Cortisol is a hormone which produced by the adrenal gland (cortex) to control blood sugar. The production of cortisol is triggered by the pituitary hormone ACTH. Cortisol is a glucocorticoid which stimulates an increase in blood glucose. Cortisol will also stimulate the release of amino acids from muscle tissue and fatty acids from adipose tissue. The amino acids are then converted in the liver to glucose (for use by the brain). The fatty acids can be used by skeletal muscles for energy (rather than glucose) thereby freeing up glucose for selective utilization by the brain. Cortisol levels are often measured to evaluate the function of the pituitary or adrenal glands. Some of the cortisol is metabolized by the liver to produce 17 hydroxycorticosteroids, which is then excreted in the urine.
The primary stress hormone. Cortisol is the major natural GLUCOCORTICOID (GC) in humans.
Synthetic cortisol, also known as hydrocortisone, is used as a drug mainly to fight allergies and inflammation.
The amount of cortisol present in the serum undergoes diurnal variation, with the highest levels present in the early morning, and lower levels in the evening, several hours after the onset of sleep. Information about the light/dark cycle is transmitted from the retina to the paired suprachiasmatic nuclei in the hypothalamus. Changed patterns of the serum cortisol levels have been observed in connection with abnormal ACTH levels, clinical depression, psychological stress, and such physiological stressors as hypoglycemia, illness, fever, trauma, surgery, fear, pain, physical exertion or extremes of temperature. There is also significant individual variation, although a given person tends to have consistent rhythms.
Cortisol also inhibits the secretion of corticotropin releasing hormone (CRH), resulting in feedback inhibition of ACTH secretion. Some researchers believe that this normal feedback system may break down when animals are exposed to chronic stress.
In normal release, cortisol has widespread actions which help restore homeostasis after stress. It acts as a physiological antagonist to insulin by promoting gluconeogenesis, breakdown of lipids, and proteins, and mobilization of extrahepatic amino acids and ketone bodies. This leads to increased blood glucose concentrations, resulting in increased glycogen formation in the liver (Freeman, 2002). It also increases blood pressure. In addition, immune and inflammatory cells have their responses to stress attenuated by cortisol, and the hormone thus lowers the activity of the immune system. Bone formation is also lowered by cortisol.
These normal endogenous functions are the basis for the physiological consequences of chronic stress – prolonged cortisol secretion causes muscle wastage, hyperglycemia, and suppresses immune / inflammatory responses. The same consequences arise from long-term use of glucocorticoid drugs.
Also, long-term exposure to cortisol results in damage to cells in the hippocampus. This damage results in impaired learning. However, short-term exposure of cortisol helps to create memories; this is the proposed mechanism for storage of flash bulb memories.
As an oral or injectable drug, cortisol is also known as hydrocortisone. It is used as an immunosuppressive drug, given by injection in the treatment of severe allergic reactions such as anaphylaxis and angioedema, in place of prednisolone in patients who need steroid treatment but cannot take oral medication, and peri-operatively in patients on long-term steroid treatment to prevent an Addisonian crisis.
It is given by topical application for its anti-inflammatory effect in allergic rashes, eczema and certain other inflammatory conditions. It may also be injected into inflamed joints resulting from diseases such as gout.
Compared to prednisolone, hydrocortisone is about 1/4th the strength. Dexamethasone is about 40 times stronger than hydrocortisone. For side effects, see corticosteroid and prednisolone.
A certain amount of cortisol is necessary for life. Without cortisol even a small amount of stress will kill you. Addison’s disease is a disease which causes low cortisol levels, and which is treated by cortisol replacement therapy.
helps maintain blood pressure and cardiovascular function;
helps slow the immune system’s inflammatory response;
helps balance the effects of insulin in breaking down sugar for energy; and
helps regulate the metabolism of proteins, carbohydrates, and fats.
Quick takeaway: I have adrenal insufficiency (one adrenal was removed with my kidney due to cancer, steroid-dependent (post-Cushing’s Disease), growth hormone insufficiency, panhypopituitary. I had some issues after my first COVID-19 injection (Moderna) but not too bad. My second injection will be March 15.
January 12, 2021 my Mom’s doctor called and offered her the vaccine but she didn’t want it. She said she didn’t go anywhere. True but my DH and I do – and she has a friend visit once a month.I joked to a friend that I could put on a wig and go as her since we have the same first name.
I have been doing the COVID-19 Patient Monitoring System through my doctor’s office since it was first offered.Just a few boxes of how I’m feeling, if I wore a mask and so on.I am a strong believer in helping to participate in medical trials, as I mention below.This one is very easy and takes about a minute out of my day.Easy-peasy.
