My Adrenal Life

My Adrenal Life

The My Adrenal Life Podcast provides calm, evidence-based education and supportive conversation for people living with adrenal insufficiency. Episodes explore primary (Addison’s), secondary, tertiary, and steroid-induced adrenal insufficiency, explaining the science in plain language while recognizing real patient experiences. Our goal is to reduce confusion, share reliable information, and help people navigating this complex condition feel less alone. Medical Disclaimer: This podcast is for educational purposes only and is not medical advice.

  1. 1d ago

    ACTH Stimulation Testing: Why 18 Is Not a Universal Pass/Fail Number

    ACTH Stimulation Testing: Why 18 Is Not a Universal Pass/Fail Number What if the cortisol number you’ve been told determines whether your adrenal glands are functioning properly isn’t actually the right number for the test your laboratory used? For decades, people undergoing ACTH stimulation testing have heard the same rule: Your cortisol needs to reach 18 µg/dL to pass. But advances in laboratory testing have revealed that interpreting adrenal function is far more complicated than comparing a result to one universal cutoff. In this episode of the My Adrenal Life Podcast, we explore new research challenging the traditional 18 µg/dL threshold and explain why the laboratory assay, testing protocol, sample timing, medication history, and type of adrenal insufficiency all influence what a cortisol result actually means. We begin with an October 2026 systematic review examining the Roche Elecsys Cortisol II assay. After analyzing six studies involving 430 adults and children, researchers proposed a peak stimulated cortisol cutoff of approximately 14.7 µg/dL for the standard 250-microgram ACTH stimulation test. That’s considerably lower than the traditional 18 µg/dL threshold. But does that mean someone who previously failed an ACTH stimulation test might now pass? Possibly—but only when the laboratory method, testing protocol, and clinical circumstances support that interpretation. We explain why newer cortisol assays often report lower concentrations than older testing methods, even when the patient’s underlying adrenal function hasn’t changed. The biology may be the same, but the measuring stick is different. We also break down what an ACTH stimulation test actually measures: the adrenal glands’ ability to produce cortisol when stimulated by synthetic ACTH. This distinction is especially important when comparing primary adrenal insufficiency with secondary, tertiary, and steroid-induced adrenal insufficiency, where impaired pituitary signaling, adrenal responsiveness, and the timing of HPA-axis suppression can complicate results. Other important questions we explore include: Why do 30-minute and 60-minute cortisol results matter? Cortisol may peak at different times, and a cutoff must match the protocol used.Is a morning cortisol test the same as an ACTH stimulation test? No. These tests answer different questions, particularly when evaluating recovery after glucocorticoid exposure.Can estrogen and cortisol-binding proteins change test results? Yes. Changes in binding proteins can influence total measured cortisol without producing equivalent changes in free cortisol.How do previous steroid treatments affect testing? Oral medications, injections, inhaled glucocorticoids, and other exposures can influence HPA-axis function and, in some circumstances, laboratory measurements.What does a passing result actually mean? A reassuring stimulated cortisol result does not necessarily establish that every aspect of the body’s natural stress response has recovered.We also discuss the 2024 Endocrine Society and European Society of Endocrinology guidance on evaluating recovery from glucocorticoid-induced adrenal insufficiency, including why morning cortisol is interpreted differently from stimulated cortisol. Perhaps most importantly, we explore what patients should ask their endocrinologists when reviewing results—especially when those results may influence decisions about glucocorticoid replacement, HPA-axis recovery, or ongoing sick-day and emergency precautions. The new 14.7 µg/dL proposal does not mean everyone below 18 is suddenly normal. And it does not mean everyone above 14.7 has a fully functioning cortisol stress response. To learn more, explore the My Adrenal Life Books Authored by founder Rick Disler available on Amazon, visit www.myadrenallife.com, and join our supportive My Adrenal Life Facebook Group for education, discussion, and community.

