Hi jill, I don't know to whom you are directing your seemingly provocative question. For what it's worth, Holistic Medical doctors have been addressing adrenal exhaustion and do use cortisol in physiological doses for this condition. See the American Board of Holistic Medicine and the American College for The Advancement of Medicine for starters.

They aren't the only ones. Naturopaths, Orthomolecular Physicians, Osteopaths, are but a few of the specialties that treat this condition with nutrition, supplements, botanicals, herbs and yes, bio-identical Cortisol (a/k/a Cortef).

In high doses, cortisone will cause alot of problems. But high doses are NOT what is indicated or used with hypoadrenia.

A good and knowledgeable practitioner will not just prescribe Cortisol willy-nilly. They will do so only after performing functional testing -- including, but not limited to, AdrenoCortex Stress Salive Profiles to test for adrenal function and levels of natural cortisol and DHEA, extensive blood work, testing for Thyroid function, etc. The cortisol that is used in this condition is a bio-identical form.

Excerpts from

"Mild Adrenocortical Deficiency, Chronic Allergies, Autoimmune Disorders and
the Chronic Fatigue Syndrome: A Continuation of the Cortisone Story"

Jefferies,W.McK., Med Hypoth 1994; 42: 183-189

"When patents expired on cortisone and cortisol, the more potent derivatives, whose patents persisted, were promoted more vigorously and the natural hormone tended to be forgotten. Package inserts no longer differentiated between physiologic and pharmacologic dosages of cortisol and it was implied that all of the grim side effects might develop at any dosage level."

"Most physicians practicing today are therefore under the impression that any dosage of cortisol can produce any of the serious side-effects that occur only with administration of large, pharmacologic dosages of this normal hormone."

"Reports documenting the safety and effectiveness of physiologic dosages of cortisol were published in reputable medical journals over 25 years ago, but computerized reviews of the medical literature, such as Medline, do not yet cover publications that remote, so few physicians today are aware of the existence of these reports."

"One of the most alarming effects of pharmacologic dosages was impairment of immunity, causing patients to become susceptible to infections.... It has even been suggested that the increased production of cortisol that occurs at the onset of infection may serve to limit the reaction from overshooting and hence would be consistent with the anti-immune effects of pharmacologic dosages, but a more likely explanation of this increased production is that of Ingle, which states: "The increased secretion of adrenal hormones serves to meet an increased need during stress and tends to maintain homeostasis rather than to disturb it. The increased secretion does not cause a state of hypercorticism such as develops when the titer of these hormones is increased artificially in the absence of need."

"Evidence that cortisol impairs immunity only in large, pharmacologic dosages and that in physiologic amounts this hormone is essential for the development and maintenance of normal immunity has been reported by investigators over the past 40 years, but largely overlooked,..."

"Before patients are given other hormones, tests of the function of the glands that produce those hormones are usually performed, but tests of adrenocortical function are seldom made on patients before the administration of glucocorticoids."

"Normal ranges for blood cortisol levels and other tests of adrenal function have been determined on subjects who did not have obvious adrenocortical excess (Cushing's syndrome), or deficiency (Addison's disease), or panhypopituitarism,or any other apparent illness, and are rather broad. Hence they may include patients with mild deficiency or excess of cortisol. Also it must be remembered that resistance to cortisol may occur because of a defect in receptor function,so blood cortisol levels in the normal or even supranormal range do not exclude the possibility of symptoms associated with deficiency of cortisol effects."

"If cortisol is administered to patients with mild primary adrenal deficiency in an amount less than a full replacement dosage, there appears to be no summation effect beyond the reaching of an optimum level since patients receiving such dosages have not developed hypercortisolism. If they receive a full replacement dosage for a prolonged period, however,their adrenals might be suppressed sufficiently to impair further their resistance to stress."

"As with patients with severe adrenal deficiency, if a patient with mild adrenal deficiency has evidence of an active inflammatory processor infection, a larger dosage of cortisol, up to 20 mg 4 times daily, in conjunction with a suitable antibiotic or other type of therapy, is advisable,but when this condition is under control, the dosage of cortisol should be tapered to the maintenance level (between 2.5-7.5 mg four times daily)over 2 to 4 days."

"During exacerbations, patients with allergies or autoimmune disorders need to take larger dosages of cortisol (20 mg four times daily is usually adequate), but as soon as symptoms are under control, the dosage should be tapered to a physiologic maintenance dosage. If this is not possible without a return of symptoms, a careful search should be made for obscure infection or other persistent source of stress that is preventing the return to a safe maintenance dosage."

"Since subreplacement dosages of cortisol do not produce an excess of glucocorticoid, they have not tended to promote the development of osteoporosis or any other undesirable side-effects that can result from administration of large, pharmacologic dosages."

"Patients have been treated with this schedule of cortisol or cortisone acetate for as long as 40 years without significant problems. Because some of these patients had ovarian dysfunction and infertility, and because continuation of small, physiologic dosages helped to protect against miscarriages,over 200 babies have been born to women who continued these physiologic dosages through their pregnancies and sometimes during their postpartum(including nursing) periods with no evidence of harm to either mothers or babies."

