Hydrocortisone Therapy: Pros and Cons

Re: Hydrocortisone Therapy: Pros and Cons

Postby Jesteroony » Wed Aug 08, 2018 6:26 pm

Hi this is very interesting as I have just been recently diagnosed as having Non alcoholic fatty liver disease after routine bloods shown sky high liver profile
I have pan-hypopituitarism and have been taking Hydrocortisone for 22 years!! 30mg a day, I live a very active lifestyle, I exercise at the gym 2 to 3 times a week, work full time for the ambulance service and eat a reasonable diet and only drink at weekends and not in any large amount.
The liver specialist I have been referred to, says that there does seem to be a link between my condition and liver disease.
To be honest there always seems to be something new to surprise me living with this condition since 1996.
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Re: Hydrocortisone Therapy: Pros and Cons

Postby Marc_U » Fri Aug 10, 2018 10:48 pm

Hi Member_44843 (Sorry, but you haven't given any other name)

Welcome to the forum, and I hope that you find it of use, and that other members will find your experience of use to them.

Unfortunately it does to tend to be very quiet here at times, as you may have guessed from the age of the last messages in the Topics that you posted on, and I don't know if any of those members are still active here.

Personally at the moment, I am on only 5mg dosage hydrocortisone - post-op.
I had my micro-adenoma removed from my pituitary gland at the beginning of July, as I was suffering from Acromegaly from it.
And am awaiting blood tests in a few weeks to find out how well my pituitary has recovered, and to whether I will need to continue with hydrocortisone, and whatever, or not.

So as yet, I don't know what my situation will be long-term.


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Re: Hydrocortisone Therapy: Pros and Cons

Postby member_41389 » Sat Aug 11, 2018 7:48 pm

I've just looked at Dr Google and found an interesting paper at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2742767/ "Non-alcoholic Fatty Liver Disease and Metabolic Syndrome in Hypopituitary Patients". Sadly it's from an american source so the numbers are in strange units but they can be translated without too much hassle.
Keep up the good work - I've relied on the help of your colleagues on three occasions now and am immensely grateful for the work of the Ambulance service.
Take good care of yourself
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Re: Hydrocortisone Therapy: Pros and Cons

Postby KitKat » Wed Dec 19, 2018 7:39 am

Hello all,
This is a fascinating thread and it left me anxiously wondering what happened with Bear's experiment in reducing hydrocortisone. Did you stick with a lower daily dose or wean completely? I know that a few lucky souls do find their pituitary function gradually returns, years or decades after surgery, so hope it worked out for you.
Thanks also to Tim for his important research citation, which points out in the opening paragraph that metabolic syndrome or fatty liver seems to be more common in people with growth hormone deficiency.
"It is now well established that patients with hypopituitarism, especially growth hormone deficiency, have increased incidence of an insulin resistant syndrome, characterised by abdominal adiposity, dyslipidemia, hyperglycemia, hypertension and nonalcoholic fatty liver disease (NAFLD)".
I believe that the EU-AIR observational study now under way across Europe tends to confirm this observation: it looks as if it's not so much the steroids as the loss of growth hormone causing these physiological changes. The EU-AIRE study is tracking people on steroid replacement who have both pituitary conditions and/or adrenal conditions (mostly autoimmune, some surgical removal of adrenals). Those with a pituitary condition are typically on a lower daily steroid dose than those with adrenal conditions – but are also more likely to be "under-tall" with heavier weight, larger waist circumference. These with adrenal conditions, to put it bluntly, are skinnier despite swallowing more steroid. How unfair is that? In other words, so long as you are on a moderate replacement dose and not partying on it, it seems less likely to be the steroids causing fatty liver changes.
That said, I know that fatty liver can be a real concern for people whose additional autoimmune conditions mean they need high doses of longer-acting steroid, such as prednisolone. I am thinking of one man I used to correspond with who had cystic fibrosis (sadly, he died a few years ago). To preserve his lung function as long as possible, he needed massive doses of prednisolone at times, which he memorably described as leaving him feeling "like Spongebob on speed". Life is full of trade-offs, and all of us can be thankful for the drugs that keep us alive, recognising that they are highly potent and need to be treated with respect.
Best wishes to all,
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