Yeah, I'm up there too with the Cortef. Got it to where I can (barely) work a 40 hour week, if I sleep most of the time when not at work. Doc's going to look at thyroid next... slowly but surely...
I am betting it is low just by what your saying. I can't believe the things my Dr. is finding wrong with me. I told him for yrs I can't take the heat. I was going into his office for bladder infections and they would check my urine and tell me to drink more water I am Dehydrated. Then later we find out I am Secondary and need to treat low cortislo and Thyroid levels still I felt like crap. Then I came accross this link and at the bottom they talked about low Aldosterone levels with poor adrenals.
I had my Dr. check them and low and behold I am bad now I am on .1 mgs. of Florinef. My fatigue is gone I can now go outside and not feel sick do to the heat. I am back at the Old Persons Club working out in there gym again and feeling better after going in 3 days a week for 90 mins. Man I can't tell you how much better I feel.
http://www.tuberose.com/Adrenal_Glands.html
Here is a cut and paste for the link.
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Regulation and Actions of Aldosterone
Adrenal Fatigue and Craving for Salt
As mentioned in the “Anatomy” section, aldosterone is manufactured in the zona glomerulosa of the adrenal cortex. Like coritsol, aldosterone follows a diurnal pattern of secretion with its major peak at around 8:00 AM and major low between midnight and 4:00 AM. Also like coritsol, its production and secretion increases and decreases in response to stimulation of the adrenal cortex by ACTH. This means that aldosterone levels generally rise in stressful situations. However, aldosterone is not part of the negative feedback loop controlling its release. Instead, it depends on the negative feedback loop in which coritsol levels trigger ACTH activity. This means that coritsol determines the amount of ACTH which controls production of both coritsol and aldosterone with aldosterone having no say in the matter.
The only thing the cells that produce aldosterone can do to regulate production is to alter their sensitivity to ACTH. Therefore, after about 24 hours, the adrenal cells of the zona glomerulosa become less sensitive to the demands of ACTH and stop manufacturing more aldosterone. The amount of circulating aldosterone then begins to decrease, even though the ACTH levels are high and the need for increased amounts of aldosterone may continue. This decreased production continues until the cells of the zona glomerulosa recover their sensitivity to ACTH, but in the meantime the decreased aldosterone leads to many of the symptoms of adrenal fatigue.
Aldosterone is the most important mineralocorticoid, but corticosterone and desoxycorticosterone are also included in this category. The effects of aldosterone depletion can be observed in a large number of hypoadrenic persons. Aldosterone depletion may create one or more different symptoms which are specifically related to the diminished mineralocorticoid levels.
In the chronically stressed person, the levels of sodium and chlorides in the urine should be measured as well as the specific gravity in the urine. Chlorides in the urine are measured by Koenisburg’s test. This test also provides information of the sodium levels being excreted in the urine. Excessive sodium in the urine is one of the first clues that a person has a hypoadrenic problem.
Aldosterone is responsible for the maintenance of fluid (water) and the concentration of certain minerals (sodium, potassium, magnesium and chloride) in the blood, the interstitial fluid (area between the cells) and inside the cells. Working with other hormones such as anti-diuretic hormone from the pituitary and rennin and angiotensin I and II from the kidneys, aldosterone keeps the fluid balance and salt concentration intact, in roughly the same concentration as sea water. In the blood and interstitial fluid, sodium is the most dominant of the four minerals. Inside the cells, potassium has the highest concentration. These four minerals are called electrolytes because they carry minute electrical charges. These electrolytes are very important for proper cell function and fluid properties and they must remain in a relatively constant ratio to each other and to the body fluids. Small deviations in their ratios to each other, or to their concentration in the body fluids, means alterations in the properties of the fluid, the cell membrane and the biochemical reactions within the cell. In fact, most of the physiological reactions in the body depend in some way on the flow or concentration of electrolytes.
Aldosterone, in times of stress is the major director of these relationships by its influence on sodium and water concentrations. Although this interaction is somewhat complex, the overall process is easy to understand if you just keep an eye on the sodium in relation to aldosterone. As the concentration of aldosterone rises, the concentration of sodium rises in the blood and interstitial fluid. Wherever sodium goes, so follows water.