****************
And there is this:

Cortisone: A Problem in Pharmaceutical Marketing

William McK. Jefferies, M.D. (Retired)

When cortisone was first reported to produce dramatic beneficial effects in patients with rheumatoid arthritis in 1949(1), its use was welcomed as a major advance in medical therapy. The fact that it was a normal hormone, the only hormone that is absolutely essential for life, and that it also produced similar dramatic beneficial effects in patients with other autoimmune disorders, in those with chronic allergic disorders, and in those with many other illnesses, resulted in its discoverers being awarded the Nobel Prize. Yet within a few years patients receiving cortisone or its derivatives had developed so many serious and sometimes fatal side effects that these medications developed a reputation for being dangerous drugs whose use should be limited to patients with serious illnesses that could not be helped by any other treatment. Meanwhile it became evident that cortisone must be converted to hydrocortisone before having its characteristic physiologic effects and chemists pointed out that cortisol was a more proper term for hydrocortisone, thus adding to the confusion of most physicians and patients.

When serious side effects developed in patients receiving the large dosages of cortisone or hydrocortisone (cortisol) that were thought to be necessary for therapeutic effects, derivatives such as prednisone or triamcinolone were introduced, but except for less tendency to produce retention of salt and water (edema), the derivatives often produced any or all of the undesirable side effects of excessive amounts of the normal hormone. Hence cortisone and cortisol developed a reputation for being dangerous drugs whose use should be confined to patients with serious, life-threatening illnesses that would not improve with any other treatment.

Having trained at the Massachusetts General Hospital under Dr. Fuller Albright, a pioneer in the study of adrenocortical function, I was developing an endocrine clinic and research laboratory at Western Reserve University Hospitals in Cleveland, Ohio and I saw every patient admitted for treatment with cortisone or its derivatives for the first two years that these medications were available. In 1955 I wrote a review article summarizing the problems that existed at that time that was published in the New England Journal of Medicine entitled, "The Present Status of ACTH, Cortisone and Related Steroids in Clinical Medicine" (2). During this time I determined that the duration of effect of a single dose of cortisol was approximately 8 hours and that normal human adrenals produced the equivalent of 35 to 40 mg of cortisol daily when taken as tablets by mouth 4 times daily, before meals and at bedtime in the absence of unusual stress.

Meanwhile I also began to work in an infertility clinic associated with Western Reserve University and found that many of its women patients had evidence of mild disorders of adrenal function that improved when they were given small, subreplacement dosages of cortisone or cortisol (3). During the next twenty years over 200 babies were born to women with mild disorders of ovarian function who took safe, physiologic dosages of cortisone or cortisol not only in order to get pregnant but also throughout their pregnancies to protect against miscarriages, without any evidence or harm to either mothers or babies (4). These dosages therefore appeared to be restoring normal function rather than impairing it.

Some of these women reported that while taking the small, safe dosages of cortisone or cortisol their symptoms of allergies, or unexplained chronic fatigue (the chronic fatigue syndrome), or autoimmune disorders such as rheumatoid arthritis or chronic thyroiditis, also improved. These beneficial effects of safe, physiologic dosages of cortisone or cortisol were reported at the annual meeting of the American College of Physicians in New York City in April, 1966, and in a paper published in the Archives of Internal Medicine in 1967 (5), but by that time patents on the normal hormones, cortisone and cortisol, had expired. Pharmaceutical laws require that when a new use is found for a medication, it must receive all of the relevant tests for its safety, including therapeutic trials, before the new use can be advertised. Because such studies are expensive, pharmaceutical companies have little incentive for performing them when they no longer have the protection for their investment that is provided by a patent. Hence pharmaceutical companies apparently could not even mention in their package inserts or advertisements any of these potential new uses of safe dosages of the normal hormone, cortisol! Further reports of the beneficial effects of safe dosages of cortisone or cortisol were published in endocrine journals and conference proceedings in the 1960's and 1970's, but these were received skeptically by most physicians when no ads or promotional efforts by the pharmaceutical companies marketing the hormones appeared.

I, like most other physicians, did not realize the cause of this problem, so I thought it might be helped by my writing a book reviewing the cortisone story and describing the beneficial effects of safe, physiologic dosages of cortisone or cortisol that had been observed. In 1981, therefore, Safe Uses of Cortisone was published by the Charles C. Thomas Company, a reputable medical publisher that had published much of the earlier work on cortisone and its derivatives.

This book also received little attention until a few patients with chronic allergies and their physicians found that this therapeutic approach was both safe and effective. During the past five years, when it has become evident that the hypothalamus-pituitary-adrenal (HPA) axis plays a major role in immunity and in the response to stress, there has been a return to considering the possibility that autoimmune disorders, especially rheumatoid arthritis, and chronic allergic disorders might be related to mild adrenocortical deficiency, either primary in the adrenal glands or secondary to deficient stimulation by adrenocorticotropic hormone (ACTH) from the pituitary gland. An update on Safe Uses of Cortisone entitled Safe Uses of Cortisol has therefore recently been published, reviewing these developments and the evidence that mild adrenocortical deficiency, a diagnosis that is not mentioned in medical textbooks, is very probably a factor in the development of many, if not all, allergic disorders and autoimmune disorders, and describing a safe treatment of these disorders with physiologic dosages of cortisol (6). Hopefully this book will help to clarify this confusing situation. Cortisol is a normal hormone, the only hormone that is absolutely essential for life, so it must be safe in proper physiologic amounts!

These developments have therefore revealed a serious problem in our pharmaceutical laws that will hopefully be corrected. If a cure for cancer were found tomorrow in a medication whose patent had expired, especially one that had developed a bad reputation like cortisone, it might be extremely difficult to get anyone to pay any attention to it!