Quick Reference For the Most Common Symptoms of Adrenal Hormone Replacement Excess and Deficiency

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
Action (hours)
Short Acting
(Cortef, Cortisol)
20 1 1 90 8-12
Cortisone Acetate 25 0.8 0.8 30 8-12
Intermediate Acting
Prednisone 5 4 0.8 60 12-36
Prednisolone 5 4 0.8 200 12-36
Triamcinolone 4 5 0 300 12-36
Methylprednisolone 4 5 0.5 180 12-36
Long Acting
Dexamethasone 0.75 30 0 200 36-54
Betamethasone .6 30 0 300 36-54
Fludrocortisone 0 15 150 240 24-36
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

Prednisone Cortisone Dexamethasone Hydrocortisone (Cortef)
5 mg = 25 mg = 0.75 mg = 20 mg

Click here for a PDF of this chart.

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