  2. 3d ago

    Waking Up at 3 A.M.? Why It Isn’t Always Low Cortisol

    Waking Up at 3 A.M.? Why It Isn’t Always Low Cortisol Do you find yourself waking up at 3 a.m., sometimes with a racing heart, sweating, or feeling strangely alert—even though you were exhausted when you went to bed? If you live with adrenal insufficiency, you may immediately wonder: Is my cortisol dropping too low? In this episode of the My Adrenal Life Podcast, we explore the fascinating relationship between cortisol, sleep, and the body’s internal clock—and challenge one of the most common assumptions in the adrenal insufficiency community: Waking up at 3 a.m. does not automatically mean your cortisol is low. We begin by examining what cortisol is actually supposed to do overnight. In a healthy body, cortisol naturally declines during the evening, remains relatively low during the early part of the night, and begins rising again as morning approaches. We explain the difference between the circadian rhythm, which regulates cortisol across approximately 24 hours, and the ultradian rhythm, which produces smaller cortisol pulses throughout the day and night. For people living with primary, secondary, tertiary, or steroid-induced adrenal insufficiency, these natural rhythms may be disrupted. Traditional glucocorticoid replacement does not perfectly reproduce the body’s normal hormone patterns, raising important questions about nighttime cortisol availability, medication timing, and sleep quality. But cortisol is only one part of the story. We take a deeper look at what actually happens inside the sleeping brain, including the transition between deep sleep and REM sleep, changes in autonomic nervous system activity, and why awakenings may become more noticeable during the second half of the night. One particularly important discussion centers on hydrocortisone wearing off overnight. While circulating cortisol from immediate-release medication declines after a dose, that does not automatically establish that a nighttime awakening is caused by clinically significant cortisol deficiency—or that additional nighttime glucocorticoid replacement is appropriate. We also examine why a single nighttime cortisol measurement or commercial at-home cortisol test may not provide the answers people expect. Throughout the episode, we distinguish ordinary sleep disruption from symptoms that may indicate inadequate cortisol availability or a developing adrenal emergency. Recognizing other possible causes of nighttime waking should never mean overlooking serious symptoms or established sick-day and emergency protocols. Finally, we explore where adrenal insufficiency sleep research needs to go next, including overnight hormone monitoring, objective sleep studies, cortisol delivery systems, autonomic function, menopause-related sleep changes, and recovery of the HPA axis after steroid exposure. The bigger message is that your body is more than one hormone. Cortisol may contribute to disrupted sleep, but so can breathing problems, pain, reproductive hormones, thyroid function, blood glucose, and the brain’s normal sleep cycles. Waking at 3 a.m. is information about your sleep. It is not, by itself, proof of cortisol deficiency. Instead of asking only, “Why is my cortisol dropping at 3 a.m.?” perhaps the more useful question is: “What is actually interrupting my sleep?” To learn more, explore the My Adrenal Life Books Authored by founder Rick Disler available on Amazon, visit www.myadrenallife.com, and join our supportive My Adrenal Life Facebook Group for education, discussion, and community.

