Q: I am in a very stressful job and as my responsibilities have increased so have my problems with my Addison's Disease. I am increasingly becoming very fatigued and irritable and am having to take time off to recuperate which is making me feel depressed as I have to relinquish some of my responsibilities. I have had it explained to me by my specialist that there is a certain inflexibility to the cortisol prescription (I am on 30mg per day) in that it cannot meet the often rapid fluctuations in a person's physiology in particular a situation that is stressful. I would like to hear your comments on my problem.

A: It is only physical stress such as fever or surgery that requires extra administration of steroids. There is no evidence that psychological stress and stressful lifestyles necessitate extra steroid administration. The physical association of stress with extra activity such as competitive sports does usually require an extra small dose of hydrocortisone say 30 to 60 minutes before the exercise. I do not believe that a stressful lifestyle associated with stressful jobs in any way necessitates extra steroid therapy and nor do I believe that extra fatigue is in any way different from the physical effects of stress suffered by other people without Addison's Disease.