Q: Is it a normal process of Addison’s disease which I have had for six years but in the last six months have been getting really bad headaches, feeling sick and dizziness. I take 2 Florinef 0.1mg and 3 hydrocortisone 10mg daily and wondered if they wanted increasing or decreasing. Is it normal to get worse as you get older, I am a 47 year old man.

A: Adequate replacement with hydrocortisone and fludrocortisone (Florinef) should not be associated with headaches, sickness and dizziness. The doses required needs to be determined individually in each patient. Thus doses of hydrocortisone should be checked by measuring the profile of circulating hydrocortisone levels throughout the day (a “Cortisol day curve”). The levels of fludrocortisone that are required by measurement of the blood pressure lying and standing, the serum sodium and potassium levels and in particular the lying renin levels which I determine two hours after the morning dose of replacement. I presume that the patient has had these matters checked. If they are satisfactory then the replacement is satisfactory and is not the cause of the symptoms. It is not true that the doses require to be increased or decreased as the patient gets older. Individuals do vary their rate of clearance of these hormones from time to time and the levels do need to be checked and occasionally the dose may need to be adjusted. The possibility remains that the symptoms are nothing to do with the Addison’s disease.