Cortisol Deficiency: Frequent, Life-Impairing, and How to Give Patients Their Lives Back by Correcting It 

by Thierry Hertoghe, MD

Complete References

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288. Michaux GP, et al. Experimental characterization of the effects of acute stresslike doses of hydrocortisone in human neurogenic hyperalgesia models. Pain. 2012 Feb;153(2):420-8 

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292. Schilling TM, et al. Rapid cortisol enhancement of psychomotor and startle reactions to side-congruent stimuli in a focused cross-modal choice reaction time paradigm. Eur Neuropsychopharmacol. 2014 Nov;24(11):1828-35

293. Ashton CH, et al. Subchronic hydrocortisone treatment alters auditory evoked potentials in normal subjects. Psychopharmacology (Berl). 2000 Sep;152(1):87-92

294. Beckwith BE, et al. Hydrocortisone reduces auditory sensitivity at high tonal frequencies in adult males. Pharmacol Biochem Behav. 1983 Sep;19(3):431-3

295. Born J, et al. Influences of cortisol on auditory evoked potentials (AEPs) and mood in humans. Neuropsychobiology. 1989;20(3):145-51.

296. Fehm-Wolfsdorf G, et al. Taste thresholds in man are differentially influenced by hydrocortisone and dexamethasone. Psychoneuroendocrinology. 1989;14(6):433-40.

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308. Besedovsky L, et al. Cortisol increases CXCR4 expression but does not affect CD62L and CCR7 levels on specific T cell subsets in humans. Am J Physiol Endocrinol Metab. 2014 Jun 1;306(11):E1322-9

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312. Hennig J, Netter P, Voigt KH. Cortisol mediates redistribution of CD8+ but not of CD56+ cells after the psychological stress of public speaking. Psychoneuroendocrinology. 2001 Oct;26(7):673-87.

313. Goulding NJ, et al. Anti-inflammatory lipocortin 1 production by peripheral blood leucocytes in response to hydrocortisone. Lancet. 1990 Jun 16;335(8703):1416-8

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316. Djurhuus CB, et al. Effects of cortisol on lipolysis and regional interstitial glycerol levels in humans. Am J Physiol Endocrinol Metab. 2002 Jul;283(1):E172-7

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323. Williamson PM, et al. Acute effects of hydrocortisone on plasma nitrate/nitrite activity and forearm vasodilator responsiveness in normal human subjects. Clin Exp Pharmacol Physiol. 2005 Mar;32(3):162-6.

324. Mangos GJ, et al. Cortisol inhibits cholinergic vasodilation in the human forearm. Am J Hypertens. 2000 Nov;13(11):1155-60.

325. Dodt C, et al. Acute suppression of muscle sympathetic nerve activity by hydrocortisone in humans. Hypertension. 2000 Mar;35(3):758-63

326. Kelly JJ, Martin A, Whitworth JA. Role of erythropoietin in cortisol-induced hypertension. J Hum Hypertens. 2000 Mar;14(3):195-8

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330. Johansen O, Brox J, Flaten MA. Placebo and Nocebo responses, cortisol, and circulating beta-endorphin. Psychosom Med. 2003 SepOct;65(5):786-90

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332. Hearn AJ, et al. Effect of sub-chronic hydrocortisone on responses to amphetamine in normal male volunteers. Psychopharmacology (Berl). 2004 Feb;171(4):458-64

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337. Riedel M, et al. Quality of life in patients with Addison's disease: effects of different cortisol replacement modes. Exp Clin Endocrinol. 1993;101(2):106-11

338. Simunkova K, et al. Effect of a pre-exercise hydrocortisone dose on short-term physical performance in female patients with primary adrenal failure. Eur J Endocrinol. 2016 Jan;174(1):97-105.

339. Weise M, et al. Stress dose of hydrocortisone is not beneficial in patients with classic congenital adrenal hyperplasia undergoing short-term, high-intensity exercise. J Clin Endocrinol Metab. 2004 Aug;89(8):3679-84.

340. Laviolle B, et al. Biological and hemodynamic effects of low doses of fludrocortisone and hydrocortisone, alone or in combination, in healthy volunteers with hypoaldosteronism. Clin Pharmacol Ther. 2010 Aug;88(2):183-90

341. Andersen M, et al. The effect of short-term cortisol changes on growth hormone responses to the pyridostigmine-growth-hormone-releasinghormone test in healthy adults and patients with suspected growth hormone deficiency. Clin Endocrinol (Oxf). 1998 Aug;49(2):241-9.

