Hi ********

I started a long mail, got interrupted and when I got back to it, there were so many posts to you on the subject and the all overriding advice from Dr. Peatfield, which is, of course, the one to follow.

However, just to explain a little about Florinef and how it works. So, for what it’s worth, below is what I had written earlier. You might find it helps a little to detangle the confusion you are in at the moment. It’s just a little background info on Florinef from a practical point of view. As I see it, you need to know exactly how Florinef works, in order to determine whether or not it might be what you need.

. Here goes my earlier mail.

In my opinion it would be wrong and not without risk to try Florinef without testing.

I don’t know your full story, and without being aware of the full picture it would be wrong, even be dangerous, for me to give any advice. However, in my personal view, it is highly risky to experiment with glucocorticoids and/or mineralcorticoids without the proper guidance of a doctor.

30 mg HC are according to Dr. Peatfield (in his chapter on the adrenal connection) above the physiological replacement dosage of 15-20 mg/day. There is a big distinction between physiological cortisone replacement and therapeutic cortisone dosages and in my view, by going up to 30 mg you might be going into deep waters if you did it off your own accord.

Florinef is a mineralcorticoid (as opposed to a glucocorticoid) and it is the drug that is used for people with primary Addison’s disease or at least it *should* be used, rather than the HC, which most doctors are using instead, because not many endos have hand-on experience with Addison’s. Primary Addison’s in humans is extremely rare – I read that 1 in 100.000 people suffer from it; although I have come across Addison’s in dogs hundreds of times on our forums AD in dogs it is no longer rare at all, although the knowledge of proper treatment for them lags behind with most vets just as much as it lags behind with human endocrinologists.

However, the point of my message is . be very careful if experimenting with Florinef. The function of Florinef is to bring up the sodium and to lower the potassium which is why it is the right drug for Addisonian people. Someone with Addison’s will have very low Sodium levels and very high potassium levels and this is a life threatening condition.

In my view it would make more sense to try and find out what your adrenals are really doing. Since you are having trouble getting an aldosterone test, one very simple way of finding out if something is seriously adrift is to ask your GP for an Electrolyte test that would be checking Sodium (Na) and Potassium (K) and it’s a cheap standard test. I would imagine, that you might have low sodium levels . but the burning question is where is your potassium? You need to know, because if your potassium were low as well as your sodium, and you then took Florinef, you could do damage. The Florinef would lower your potassium even further, whilst your sodium would rise. you might finish up with serious heart and kidney complications.

Just as a guideline for you Lab ref ranges differ slightly, but usually the ref range for Na (sodium) is between 138 160 or thereabouts. The ref range for Potassium (K) is roughly between 3.8 6.0 ==- as I said, the exact figures differ from lab to lab and you’d need to find out the figures your lab is using.

A healthy Na:K ratio would be one that turns out to be in the low to mid thirties, a worrying one is below 27. But I have to stress that one can’t judge by the ratio figure alone. You’d need to look at the whole picture and the relation between sodium and potassium figures.

You get the ratio be dividing the lower figure (Potassium) into the higher figure (Sodium) – for example. lets say for arguments sake that the Na is 140 and the potassium 4.8

140 divided by 4.8 = ~29.2 – which would mean, that the adrenals are not functioning brilliantly (the sodium is too low) but this is not Addison’s disease. If with a reading like that you’d take Florinef, the potassium -which is a good reading with 4.8, and you did not really want it to come down (!) would come down, whilst the sodium goes up. It’s a very fine balance, and if you got it wrong, you could finish up in dire straights.

As a rule of thumb good figures to aim for would be a sodium in the middle of the norm range (around the 145-148 mark) and a potassium figure around 4.5 certainly not above 5 and not below 4.

I hope this helps,

Best wishes,

Christina