  3. 5d ago

    Beyond the Daily Pill: Reimagining Cortisol Replacement

    Beyond the Daily Pill: Reimagining Cortisol Replacement What if replacing cortisol isn't the same as recreating the way cortisol actually works in the human body? In this episode of the My Adrenal Life Podcast, we explore one of the most fascinating questions shaping the future of adrenal insufficiency care: Can we move beyond simply replacing cortisol toward treatments that more closely reproduce the body's natural hormone rhythms? For people living with adrenal insufficiency, glucocorticoid replacement is essential and life-saving. But even when medications are taken exactly as prescribed, conventional treatment cannot fully reproduce the complex timing, fluctuations, and continuous adjustments of natural cortisol production. We begin by exploring the science of cortisol's two overlapping rhythms: the circadian rhythm, which helps regulate cortisol throughout the day and night, and the ultradian rhythm, which produces smaller hormonal pulses approximately every 60–120 minutes. These rhythms influence far more than when someone feels awake or tired. Cortisol signaling affects metabolism, immune regulation, cellular activity, and how genes respond to hormonal messages. Research suggests that cells can respond differently to pulsatile versus continuous glucocorticoid exposure—even when the total amount of hormone is similar. We then examine why traditional oral hydrocortisone creates a different pattern. Rather than continuously adjusting to the body's needs, each dose produces a rise and subsequent decline in circulating cortisol. Two people taking the same daily dose may experience very different patterns of hormone exposure because of differences in absorption, metabolism, medication timing, and individual physiology. That raises an important question for patients who experience predictable fatigue, weakness, brain fog, or changes in functioning between doses: Could the timing of cortisol exposure be part of the problem? We discuss why these patterns deserve attention, while also recognizing that symptoms alone cannot determine whether someone is receiving too much or too little cortisol. The conversation then turns toward emerging treatment approaches. Modified-release hydrocortisone formulations are designed to better approximate certain features of natural cortisol secretion, including the early-morning rise or more sustained daytime coverage. Continuous subcutaneous hydrocortisone infusion, sometimes called cortisol pump therapy, offers another approach by delivering medication through a programmable device rather than relying entirely on oral tablets. We also explore research into pulsatile cortisol delivery, including the PULSES study, which investigates whether recreating the body's natural hormonal pulses could influence sleep, fatigue, emotional processing, and other aspects of health. These developments are exciting, but important questions remain. Producing a more natural-looking cortisol pattern does not automatically guarantee better long-term health or quality of life. Researchers still need to determine which approaches provide meaningful benefits, for whom, and with what risks. Finally, we discuss how patients can bring these questions into their endocrinology appointments by tracking medication timing, recurring symptoms, and changes in daily functioning—creating a clearer picture for conversations about treatment. Whether you're living with primary, secondary, tertiary, or steroid-induced adrenal insufficiency, this discussion offers a deeper understanding of why the total daily dose is only one part of the cortisol replacement story. To learn more, explore the My Adrenal Life Books Authored by founder Rick Disler available on Amazon, visit www.myadrenallife.com, and join our supportive My Adrenal Life Facebook Group for education, discussion, and community.

  4. 5d ago

    Thyroid & Cortisol: Same Symptoms. Different Rules.

    Thyroid & Cortisol: Same Symptoms. Different Rules. Fatigue, brain fog, weight changes, muscle weakness, temperature intolerance, heart-rate changes, and poor sleep. Are these symptoms coming from your thyroid, your adrenal insufficiency, or both? In this episode of the My Adrenal Life Podcast, we explore the complicated relationship between thyroid hormones and cortisol—and why understanding how these two endocrine systems interact can make an enormous difference in recognizing symptoms, interpreting laboratory results, and managing treatment safely. The thyroid and adrenal systems influence many of the same functions, including metabolism, cardiovascular health, energy, glucose regulation, and physical stamina. But similar symptoms do not mean the same underlying problem—or the same treatment approach. We begin with one of the most important principles in endocrinology: When both adrenal insufficiency and hypothyroidism are suspected, adequate cortisol availability must be addressed before thyroid hormone treatment is initiated or substantially increased. Thyroid hormone can increase cortisol metabolism, potentially exposing an already limited adrenal reserve and, in some circumstances, precipitating adrenal crisis. We also explain why thyroid testing follows different rules depending on where the problem originates. In primary hypothyroidism, TSH is generally an important guide. But in central hypothyroidism caused by pituitary or hypothalamic dysfunction, a normal or low TSH can be misleading, making free T4 particularly important. The conversation goes even deeper into how cortisol and glucocorticoid medications can influence thyroid laboratory results. Higher glucocorticoid exposure may suppress TSH and reduce the conversion of T4 to T3, while cortisol deficiency can sometimes raise TSH. Significant illness, hospitalization, and stress dosing can further complicate interpretation. We also explore two important connections: autoimmune Addison’s disease and autoimmune thyroid disease can occur together, while pituitary disorders can simultaneously disrupt ACTH and TSH signaling, leading to secondary adrenal insufficiency and central hypothyroidism. Other topics include how thyroid and adrenal disorders can affect weight, heart rate, blood pressure, sodium, and blood glucose; why low T3 doesn’t automatically mean someone needs T3 medication; and how supplements such as biotin, iodine, ashwagandha, and licorice may complicate endocrine management or laboratory interpretation. Perhaps one of the most practical distinctions involves illness. Cortisol replacement has sick-day and emergency protocols. Thyroid hormone generally does not follow those same rules. Vomiting that prevents someone from retaining oral glucocorticoid medication can become an emergency, while missing a single levothyroxine tablet usually carries a very different level of urgency. Throughout this discussion, we emphasize why persistent symptoms deserve thoughtful evaluation rather than automatically increasing thyroid medication or glucocorticoid replacement. Medication timing, absorption, other medical conditions, and the broader symptom pattern all matter. Whether you’re living with primary, secondary, tertiary, or steroid-induced adrenal insufficiency—and whether your thyroid condition is primary or central—understanding these differences can help you have more informed conversations with your healthcare team. The central message: Don’t treat the symptom list. Understand the physiology. Because when thyroid hormones and cortisol produce overlapping symptoms, the most useful question isn’t simply, “Which medication should I change?” It’s “Which system is actually asking for help?” To learn more, explore the My Adrenal Life Books Authored by founder Rick Disler available on Amazon, visit www.myadrenallife.com, and join our supportive My Adrenal Life Facebook Group for education, discussion, and community.

