Would love to hear some anecdotal experience, but here is something on point:
2) Physiologic studies indicate that the average daily production of cortisol by human adrenals under basal conditions is approximately 15-20 mg, but this dosage will not maintain a totally adrenalectomized patient. 35-40 mg daily is necessary to inhibit endogenous adrenal steroid production to zero, and this dosage will satisfactorily maintain an adrenalectomized patient with a minimum of supplementary sodium-retaining steroid. Taken by mouth, even in divided doses, cortisone acetate or cortisol is only approx. 60% as efficient as when the hormone is naturally produced by the adrenals or released directly into the blood. 13 (the last statement makes you wonder about doing cortisol sublingually! Janie)
3) It has been demonstrated that when subjects with intact adrenals receive less than full replacement dosages of cortisol, endogenous adrenal function is suppressed only sufficiently to achieve a normal glucocorticoid level. For example, subjects receiving 20 mg (5 mg. four times) daily of cortisol have their endogenous adrenal steroid production decreased by approx. 60%, and subjects receiving 10 mg. (2.5 mg. four times) daily have their adrenal steroid production decreased by approx. 30%. The residual functioning tissue is adequate for apparently normal responses to stresses such as respiratory or gastrointestinal infections or even major surgery, but because their hypothalamus-pituitary-adrenal (HPA) response to stress might be impaired, and because of recent evidence that at least some autoimmune disorders are associated with a defective HPA response to stress, it seems advisable to supplement their cortisol dosages at times of any increased stress and especially at times of surgery or similar severe stress as in patients with more severe adrenocortical deficiency. 14
Subreplacement dosages also avoid the complete suppression of endogenous adrenal androgen production that probably causes a higher incidence in women than in men of undesirable side effects such as osteoporosis when larger dosages are taken for long periods. Many patients who need subreplacement dosages have low adrenal reserve, so the administration of such dosages actually improves the adrenals’ ability to respond to stress in these cases. 14
4) The schedule of administering cortisol every eight hours or four times daily is followed because of evidence that normal blood levels and some metabolic effects of a single dose of cortisol do not last longer than 8 hours. For practical purposes, dividing the total daily dosage into four parts taken before each meal and at bedtime has two advantages. It is easier for a patient to remember to take a medication at these times than at other times, and the ingestion of food tends to counteract the development of acid indigestion from the cortisol. For the bedtime dose, patients are instructed to drink milk or take an antacid with the medication. 15-16 (from Janie–In Wilson’s book, Adrenal Fatigue 21st Century, he recommends the following: 12 mg. first thing in the morning, then 5 mgs at noon, then 2 mgs at 3 pm, and finally 1 mg at 6 pm. That better follows the normal rhythm.)