I’ve been on the Fairfax Waiting List since January 19, 2021.As of right now, they are still scheduling people from January 18 – I read somewhere that 41,000-some people registered on the 18th, so it may be a while to get to my date.They have set up an interesting dashboard to track how things are going– https://www.fairfaxcounty.gov/health/novel-coronavirus/vaccine/data
I kept the CVS link open and checked it every morning. Everything was full until Saturday, February 13.I was able to register at about 5 am.When I went back about 20 minutes later, everything was gone.
CVS sent out an informative email with directions, dates, ics file to easily add to calendar,
On the day of your appointment:
•Please arrive early enough to check in before your scheduled appointment. Arriving late for your appointment may result in an extended wait time.
•Bring your ID and insurance card, voucher or other coverage
•Don’t forget a face covering—wearing it throughout your visit is required
•When you arrive, please check in at the pharmacy area inside the store or follow the signs for the COVID-19 vaccine
CVS tips for vaccine shots:
•Wearing short sleeves makes getting a shot easier and faster
•If you must wear long sleeves, dress in layers with the short sleeves underneath
•The CDC has created a way for you to report how you feel after the COVID-19 vaccination through a smartphone-based tool that uses text messaging and web surveys to check in with you. Learn about v-safe and sign up today.
And a short survey, which I took – just add up to 5 stars and write a short paragraph.
Monday, February 15, 2021: When I got to CVS, I found that everything was very well run.
I got a text from CVS asking me to click a link when I arrived at 3:30 and it gave me directions on where to go.
I was met by someone at door who checked my name – I showed him my phone screen – he showed me where to walk following arrows on floor. Then I was met by so someone who checked my name and he asked if I had done the texting thing (yes!).
There were 4 people ahead of me that I could see.It went very fast.I was in the little room within less than 10 minutes.
The nurse asked if left arm was ok to use.
She told me to treat the little quarantine form like gold.Take a picture on my phone, just in case.Maybe laminate after second shot.Keep it with passport.
She said that old folks (like me!) didn’t have as many issues after second shot.
The shot was very fast – I never felt it.
The nurse said if I get a headache, take Tylenol only. I said that was all I could take anyway because I have only one kidney.
I sat in the waiting area for 15 minutes to be sure there were no problemsThere were about 10 or so people sitting around the store that I could see at various stages of their 15 minutes.
I was glad to see that it was Moderna (MRNA) although I would have taken either.I have a long-standing issue with the other drug company, unrelated to COVID vaccines.
I posted on FB that I had done my first injection and a friend told me about registering at vsafe.cdc.gov for them to keep track of me after the vaccination. I signed up for that right away – and I noticed that CVS had also given me that link.
About 12 hours later (3:30 am) I got up to go to the bathroom and noticed that my arm was a little sore. No biggie.
Tuesday, February 16, 2021: I just got my first dose of Moderna yesterday – sore arm, so far.
The nurse told me yesterday that older people like myself (I’m 72) had fewer side effects since we had been exposed to more things over the years.I’m not sure how accurate that is but I’ll hold on to that hope until I get my second dose on March 15!
Wednesday, February 17, 2021: I had weird dreams overnight but I got up about 4:00 am.I did some work and fell back asleep until 10:15.
We didn’t go to water exercise. I decided at the very last minute, walking out the door. Reaction to Monday shot? I had a little headache, dizzy, congested, very tired.I should have taken more cortisone at this time but didn’t remember until 8:30 pm.
I slept more until about 2 pm and had very weird dreams – I don’t know if the dreams are part of it or not but I reported them to the safe.cdc.gov questionnaire.
I cancelled piano lessons for the day.I wrote to my students:
I am so sorry but I need to cancel today’s lesson. I had the first COVID vaccination on Monday afternoon. I was feeling fine yesterday so I assumed that I wasn’t going to have any side effects but they caught up with me today. It’s just a headache , a bit of congestion and fatigue (I’ve been sleeping all day so far) but I don’t think I would be at my best during XXX’s lesson.
See you next week…
After cancelling lessons, I went back to sleep until time for Pender’s 7 pm Ash Wednesday service. I was felling cold but I don’t know if it was chills or really a cold. I started coughing a little.
At night, I remembered I should have up-dosed. I told my DH that night if he ever noticed me like this again, it was the perfect time to tell me to stress dose. It never occurred to me during the day.
At that point, I realized I hadn’t eaten all day.I had dinner (I was surprised that I could eat it) at 9:25 and did my growth hormone injection.
I went to bed at 11 p.
Thursday, February 18, 2021: I’m a little more tired than usual but ok. I spent time napping and working alternated through the day.