  5. Oct 12

    Flu, the Flu Shot & Adrenal Insufficiency

    Flu, the Flu Shot & Adrenal Insufficiency: What Changes When Your Body Cannot Make Enough Cortisol? For most people, the flu means several miserable days of fever, body aches, and exhaustion. But when you live with adrenal insufficiency, influenza can create an entirely different challenge: your body may not be able to produce the additional cortisol it needs to respond to illness. In this episode of the My Adrenal Life Podcast, we explore why influenza deserves special attention in people living with primary, secondary, tertiary, and steroid-induced adrenal insufficiency—and how vaccination, sick-day planning, and emergency preparedness can help reduce the risks. We begin with the science behind the body’s response to infection. During influenza, fever, inflammation, dehydration, and changes in metabolism increase the body’s need for cortisol. For someone with adrenal insufficiency, that increased demand can exceed the body’s ability to respond, making an ordinary respiratory infection a potential adrenal-management emergency. We discuss why infections can trigger adrenal crisis, how vomiting or diarrhea can interfere with oral glucocorticoid absorption, and why recognizing worsening symptoms early is so important. We also explain the differences between primary adrenal insufficiency, where aldosterone deficiency may complicate fluid and sodium balance, and secondary or tertiary adrenal insufficiency, where aldosterone production is generally preserved. Then we tackle one of the biggest questions in our community: Should people with adrenal insufficiency get the flu shot? We examine the 2026–2027 influenza vaccine recommendations, how vaccination helps reduce the risk of influenza and serious complications, and why taking physiologic cortisol replacement is not the same as being immunosuppressed by high-dose corticosteroid treatment. We also explore the differences between injectable influenza vaccines and the live attenuated nasal spray, along with another frequently debated question: Does getting a flu shot automatically mean you need to stress dose? The discussion explains why vaccine administration alone does not create a universal need for additional glucocorticoids, while fever or significant systemic symptoms may require following an individual’s prescribed sick-day plan. Beyond vaccination, we discuss antiviral medications, blood sugar changes during illness, hydration and sodium considerations, and the added complexity of managing influenza alongside diabetes, hypertension, thyroid disease, or other chronic conditions. Perhaps most importantly, we focus on preparedness. Knowing your sick-day instructions, understanding when oral medication may no longer be reliable, having an emergency injection kit available, and recognizing when urgent medical care is needed can make a meaningful difference when illness strikes. The flu shot doesn’t guarantee you won’t get influenza, and having adrenal insufficiency doesn’t mean you need to live in fear of every virus. It means understanding how your body’s response to illness is different—and having the knowledge, medical guidance, and emergency plan to respond appropriately. Because the goal isn’t to fear flu season. It’s to enter it informed, prepared, and confident about what to do if you become sick. To learn more, explore the My Adrenal Life Books Authored by founder Rick Disler available on Amazon, visit www.myadrenallife.com, and join our supportive My Adrenal Life Facebook Group for education, discussion, and community.

  6. Oct 10

    Steroids, Cortisol, and Weight Changes — Part 4: “Okay. So What Can I Actually Do About It?”

