​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: Paul Margulies, MD, FACE, FACP, Medical Director, NADF (updated 2-20-2020)  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
Hydrocortisone (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
Mineralocorticoid
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.
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Reference: Katzung BG. Basic and Clinical Pharmacology. 6th ed. East Norwalk: Appleton & Lange;1995:590-607