Friday, February 19, 2021: Just the normal tiredness. Hooray!
Moderna started Phase III clinical trials for its vaccine candidate in July. In earlier trials, nearly half of patients experienced common adverse effects like injection site pain, rash, headaches, muscle soreness, nausea and fevers after the second injection. These effects generally subsided within two days. CNBC spoke to a few individuals, some participating in Moderna’s trial and some in Pfizer’s trial who said much the same thing: the side effects were intense and included a high fever, body aches, bad headaches and exhaustion, but were worth it for protection from Covid-19.
In the FDA report published in December, the most common side effects were pain at injection site (91.6% of patients), fatigue (68.5%), headache (63.0%), muscle pain (59.6%), joint pain (44.8%), and chills (43.4%). Three patients experienced Bell’s Palsy, a sudden, and usually temporary, weakening or paralysis of the facial muscles.
A few patients with facial fillers experienced swelling after receiving the vaccine. They were treated with antihistamines and steroids. In California, officials halted the use of one particular batch of Moderna vaccines (lot 41L20A) after a small cluster (fewer than 10) of patients at one particular site experienced allergic reactions that required medical attention.
Out of the first 7.5 million doses administered from Dec 14- Jan 18, 19 cases of anaphylaxis were reported to VAERS after the Moderna vaccine. No patients have died from anaphylaxis. Patients are now being monitored for 15-30 minutes after receiving the vaccine to watch for signs of anaphylaxis.
Many patients are reporting injection site reactions that show up shortly after the injection or up to a week later. These reactions — which are characterized by swelling, redness, itching, rashes, heat and pain — are expected to last a day to a week. Physicians emphasize that while these effects can be scary, they are not dangerous and should not prevent someone from getting the second shot. So far, doctors do not report seeing these reactions after the second shot, however so few have been given so far that scientists are not sure how common it will be on round two.
The CDC reports that 11% of patients experienced swollen lymph nodes after the first shot. That raised to 16% after the second shot.
A study posted on Feb 1 showed that patients who received the vaccine after having been previously infected with COVID-19 showed greater immune response to the first shot and more intense side effects that are associated with strong immune responses like fever and muscle aches. The study included patients who received either the Moderna or Pfizer vaccine. Some scientists believe these patients may only need a single shot to provide sufficient immunity, but more research is needed.
Moderna has announced that it will begin testing its vaccine in children and adolescents, who they believe may have stronger immune responses, leading to more intense side effects.
Pre-Cushing’s I had no problem working a full day, having a piano studio overflowing with students, going out at night, cleaning the house, being a normal mom.
I could do as I chose – if I wanted to go somewhere, or do something, I just did.
Now, I work part-time and my studio is much smaller. Everything I do is to accommodate my nap schedule. I have to plan everything carefully so I can take my meds on time and be ready to sleep.
Even going to regular doctors is harder, explaining why I take cortisone and growth hormone, why I can’t take whatever meds they want to prescribe.
Discussing with a sports medicine doctor why I should (or shouldn’t) have a cortisone shot in my knee. (I went for it September 12! Now I’ll have to explain to my endo.)
Unfortunately, I also haven’t lost all my Cushing’s weight (probably at least partly my own fault LOL) and I still have to shave my chin every day.
I honestly believed that my kidney cancer was due to my taking growth hormone, which I take because of my pituitary tumor. Now, since I’m back on it, I’m not entirely sure – but who knows what else might be growing? Or maybe the different brand is better for me. Who can say?
What about you? How has your life changed due to Cushing’s?
When I got kidney cancer, I had to stop the GH, even though no doctor would admit to any connection between the two.
Last year I went back on it (Omnitrope this time) in late June. Hooray! I still don’t know if it’s going to work but I have high hopes. I am posting some of how that’s going here.
During nephrectomy, doctors removed my left kidney, my adrenal gland, and some lymph nodes. Thankfully, the cancer was contained – but my adrenal insufficiency is even more severe than it was.
In the last couple years, I’ve developed ongoing knee issues. Because of my cortisol use to keep the AI at bay, my endocrinologist doesn’t want me to get a cortisone injection in my knee. September 12, 2018 I did get that knee injection (Kenalog) and it’s been one of the best things I ever did. I’m not looking forward to telling my endo!
I also developed an allergy to blackberries in October and had to take Prednisone – and I’ll have to tell my endo that, too!
My mom has moved in with us, bring some challenges…
But, this is a post about Giving Thanks. The series will be continued on this blog unless I give thanks about something else Cushing’s related 🙂
I am so thankful that in 1987 the NIH existed and that my endo knew enough to send me there.