    Steroids, Cortisol, and Weight Changes — Part 4: “Okay. So What Can I Actually Do About It?” You’ve learned why weight changes happen with adrenal insufficiency, explored whether cortisol replacement may be contributing, and considered different approaches to weight management. But the biggest question remains: What can you actually do about it? In the final installment of our Steroids, Cortisol, and Weight Changes series, we bring everything together and focus on realistic, sustainable ways to manage weight while protecting the health and stability that people with adrenal insufficiency work so hard to maintain. We begin by looking beyond the scale. Glucocorticoid replacement, other medications, thyroid and metabolic conditions, menopause, sleep problems, chronic pain, and mobility limitations can all influence weight. Understanding what may be contributing is an important first step before pursuing increasingly restrictive diets or more intense exercise. We also explore why there is no single adrenal insufficiency diet and why nutrition and hydration needs can differ, particularly between primary adrenal insufficiency with aldosterone deficiency and other forms of AI. Healthy eating matters, but any approach needs to respect individual medical needs and established adrenal insufficiency protocols. Physical activity is another important part of the conversation. Walking, swimming, strength training, modified exercise, and even short periods of movement can contribute to better health. The goal isn’t to push the body to its limits. It’s to find activity that can be safely recovered from and repeated. And what if the weight comes off slowly? We discuss why gradual progress can still be meaningful progress and why successful weight management involves more than a number. Improvements in strength, stamina, mobility, body composition, metabolic health, and everyday functioning can matter just as much as changes on the scale. We also address additional weight-management options, including registered dietitian support, prescription medications, and bariatric surgery when medically appropriate. In particular, we examine GLP-1–based medications such as semaglutide and tirzepatide, their potential role in weight management, and why gastrointestinal side effects, delayed gastric emptying, and oral glucocorticoid absorption deserve special attention for people living with adrenal insufficiency. Throughout the episode, one principle remains central: Weight loss should never come at the expense of medically necessary cortisol replacement, sick-day management, or emergency preparedness. Whether you’re living with primary, secondary, tertiary, or steroid-induced adrenal insufficiency, your weight-management approach needs to account for your individual health, physical capacity, medications, and daily realities. Ultimately, this conversation challenges the familiar advice to “just eat less and move more.” Weight management still involves nutrition, activity, and energy balance, but building a plan that works with adrenal insufficiency requires more thought, flexibility, and individualized support. The goal isn’t to lose weight at any cost. It’s to improve your health without sacrificing the health you’re trying to improve. To learn more, explore the My Adrenal Life Books Authored by founder Rick Disler available on Amazon, visit www.myadrenallife.com, and join our supportive My Adrenal Life Facebook Group for education, discussion, and community.

  7. Oct 10

    Weight Gain & Adrenal Insufficiency — Part 3: Managing Weight With Adrenal Insufficiency

    Weight Gain & Adrenal Insufficiency — Part 3: Managing Weight With Adrenal Insufficiency How do you manage your weight when your body depends on cortisol replacement, your energy is unpredictable, and traditional weight-loss advice doesn’t account for the realities of adrenal insufficiency? In Part 3 of our Weight Gain & Adrenal Insufficiency series, we move beyond understanding why weight changes happen and explore what people living with adrenal insufficiency can realistically do about them. Weight management is possible, but “eat less and exercise more” isn’t much of a plan when fatigue, muscle weakness, chronic pain, poor sleep, dizziness, and fluctuating energy can make even ordinary daily activities challenging. We discuss practical, sustainable approaches to nutrition, physical activity, and healthy routines that work with the body rather than against it. From building satisfying meals and planning for low-energy days to finding movement that fits individual abilities, the focus is on creating habits that can survive real life—not chasing perfection. We also explore why the scale doesn’t tell the whole story. Changes in strength, stamina, mobility, body composition, and metabolic health may be meaningful signs of progress, even when weight loss is slower than expected. Another important conversation involves cortisol itself. Online advice about “cortisol belly,” detoxes, fasting, and lowering cortisol can be particularly misleading for people with primary, secondary, tertiary, or steroid-induced adrenal insufficiency. Medically necessary glucocorticoid replacement is not something to reduce or sacrifice for weight loss. We also take a closer look at prescription weight-management medications, including GLP-1–based treatments, and why gastrointestinal side effects, delayed gastric emptying, and the potential impact on oral medication absorption deserve special consideration when someone depends on glucocorticoid replacement. And what happens when illness interrupts your progress? We discuss why recovery and prescribed sick-day management must take priority over weight-loss goals—and why there is no need to compensate afterward with extreme restriction or excessive exercise. Throughout this conversation, we emphasize an important distinction: a weight-management plan should support your health, not leave you exhausted, symptomatic, or medically under-replaced. Progress may be slower. Plans may need to change from day to day. And sometimes the most productive next step is looking beyond food and exercise to other medications, hormonal changes, sleep problems, or medical conditions that could be contributing. Ultimately, successful weight management with adrenal insufficiency isn’t simply about losing pounds. It’s about building strength, protecting your health, improving daily function, and finding a sustainable approach that allows you to enjoy life beyond the scale. Coming next in Part 4: When the Scale Isn’t the Whole Story. We’ll explore body composition, strength, metabolic health, and the meaningful improvements that may be happening even when the number on the scale isn’t changing. To learn more, explore the My Adrenal Life Books Authored by founder Rick Disler available on Amazon, visit www.myadrenallife.com, and join our supportive My Adrenal Life Facebook Group for education, discussion, and community.