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343. Giustina A, et al. Effect of pyridostigmine on the hydrocortisone-mediated decrease of circulating growth hormone levels in acromegaly. Horm Metab Res. 1994 Jun;26(6):288-92.  

344. Cleare AJ, O'Keane V, Miell JP. Levels of DHEA and DHEAS and responses to CRH stimulation and hydrocortisone treatment in chronic fatigue syndrome. Psychoneuroendocrinology. 2004 Jul;29(6):724-32

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346. Cleare AJ, O'Keane V, Miell J. Plasma leptin in chronic fatigue syndrome and a placebo-controlled study of the effects of low-dose hydrocortisone on leptin secretion. Clin Endocrinol (Oxf). 2001 Jul;55(1):113-9.

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348. McKenzie R, et al. Low-dose hydrocortisone for treatment of chronic fatigue syndrome: a randomized controlled trial. JAMA. 1998 Sep 2330;280(12):1061-6.

349. Blockmans D, et al. Combination therapy with hydrocortisone and fludrocortisone does not improve symptoms in chronic fatigue syndrome: a randomized, placebo-controlled, double-blind, crossover study. Am J Med. 2003 Jun 15;114(9):736-41

350. Putman P, et al. A single administration of cortisol acutely reduces preconscious attention for fear in anxious young men. Psychoneuroendocrinology. 2007 Aug;32(7):793-802

351. van Peer JM, Spinhoven P, Roelofs K. Psychophysiological evidence for cortisol-induced reduction in early bias for implicit social threat in social phobia. Psychoneuroendocrinology. 2010 Jan;35(1):21-32

352. van Peer JM, et al. Cortisol-induced enhancement of emotional face processing in social phobia depends on symptom severity and motivational context. Biol Psychol. 2009 May;81(2):123-30.

353. DeBattista C, et al. Acute antidepressant effects of intravenous hydrocortisone and CRH in depressed patients: a double-blind, placebocontrolled study. Am J Psychiatry. 2000 Aug;157(8):1334-7. 

354. O'Dwyer AM, et al. Treatment of major depression with metyrapone and hydrocortisone. J Affect Disord. 1995 Feb 21;33(2):123-8

355. Schmid DA, et al. Acute cortisol administration increases sleep depth and growth hormone release in patients with major depression. J Psychiatr Res. 2008 Oct;42(12):991-9.

356. Bhagwagar Z, et al. Lack of effect of a single dose of hydrocortisone on serotonin(1A) receptors in recovered depressed patients measured by positron emission tomography with [11C]WAY-100635. Biol Psychiatry. 2003 Nov 1;54(9):890-5

357. Kuehl LK, et al. Effects of cortisol on the memory bias for emotional words? A study in patients with depression and healthy participants using the Directed Forgetting task. J Psychiatr Res. 2017 Sep;92:191-198

358. Terfehr K, et al. Effects of acute hydrocortisone administration on declarative memory in patients with major depressive disorder: a placebocontrolled, double-blind crossover study. J Clin Psychiatry. 2011 Dec;72(12):1644-50

359. Terfehr K, et al. Hydrocortisone impairs working memory in healthy humans, but not in patients with major depressive disorder. Psychopharmacology (Berl). 2011 May;215(1):71-79

360. Schlosser N, et al. Effects of acute cortisol administration on autobiographical memory in patients with major depression and healthy controls. Psychoneuroendocrinology. 2010 Feb;35(2):316-20

361. Posener JA, et al. Cortisol feedbackduring the HPA quiescent period in patients with major depression. Am J Psychiatry. 2001 Dec;158(12):2083-5

362. Bhagwagar Z, Hafizi S, Cowen PJ. Cortisol modulation of 5-HT-mediated growth hormone release in recovered depressed patients. J Affect Disord. 2002 Dec;72(3):249-55

363. Schlosser N, et al. Effects of acute cortisol administration on response inhibition in patients with major depression and healthy controls. Psychiatry Res. 2013 Oct 30;209(3):439-46

364. Zohar J, et al. High dose hydrocortisone immediately after trauma may alter the trajectory of PTSD: interplay between clinical and animal studies. Eur Neuropsychopharmacol. 2011 Nov;21(11):796-809.