In adrenal fatigue, the craving for salt is a direct result of the lack of adequate aldosterone. As mentioned above, aldosterone controls sodium, potassium and fluid volumes in your body. When aldosterone secretions are normal, potassium, sodium and fluid levels are also normal. When aldosterone is high, sodium is kept high in the fluids circulating in your body.
However, as circulating aldosterone levels fall, sodium is removed from your bloodstream as it passes through the kidneys and is excreted in the urine. When sodium is excreted it takes water with it. Initially, there is some loss of volume of your body fluids but it does not become severe unless the condition worsens. Once your circulating sodium level drops to about 50% of its original concentration in body fluids, even a small loss of sodium or sodium restriction in your diet begins to have severe consequences. Tiny fluctuations in blood sodium concentration have a significant effect o blood volume when sodium is depleted to this level.
When the sodium supply of the blood is not replenished by eating salt-containing foods or liquids, sodium and water is pulled from your interstitial fluids into the blood to keep your blood sodium levels and water volume from getting too low. If too much salt or fluid is pulled from the interstitial fluids, the small amount of sodium in the cells begins to migrate out of the cells into the interstitial fluid.
The cell does not have a great reserve of sodium because it needs to maintain its 15:1 ratio of potassium to sodium. As the sodium is pulled from the cell, water follows the sodium out.
This leaves the cell dehydrated as well as sodium deficient. In addition, in order to keep the sodium/potassium ratio inside the cell constant, potassium then begins to migrate out in small quantities. However, each cell has minimum requirements for the absolute amounts of sodium, potassium and water necessary for its proper function. When these requirements are not met, cell function suffers, even if the proper ratio is maintained.
If you are suffering from moderately severe adrenal fatigue, you must be careful how you re-hydrate yourself. Drinking much water or liquid without adequate sodium replacement will make you feel worse because it will dilute the amount of sodium in your blood even further. Also, your cells need salt to absorb fluids because sufficient sodium must be inside the cell before water can be pulled back across the membrane into the cell.
When you are already low on body fluids and electrolytes, as you are in this situation, you should always add salt to your water. Do not drink soft drinks or electrolyte-rich sports drinks, like Gatorade, because they are high in potassium and low in sodium, the opposite of what someone with low coritsol levels who is dehydrated needs. Commercial electrolyte replacement drinks are designed for people who produce an excess of coritsol when exercising, not people who are low on coritsol and aldosterone. Instead, yo are much better off having a glass of water with ¼ - 1 teaspoon salt in it, or eating something salty with water to help replenish both sodium and fluid volume.
In a nation of people suffering from adrenal fatigue, the fast food restaurants come to the rescue. Such restaurants use an excessive amount of salt in their foods; a custom left-over from the old road houses where lots of salt was used in the food to stimulate appetites and whet the thirst (for alcohol, the biggest profit item). Although not a good solution, it supplies “emergency” rations daily to people living in marginal health. It averts the crisis and replenishes their supplies for another few hours.
When your aldosterone levels are low and you are dehydrated and sodium deficient, you may also crave potassium because your body is sending you the message that your cells are low on potassium as well as sodium and water. However, after consuming only a small amount of potassium containing foods or beverages (fruit, fruit juice, sodas and commercial electrolyte replacement drinks), you will probably feel worse because the potassium/sodium ration will be further disrupted.
What you really need in this situation is a combination of all three, water, salt and potassium in the right proportions. One of the easiest ways to accomplish this is to drink small repeated doses of water accompanied by a little food sprinkled with kelp powder. Kelp powder contains both potassium and sodium in an easily assimilated form. Depending upon taste and symptoms, extra salt can be added. Sea salt is a better choice than regular refined table salt, because it contains trace amounts of other minerals in addition to the sodium. Another choice is to drink a vegetable juice blend containing some celery and chard and diluted with purified water.
