Most common symptoms of:
|glucocorticoid (cortisol) deficiency||Severe fatigue, weakness, weight loss, hyperpigmentation, nausea, loss of appetite.|
|glucocorticoid (cortisol) excess||Weight gain, fatigue, easy bruising, muscle weakness, redness in the face, pink stretch marks, mood swings, inappropriate hunger.|
|mineralocorticoid (fludrocortisone acetate) deficiency||Reduced blood pressure, nausea (sometimes to the point of vomiting), dizziness (sometimes to the point of passing out), salt craving, muscle cramps.|
|mineralocorticoid (fludrocortisone acetate) excess||Hypertension, ankle swelling, exertion headache.|
Reference: Dr. Paul Margulies, MD, FACP, FACE, NADF Medical Director (updated 7-12-2014) Click here for a PDF of this chart.
Corticosteroid Comparison Chart
|Potency relative to Hydrocortisone||Half-Life|
|Equivalent Glucocorticoid Dose (mg)||Anti-Inflammatory||Mineral-Corticoid||Plasma(minutes)||Duration of
|Aldosterone||0||0||400 +||20||– –|
|Reference: Adrenal Cortical Steroids. In Drug Facts and Comparisons. 5th ed. St. Louis, Facts and Comparisons, Inc.:122-128, 1997|
Commonly Prescribed Replacement Steroid Equivalents
|5 mg||=||25 mg||=||0.75 mg||=||20 mg|
The Hypothalamic-Pituitary-Adrenal Connection
A defect at any point along the hypothalamic-pituitary-adrenal (HPA)-axis could disrupt normal physiologic glucocorticoid levels. Administration of exogenous glucocorticoids leads to suppression of cortisol production by the adrenal cortex.
HPA-axis suppression is a well-known adverse effect of glucocorticoid therapy; however, considerable controversy exists over the dose and duration of glucocorticoid therapy required to suppress the HPA-axis.
Some of the many factors that influence HPA-axis suppression include time of day that the doses are administered, route of administration, dose and duration of therapy, and duration of action of the agent used.
Reference: Helfer EL, Rose LI. Corticosteroids and adrenal suppression: characterizing and avoiding the problem. Drugs. 1989;38(5):838-845
Normal Cortisol Secretion
Hormone production by the adrenal gland is influenced by many factors. Normal cortisol production follows a diurnal cycle. Levels peak in the early morning hours (6 am–8 am) and decline throughout the day with a second, lower peak in the late afternoon (4 pm–6 pm).
In an adult who is not experiencing stress, the average amount of cortisol secreted by the adrenal gland is equivalent to 5 mg of prednisone.
Reference: Katzung BG. Basic and Clinical Pharmacology. 6th ed. East Norwalk: Appleton & Lange;1995:590-607