365. Schelling G, et al. The effect of stress doses of hydrocortisone during septic shock on posttraumatic stress disorder in survivors. Biol Psychiatry. 2001 Dec15;50(12):978-85

366. Yehuda R, et al. Cortisol augmentation of a psychological treatment for warfighters with posttraumatic stress disorder: Randomized trial showing improved treatment retention and outcome. Psychoneuroendocrinology. 2015 Jan;51:589-97

367. Wingenfeld K, et al. Cortisol effects on autobiographic memory retrieval in PTSD: an analysis of word valence and time until retrieval. Stress. 2013 Sep;16(5):581-6.

368. Delahanty DL, et al. The efficacy of initial hydrocortisone administration at preventing posttraumatic distress in adult trauma patients: a randomized trial. CNS Spectr. 2013 Apr;18(2):103-11

369. van Marle HJ, et al. The effect of exogenous cortisol during sleep on the behavioral and neural correlates of emotional memory consolidation in humans. Psychoneuroendocrinology. 2013 Sep;38(9):1639-49.

370. Wingenfeld K, et al. Cortisol has enhancing, rather than impairing effects on memory retrieval in PTSD. Psychoneuroendocrinology. 2012 Jul;37(7):1048-56.

371. Miller MW, et al. Hydrocortisone suppression of the fear-potentiated startle response and posttraumatic stress disorder. Psychoneuroendocrinology. 2011 Aug;36(7):970-80

372. Yehuda R, et al. Changes in relative glucose metabolic rate following cortisol administration in aging veterans with posttraumatic stress disorder: an FDG-PET neuroimaging study. J Neuropsychiatry Clin Neurosci. 2009 Spring;21(2):132-43.

373. Yehuda R, et al. Enhanced effects of cortisol administration on episodic and working memory in aging veterans with PTSD. Neuropsychopharmacology. 2007 Dec;32(12):2581-91.

374. Aerni A, et al. Low-dose cortisol for symptoms of posttraumatic stress disorder. Am J Psychiatry. 2004 Aug;161(8):1488-90

375. Ludäscher P, et al. No evidence for differential dose effects of hydrocortisone on intrusive memories in female patients with complex posttraumatic stress disorder--a randomized, double-blind, placebo-controlled, crossover study. J Psychopharmacol. 2015 Oct;29(10):1077-84

376. Brown ES, et al. A randomized, placebo-controlled proof-of-concept, crossover trial of phenytoin for hydrocortisone-induced declarative memory changes. J Affect Disord. 2013 Sep 5;150(2):551-8

377. Grossman R, et al. Cognitive effects of intravenous hydrocortisone in subjects with PTSD and healthy control subjects. Ann N Y Acad Sci. 2006 Jul;1071:410-21.

378. Vythilingam M, Lawley M, Collin C, Bonne O, Agarwal R, Hadd K, Charney DS, Grillon C. Hydrocortisone impairs hippocampal-dependent trace eyeblink conditioning in post-traumatic stress disorder. Neuropsychopharmacology. 2006 Jan;31(1):182-8

379. Yehuda R, et al. Hydrocortisone responsiveness in Gulf War veterans with PTSD: effects on ACTH, declarative memory hippocampal [(18)F]FDG uptake on PET. Psychiatry Res. 2010 Nov 30;184(2):117-27

380. Yehuda R, et al. Alterations in cortisol negative feedback inhibition as examined using the ACTH response to cortisol administration in PTSD. Psychoneuroendocrinology. 2006 May;31(4):447-51

381. Nenke MA, et al. Low-dose hydrocortisone replacement improves wellbeing and pain tolerance in chronic pain patients with opioid-induced hypocortisolemic responses. A pilot randomized, placebo-controlled trial. Psychoneuroendocrinology. 2015 Jun;56:157-67

382. Yadav M, Durga P, Gopinath R. Role of hydrocortisone in prevention of pain on propofol injection. J Anaesthesiol Clin Pharmacol. 2011 Oct;27(4):470-4

383. Hornyak M, et al. Low-dose hydrocortisone in the evening modulates symptom severity in restless legs syndrome. Neurology. 2008 Apr 29;70(18):1620-2

384. Roquilly A, et al. Hydrocortisone therapy for patients with multiple trauma: the randomized controlled HYPOLYTE study. JAMA. 2011 Mar 23;305(12):1201-9

385. Wingenfeld K, et al. Effects of cortisol on memory in women with borderline personality disorder: role of co-morbid post-traumatic stress disorder and major depression. Psychol Med. 2013 Mar;43(3):495-505

