Q: Would the taking of hydrocortisone over a period of time cause problems? The reason I am asking is that lately my blood pressure is a bit erratic and a blood test showed signs of thyroid activity. If there are likely to be problems, what are they?

A: As indicated in the answer to Q3- No.33 August 1997, in Addison's Disease replacement doses of hydrocortisone are given rather than the inflammation-suppressing doses used in other diseases and will not cause problems over long periods of time. This is quite different from the use of steroids for inflammatory disease which necessitates higher doses. If your group member has hypertension and if her replacement dose and blood levels are accurately monitored, then hydrocortisone replacement will not cause hypertension of itself. Of course hypertension is very common and many patients with Addison's Disease will suffer hypertension the same as anyone else. Reduction in hydrocortisone levels to doses that are below that needed for normal functioning of the body is most unwise even though of itself it will lower the blood pressure - low blood pressure may be a feature of a hydrocortisone deficiency state. Similarly varying levels of hydrocortisone will not effect the thyroid gland activity providing correct doses of replacement are given. Sometimes in patients with Addison's Disease there may be co-existent failure or excess function of the thyroid due to a separate disease process.