription from an endocrinologist). Unfortunately these regular pharmacies will charge a lot more.

Body builders sometimes take T3 at fairly high doses (eg: 50 mcg daily) for a few months to increase metabolism and thus burn off body fat.

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[Hip]

Thyroid hormone causes adrenal reserves to be used up faster.

Would you happen to have any good links or references to this?

 

[golden]

@golden I used to have readings like that but since being on full adrenal replacement my bp is now completely normal, around 127/78 and just goes up a bit on standing, pulse around 72. When it is hot I might need a small amount of Fludrocortisone to replace the salt that I loose but in general I don't need this when the weather is cooler.

I believe I had a mild Sheehan's syndrome that affected all my hormones but they were never at Addison's level, however I still needed 6 mg Prednisolone in order to feel better and to be able to tolerate the 2 grains of dessicated thyroid that I need.

Treating the adrenals and thyroid can make a massive difference to how one can feel and what one can do although I still have late stage Lyme to deal with which causes me many problems.

Pam

Thanks Pam. Thats very interesting that you recognise a pattern in my bp issues that was similar to yours and yours was cured by adrenal support.

I dont feel confident enough to mess about with my adrenals or thyroid unless under a Doctor with experience of such - Unfortunately there just isnt any support in the NHS for these issues.

Hope you can reverse some/all damage of late stage lyme...

 

[A.B.]

Would you happen to have any good links or references to this?

Unfortunately no. I read this in an Italian endocrinology textbook, which I didn't bookmark and can't find at the moment. And I know that this is applied by doctors in clinical practice because when I did an ACTH stimulation test, the patient next to me explained that she was having her adrenals checked for this very reason before starting thyroid hormone replacement.

I'm still waiting for the results. Maybe I do have some pituitary problem and not ME/CFS after all.

 

[Sidereal]

Unfortunately no. I read this in an Italian endocrinology textbook, which I didn't bookmark and can't find at the moment. And I know that this is applied by doctors in clinical practice because when I did an ACTH stimulation test, the patient next to me explained that she was having her adrenals checked for this very reason before starting thyroid hormone replacement.

I'm still waiting for the results. Maybe I do have some pituitary problem and not ME/CFS after all.

Fingers crossed, @A.B. Almost anything out there has better treatment options than ME/CFS.

I wonder how many with a CFS diagnosis actually have panhypopituitarism given that almost all of them will be told they have "chronic fatigue" until the situation becomes life-threatening. There was an article in the Daily Mail (a British newspaper) about this earlier this year.

How doctors are failing to spot the brain injury that could be behind 30,000 cases of 'chronic fatigue'

• Patients misdiagnosed with CFS when they have brain damage
• Post-traumatic hypopituitarism (PTHP) is often cause by head injury
• Symptoms include depression, obesity, fatigue and chronic pain

Thousands of British patients suffering from chronic pain and fatigue could be misdiagnosed with psychological problems when they unknowingly have a type of brain damage.

[...]

Studies suggest there could be between 18,000 and 30,000 cases in the UK each year.

Treatment involves lifelong hormone replacement therapy, which is said to be highly effective but costs up to £6,000 a year.

Professor Christopher Thompson, one of Britain’s foremost experts on PTHP, says: ‘The overwhelming evidence from research studies carried out independently in a wide range of places, including the USA, Europe and Turkey, is that hypopituitarism occurs in up to 30 per cent of people who have survived moderate or severe traumatic brain injury. There is no debate.

‘However, the failure to make the right diagnosis after such injury means patients miss out on essential treatment. That it’s not included in the NICE guidelines [for treatment of head injury] is nonsensical.’

Serious head injury is defined as an injury causing unconsciousness for more than 15 minutes. However, some studies suggest even knocks that lead to a minor concussion, or repeated small impacts such as heading a football, may damage the pituitary gland.

PTHP sufferer Jill Mizen, 67, was misdiagnosed with CFS in 2006, having suffered from pain and blood pressure problems for almost 20 years. A former BT manager, she was advised to exercise more, but found her condition worsened.

During her illness, Jill was screened for deficiency in the hormone cortisol, a characteristic of hypopituitarism. However, the test – known as the short synacthen test (SST) – produced a normal result. ‘That was when I was told I had CFS,’ she says.

Yet SST misses two of out every five cases where the cause of cortisol deficiency is damage to the pituitary. In 2007, Jill came across a magazine article about Christine Wrighton, who was incorrectly diagnosed with CFS when in fact she was suffering from hypopituitarism.

‘Eventually, after huge persistence, Christine was able to pay privately for a test which the NHS would accept. This proved she had been right all along – her pituitary was faulty. Her story opened my eyes,’ says Jill.

Coincidentally, the two women were patients at the same hospital and struck up a friendship. Jill says: ‘Doctors believe Christine’s hypopituitarism was caused by inflammation – she suffered rheumatoid arthritis for 30 years. In 2005 she had a virus that wouldn’t go, and the fatigue started then.’

Jill chose to be retested privately with the more reliable glucagon stimulation test, and was diagnosed as being deficient in cortisol and growth hormone. This proved she too had hypopituitarism.

Sadly, Christine died in July 2011 from complications related to her arthritis treatment, perhaps exacerbated by the fatigue she had suffered for so many years.