386. Asehnoune K, et al. Hydrocortisone and fludrocortisone for prevention of hospital-acquired pneumonia in patients with severe traumatic brain injury (Corti-TC): a double-blind, multicentre phase 3, randomised placebo-controlled trial. Lancet Respir Med. 2014 Sep;2(9):706-16

387. de Leon MJ, et al. Cortisol reduces hippocampal glucose metabolism in normal elderly, but not in Alzheimer's disease. J Clin Endocrinol Metab. 1997 Oct;82(10):3251-9

388. Tsai MS, et al. The effect of hydrocortisone on the outcome of out-of-hospital cardiac arrest patients: a pilot study. Am J Emerg Med. 2007 Mar;25(3):318-25

389. Alam MR, Rahman MA, Ershad R. Role of very short-term intravenous hydrocortisone in reducing postdural puncture headache. J Anaesthesiol Clin Pharmacol. 2012 Apr;28(2):190-3

390. Salas G, Travaglianti M, Leone A, Couceiro C, Rodríguez S, Fariña D. Hydrocortisone for the treatment of refractory hypotension: a randomized controlled trial. An Pediatr (Barc). 2014 Jun;80(6):387-93.

391. Hochwald O, Palegra G, Osiovich H. Adding hydrocortisone as 1st line of inotropic treatment for hypotension in very low birth weight infants. Indian J Pediatr. 2014 Aug;81(8):808-10

392. Bassan MM, Sheikh-Hamad D. Prevention of lidocaine-infusion phlebitis b yheparin and hydrocortisone. Chest. 1983 Oct;84(4):439-4

393. Rubin LH, et al. Brief Report: Low-Dose Hydrocortisone Has Acute Enhancing Effects on Verbal Learning in HIV-Infected Men. J Acquir Immune Defic Syndr. 2017 Jul 1;75(3):e65-e70

394. Bollaert PE, et al. Reversal of late septic shock with supraphysiologic doses of hydrocortisone. Crit Care Med. 1998 Apr;26(4):645-50

395. Annane D, et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA. 2002 Aug 21;288(7):862-71

396. Laviolle B, et al. Gluco- and mineralocorticoid biological effects of a 7-day treatment with low doses of hydrocortisone and fludrocortisone in septic shock. Intensive Care Med. 2012 Aug;38(8):1306-14

397. Moreno R, et al. Time course of organ failure in patients with septic shock treated with hydrocortisone: results of the Corticus study. Intensive Care Med. 2011 Nov;37(11):1765-72

398. Aboab J, et al. Hydrocortisone effects on cardiovascular variability in septic shock: a spectral analysis approach. Crit Care Med. 2008 May;36(5):1481-6

399. Kaufmann I, et al. Stress doses of hydrocortisone in septic shock: beneficial effects on opsonization-dependent neutrophil functions. Intensive Care Med. 2008 Feb;34(2):344-9

400. Oppert M, et al. Low-dose hydrocortisone improves shock reversal and reduces cytokine levels in early hyperdynamic septic shock. Crit Care Med. 2005 Nov;33(11):2457-64

401. Keh D, et al. Immunologic and hemodynamic effects of "low-dose" hydrocortisone in septic shock: a double-blind, randomized, placebocontrolled, crossover study. Am J Respir Crit Care Med. 2003 Feb 15;167(4):512-20

402. Wang C, et al. Low-dose hydrocortisone therapy attenuates septic shock in adult patients but does not reduce 28-day mortality: a meta-analysis of randomized controlled trials. Anesth Analg. 2014 Feb;118(2):346-57

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404. Arabi YM, et al. Low-dose hydrocortisone in patients with cirrhosis and septic shock: a randomized controlled trial. CMAJ. 2010 Dec 14;182(18):1971-7

405. Sprung CL, et al; CORTICUS Study Group. Hydrocortisone therapy for patients with septic shock. N Engl J Med. 2008 Jan 10;358(2):111-24

406. Mussack T, et al. Hemofiltration does not influence early S-100B serum levels in septic shock patients receiving stress doses of hydrocortisone or placebo. Eur J Med Res. 2005 Feb 28;10(2):81-7

407. Mussack T, et al. Hemofiltrastion does not influence early S-100B serum levels in septic shock patients receiving stress doses of hydrocortisone or placebo. Eur J Med Res. 2005 Jan 28;10(1):11-7.