Usually, within 24-48 hours, your hydration and electrolyte balance will have stabilized enough that you can proceed to an adrenal-supporting diet. You must continue to be careful to drink salted water or vegetable juices 2-4 times during the day, varying the amount of salt according to your taste, and you should avoid potassium-containing foods in the morning when your coritsol and aldosterone levels are low. Never eat or drink electrolyte-depleting or diuretic foods and beverages such as alcohol and coffee, especially if you have been out in the sun or are otherwise dehydrated. One of the problems people with adrenal fatigue constantly deal with is a mild dehydration and sodium depletion.
When there is inadequate aldosterone, the kidney allows sodium, chlorides and water to spill into the urine, and maintains ionic balance by retaining, rather than excreting, potassium. Some of these low aldosterone persons present with symptoms of dehydration. The appearance of the tongue is one of the easily monitored indicators of dehydration. Normally, one should feel considerable slickness when running a finger down the protruded tongue of a person. It should slide easily across the tongue like a cube of ice across a wet piece of waxed paper. If the tongue is rough like sandpaper, or if you feel friction, with your finger catching or sticking to the tongue’s surface, it is an indication of inadequate tissue hydration. The person needs more water intake.
The person may report excessive urination, up to 15 or 20 times daily. Likewise, due to the effect of aldosterone on the sweat glands, the person may report excessive perspiration or perspiration with little or no physical activity. The common factor in all of these persons is a weakness of sartorius, gracilis, posterior tibialis, gastrocnemius, or soleus, and a background of some type of stress.
A person with lowered aldosterone may also demonstrate other symptoms. For a nervous system action potential to take place there must be an adequate supply of sodium on the outside of the cell membrane and an adequate supply of potassium inside the cell. They must be balanced. If this balance is undermined by a loss of sodium and retention of potassium, the nervous system will find it difficult to propagate normal action potentials and maintain itself at a good functional level. This may result in a wide variety of symptoms, including muscle twitches and even cardiac arrhythmias (heart palpitations).
With a chronic sodium-potassium imbalance, the person will show the sign of a paradoxical pupillary reflex. Normally, shining a light into a person’s eye will cause the pupil to constrict. This papillary constriction to light should be able to maintain itself for at least 30 seconds. In the hypoadrenic person (especially in the exhaustion stage of the GAS) you will find one of three things:
1. The pupil will fluctuate opened and closed in response to light.
2. The pupil will fluctuate opened and closed in response to light. (This is a deliberate opening and closing, not the minor flutter or twitch of the normally encountered hippus activity.)
3. The pupil will initially constrict to light, but it will dilate paradoxically with continued light stimulation of less than 30 seconds. This patient will frequently complain of eyes that are sensitive to light (such as when going from indoors to outside on a sunny day) or will be seen wearing sunglasses whenever outdoors or even indoors under bright light.
Another problem related to lowered mineralocorticoid levels in hypoadrenia is a paradoxical, non-pitting edema of the extremities. When the patient with hypoadrenia spills sodium and water into the urine and perspiration, and has a tendency to be dehydrated, we would hardly expect him to show signs of holding water, such as edema. But that is exactly what we do see in some hypoadrenic patients.
With the body spilling large amounts of extracellular sodium and likewise retaining intercellular potassium, we can see how an osmotic differential could develop in the patient’s tissues. If the osmotic difference (created by the increased potassium seeking its intercellular position and the lowered extracellular sodium levels) is severe enough, the body will most often attempt to correct this osmotic imbalance by allowing extracellular fluid to enter the cells. (It is also possible that the body could kick the potassium out of the cell and into the extracellular fluids, and although this occasionally occurs, we rarely see signs of this in the blood potassium levels.) The body is trying to dilute the potassium in the cell with water, to bring the system into osmotic equilibrium. The cells take on water, and the patient has swelling.
Often, these patients are placed on a diuretic by an unenlightened physician whose only basis for this prescription is the patient’s symptoms. The diuretic in these patients rarely helps the condition and often aggravates the tendency toward dehydration. Further, many diuretics act as adrenal (aldosterone) inhibitors, adding even more stress to the adrenals and tending to make the patient worse in the long run.
Even in adrenal fatigue, the body is still wonderful, beautiful and incredibly wise. It is our society, our maladaptation to the stresses of modern life, and our poor judgment that need to change. We may not be able to change society but we can learn to use better judgment when it comes to taking care of ourselves and to respond to stress in healthier ways.
