15 November 2023
At least I feel I have some idea as to why I haven’t been feeling well this past few weeks. Yesterday, Farah, Dr. Jellinger’s aide (Dr. Jellinger is my endocrinologist) called to tell me my cortisol levels were low.
Cortisol is a hormone produced by the adrenal glands (which sit atop the kidneys) and has several effects on the body. I used to define a hormone to my students as a chemical substance produced in one part of the body but has its effect on another part of the body. Cortisol releases stress, helps regulate blood pressure, helps regulate glucose levels, suppresses inflammation and affects sleep patterns.
Farah says Dr. Jellinger wants me to continue with prednisone. The new prescription is 2.5 mg (versus 5 mg) and I’ll take it every other day. After 4 days, Dr. Jellinger wants another blood draw – which means fasting, which means breaking my routine.
All this seems to be brought about by my taking Dexamethasone for nausea during chemotherapy. The day before chemo, I was to take a 4 mg tablet of Dexamethasone and then the day after chemo. During chemo, I was given a cocktail of Benadryl, Dexamethasone, Pepsid, and Zofran. I can only assume the Dexamethasone was at least 4 mg, so that was a total of 12 mg of Dexamethasone a week.
Dexamethasone is human made corticosteroid that mimics cortisol in that it attaches to the same receptors as cortisol. The effect is that instead of cortisol attaching to specific receptors that affect Adrenocorticotrophic Hormone (ACTH), Dexamethasone attaches instead.
ACTH is produced in the pituitary gland in the brain but exerts its influence on the adrenal glands. Reducing ACTH (which Dexamethasone does) causes a reduction in cortisol in the blood.
Low levels of cortisol result in adrenal insufficiency (also called Addison’s Disease). Symptoms of adrenal insufficiency include: extreme fatigue, weight loss and appetite loss, areas of darkened skin, low blood pressure and even fainting, salt craving, low blood sugar, nausea, diarrhea, vomiting, abdominal pain, muscle and joint pain, irritability, depression, body hair loss, and loss of libido.
Out of all those, I can say I don’t really have a salt craving and haven’t had nausea or vomiting. Otherwise, everything else on the list is spot on. I wonder if I’ve had this condition since beginning the chemo? The problem is that a lot of the effects are also the same effects of chemo. Dr. Velez at the cancer center probably assumed my complaints were chemo related. Dr. Jellinger saw my last blood work and when I told him I was on Dexamethasone, immediately suspected adrenal insufficiency. I think both are a little bit correct.
Hopefully, the tapering off of the prednisone will get me back on the road to recovery. Since Dexamethasone was mimicing cortisol, and I suddenly stopped taking it when the 9 weeks of Taxol treatment ended, I ended up with withdrawal symptoms of cortisol. By prescribing prednisone (which mimics cortisol) over a period of time, Dr. Jellinger is trying to lessen the withdrawal symptoms.
The result of all this is I need to drive to Walgreens to pick up the prescription. Then if I feel up to it, I’ll drive to Wilton Manors for my massage at 1 pm. Life seems to be getting more complicated, particularly medically. The cancer center may save me from cancer but kill me with the cure.
Stay tuned!