Adrenal Insufficiency

The Problem

Conventional management for true insufficiency is NECESSARY and life-saving (hormone replacement is not optional—adrenal insufficiency is fatal without treatment), patients MUST take steroids, BUT: Conventional approach often: Doesn't optimize DHEA replacement (improves quality of life, energy, mood—especially women, but rarely offered), Doesn't support with nutrients (vitamin C, B5, magnesium—adrenal support), Doesn't educate adequately about sick-day rules (many patients don't know to increase dose during illness—risk of crisis), Doesn't provide psychological support (living with chronic condition, anxiety about crisis), Doesn't distinguish HPA dysfunction from true insufficiency (many patients with "adrenal fatigue" symptoms told they're fine because ACTH stim test normal—but HPA dysregulation is real, different condition, recoverable), Overdiagnosis of insufficiency (some clinicians diagnose based on symptoms alone without proper testing—dangerous to put someone on long-term steroids unnecessarily), Underdiagnosis (some dismissed as "just tired"—true insufficiency missed, rare but serious), Dosing sometimes suboptimal (circadian dosing better—most in morning, some midday, small amount afternoon, mimics natural rhythm—many just given once or twice daily), Fludrocortisone dose (often needs adjustment based on symptoms, BP, electrolytes—sometimes inadequate), NOTE: This is one condition where hormone replacement is truly needed and life-saving—functional medicine supportive but not sufficient alone for true insufficiency (different from "adrenal fatigue"/HPA dysfunction which is recoverable without steroids)