[...]

 

[Hip]

@A.B.

I managed to find some references for the caution required when administering thyroid hormones in the context of adrenal insufficiency. It says here that:

If there is co-existent thyroid deficiency then thyroid hormones should not be replaced before glucocorticoids, as a crisis may be precipitated.

Though it does not specify the nature of this crisis.

This study is also interesting:
Reversible subclinical hypothyroidism in the presence of adrenal insufficiency

It found that this subclinical hypothyroidism was fixed just by using adrenal hormone replacement therapy (I am not sure which particular adrenal hormones), without needing to use thyroid hormone replacement.

 

[Hip]

The overwhelming evidence from research studies carried out independently in a wide range of places, including the USA, Europe and Turkey, is that hypopituitarism occurs in up to 30 per cent of people who have survived moderate or severe traumatic brain injury

That is very interesting, @Sidereal. Physical trauma such as car crash is thought to be one of the triggers of ME/CFS, especially when head or neck injuries are involved.

But perhaps it's possible that these car crash ME/CFS patients are in fact misdiagnosed with ME/CFS, and more likely have hypopituitarism as a result of sustaining a traumatic brain injury during the car crash.

 

[CFS_for_19_years]

I researched traumatic brain injury (TBI) and how it affects hormones because I had a whiplash injury shortly before developing ME/CFS. I just recently shared some of these articles with my primary doc and endocrinologist. Here are some of the articles I found:

http://www.eje-online.org/content/152/5/679.full
Hypopituitarism after traumatic brain injury

I think the article is saying that hypopituitarism is common even with mild concussion.

A low T4 in the absence of elevated TSH indicates secondary hypothyroidism. TSH deficiency has been found in TBI patients evaluated by assessing either basal hormone levels (1–22%)or response to TRH stimulation (4.5%). A previous series demonstrated a very high occurrence of thyrotropin deficiency among TBI patients with hypopituitarism, suggesting TBI as an important cause of otherwise unexplained central hypothyroidism.

http://www.hormones.gr/177/article/article.html
Title: Endocrine evaluation of patients after brain injury: what else is needed to define specific clinical recommendations?
Here's a gem:

ACTH stimulation tests (low and standard dose) have been found to be of poor reliability in the diagnosis of adrenal deficiency in patients with baseline cortisol between 3.5 and 10 µg/dl; therefore, the Insulin Tolerance test (ITT) will be done when not contraindicated.

http://pituitary.mgh.harvard.edu/NCBV11I2.htm
Brain Injury and Pituitary Dysfunction

http://www.ncbi.nlm.nih.gov/pubmed/15253797
Occurrence of pituitary dysfunction following traumatic brain injury

http://drbobseiler.com/wp-content/uploads/2010/09/article_05-44_gaab.pdf
Reduced reactivity and enhanced negative feedback sensitivity of the hypothalamus-pituitary-adrenal axis in chronic whiplash-associated disorder

Here's a good outline discussing hypopitutiarism:
http://www.merckmanuals.com/home/ho...ituitary_gland_disorders/hypopituitarism.html

 

[Hip]

Pituitary damage and subsequent hypopituitarism can also be caused by a virus, according to the Daily Mail article. I actually had viral meningitis, and this too has been shown to cause long term hypopituitarism.

 

[Hip]

@Ema

When you take hydrocortisone tablets, do you try to synchronize taking them with the daily variations in cortisol levels?

Over the daily 24 hour cycle, as you know, cortisol levels have a sharp peak in the early morning, around the time you get up. This peak may actually caused by two factors: the normal rise in cortisol that occurs just before waking, and the cortisol awakening response, which occurs around 30 minutes after awakening in the morning in some but not all people.


So I am just wondering whether the early morning would be the bast time to take supplemental hydrocortisone, in order to best replicate or synchronize with the normal cortisol cycle, and the normal early morning cortisol peak.

Though in this paper: Replication of cortisol circadian rhythm: new advances in hydrocortisone replacement therapy the authors say that immediate release hydrocortisone tablets will not be able to properly replicate the daily cortisol cycle, and suggest that development of sustained release hydrocortisone formulations would be better for this purpose.

There is a thread here about how to make your own sustained release tablets.

I am also wondering whether simulating the normal diurnal cortisol cycle using sustained release hydrocortisone tablets might help ME/CFS patients with circadian rhythm sleep cycle problems. The daily cortisol cycle has a flattened response in ME/CFS patients,† so by artificially reproducing the normal morning peaks and evening troughs in cortisol, using sustained release hydrocortisone tablets, I wonder if this might help resynchronize the circadian sleep rhythm, and improve the sleep cycle problems of ME/CFS.

Lots of ME/CFS have circadian rhythm sleep cycle problems. For example, I suffer from sleep cycle inversion, where my body seems to always want to synchronize to a clock rhythm where I sleep during the day, and am wide awake at night


Though I suspect it is the circadian sleep rhythm that controls the cortisol cycle, and not the other way around, so artificially reproducing the normal cortisol cycle may have no effect on the circadian sleep rhythm. (Though interestingly, the adrenals have their own built-in clock).

Artificially reproducing the normal cortisol cycle might have some other interesting benefits for ME/CFS though.