408. Lv QQ, et al. Early initiation of low-dose hydrocortisone treatment for septic shock in adults: A randomized clinical trial. Am J Emerg Med. 2017 Jun 5. [Epub ahead of print]

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410. Plassais J, et al. Transcriptome modulation by hydrocortisone in severe burn shock: ancillary analysis of a prospective randomized trial. Crit Care. 2017 Jun 16;21(1):158

411. Venet F, et al. Low-dose hydrocortisone reduces norepinephrine duration in severe burn patients: a randomized clinical trial. Crit Care. 2015 Jan 26;19:21

412. Mussack T, et al. Effect of stress doses of hydrocortisone on S-100B vs. interleukin-8 and polymorphonuclear elastase levels in human septic shock. Clin Chem Lab Med. 2005;43(3):259-68

413. Laaninen M, et al. Perioperative hydrocortisone reduces major complications after pancreaticoduodenectomy: a randomized controlled trial. Ann Surg. 2016 Nov;264(5):696-702. 

414. Safavi M, et al. The evaluation of effects two different doses of hydrocortisone on the intensity of perioperative shivering in elective surgery under spinal anesthesia: A double-blind randomized controlled trial study. J Res Med Sci. 2016 Jun 14;21:40.

415. Laaninen M, et al. Perioperative hydrocortisone reduces major complications after pancreaticoduodenectomy: a randomized controlled trial. Ann Surg. 2016 Nov;264(5):696-702. 

416. Kilger E, et al. Stress doses of hydrocortisone reduce systemic inflammatory response in patients undergoing cardiac surgery without cardiopulmonary bypass. Minerva Anestesiol. 2011Mar;77(3):268-74.

417. Weis F, et al. Stress doses of hydrocortisone in high-risk patients undergoing cardiac surgery: effects on interleukin-6 to interleukin-10 ratio and early outcome. Crit Care Med. 2009 May;37(5):1685-90.

418. Weis F, et al. Stress doses of hydrocortisone reduce chronic stress symptoms and improve health-related quality of life in high-risk patients after cardiac surgery: a randomized study. J Thorac Cardiovasc Surg. 2006 Feb;131(2):277-82

419. Eydi M, Kolahdouzan K, Golzari SE. Effect of Intravenous Hydrocortisone on Preventing Postoperative Sore Throat Followed by Laryngeal Mask Airway Use in patients Undergoing Urogenital Surgeries. J Cardiovasc Thorac Res. 2013;5(1):29-33

420. Katayama Y, et al. A randomized controlled trial of hydrocortisone against hyponatremia in patients with aneurysmal subarachnoid hemorrhage. Stroke. 2007 Aug;38(8):2373-5.

421. Hashi K, et al. Intravenous hydrocortisone in large doses in the treatment of delayed ischemic neurological deficits following subarachnoid hemorrhage--results of a multi-center controlled double-blind clinical study. No To Shinkei. 1988 Apr;40(4):373-82

422. Farrell RJ, et al. Intravenous hydrocortisone premedication reduces antibodies to infliximab in Crohn's disease: a randomized controlled trial. Gastroenterology. 2003 Apr;124(4):917-24

423. Rakela J, et al. A double-blinded, randomized trial of hydrocortisone in acute hepatic failure. The Acute Hepatic Failure Study Group. Dig Dis Sci. 1991 Sep;36(9):1223-8

424. Manolakopoulos S, et al. Octreotide versus hydrocortisone versus placebo in the prevention of post-ERCP pancreatitis: a multicenter randomized controlled trial. Gastrointest Endosc. 2002 Apr;55(4):470-5

425. Tongyoo S, et al. Hydrocortisone treatment in early sepsis-associated acute respiratory distress syndrome: results of a randomized controlled trial. Crit Care. 2016 Oct 15;20(1):329

426. Ho LI, et al. Postextubation laryngeal edema in adults. Risk factor evaluation and prevention by hydrocortisone. Intensive Care Med. 1996 Sep;22(9):933-6

427. Ussher M, et al. A randomised placebo-controlled trial of oral hydrocortisone for treating tobacco withdrawal symptoms. Psychopharmacology (Berl). 2011 Jul;216(1):43-51

428. Walter M, et al. Effects of cortisol administration on craving in heroin addicts. Transl Psychiatry. 2015 Jul 28;5:e610 429. Hopper JW, et al. Effects of acute cortisol and cocaine administration on attention, recall and recognition task performance in individuals with cocaine dependence. Hum Psychopharmacol. 2004 Oct;19(7):511-6

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