  8. Oct 8

    Steroids, Cortisol, and Weight Changes in Adrenal Insufficiency

    Steroids, Cortisol, and Weight Changes — Part 2: Is It the Steroids? If you’re living with adrenal insufficiency and watching the number on the scale climb, it’s natural to wonder: Is my cortisol replacement causing me to gain weight? In Part 2 of our Steroids, Cortisol, and Weight Changes series, we take a closer look at one of the most common and frustrating questions in the adrenal insufficiency community: Are the steroids responsible, or is something else happening? Glucocorticoids such as hydrocortisone and prednisone are essential for replacing cortisol the body cannot adequately produce. But replacement therapy isn’t identical to the body’s natural cortisol rhythm, and excessive glucocorticoid exposure over time can influence appetite, glucose metabolism, fat distribution, and body composition. We explore the important difference between weight regained during recovery and continued unwanted weight gain, why the number of milligrams taken doesn’t tell the whole story, and why weight gain alone cannot determine whether someone is receiving too much cortisol replacement. We also discuss the many other factors that may contribute to weight changes, including poor sleep, chronic pain, fatigue, reduced activity, menopause, thyroid conditions, other medications, and metabolic changes. Sometimes several factors are working together. Another important topic is stress dosing. Fear of gaining weight should not prevent someone from following their prescribed sick-day or emergency glucocorticoid plan. We explain why temporary, medically necessary increases in cortisol replacement serve a different purpose than prolonged excessive exposure—and why the circumstances surrounding illness and recovery can also affect the scale. Most importantly, we look at how recognizing patterns in weight, appetite, symptoms, medication changes, and daily functioning can support more productive conversations with healthcare providers. Because the answer shouldn’t automatically be “It’s just the steroids” or “You’re only taking replacement, so it can’t be the steroids.” The better question is: What’s actually contributing to the weight change, and how can we understand it without compromising essential adrenal insufficiency treatment? Coming next in Part 3, we’ll explore weight management with adrenal insufficiency, including why the familiar advice to “just eat less and exercise more” often fails to recognize the realities of living with this condition. To learn more, explore the My Adrenal Life Books Authored by founder Rick Disler available on Amazon, visit www.myadrenallife.com, and join our supportive My Adrenal Life Facebook Group for education, discussion, and community.

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5
out of 5
7 Ratings

About

The My Adrenal Life Podcast provides calm, evidence-based education and supportive conversation for people living with adrenal insufficiency. Episodes explore primary (Addison’s), secondary, tertiary, and steroid-induced adrenal insufficiency, explaining the science in plain language while recognizing real patient experiences. Our goal is to reduce confusion, share reliable information, and help people navigating this complex condition feel less alone. Medical Disclaimer: This podcast is for educational purposes only and is not medical advice.

Information

  • Creator
    My Adrenal Life
  • Years Active
    2026
  • Episodes
    168
  • Rating
    Clean
  • Copyright
    © My Adrenal Life
  • Show Website
    My Adrenal Life

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