By Alfred J. Plechner, D.V.M.

When there is an over production of cortisol, this is called Cushing syndrome. But the real Cushing syndrome is an excess production of active cortisol, produced by the middle layer of the adrenal cortex. Dr. Harvey Cushing identified a tumor in the pituitary gland that produced a hormone called ACTH, which caused the middle layer adrenal cortex to produce too much active cortisol. It is thought that a tumor of this middle layer, adrenal cortex, may also cause the production of too much active cortisol. It is also thought that giving too much cortisone can cause an increased production of active cortisone which is true, if the cells in the middle adrenal cortex are still productive, or this cannot happen. If these cells are still productive, and exogenous steroids are, this is referred to as iatrogenic, which means that the use of a cortisol replacement by your healthcare professional has caused this excess production of active cortisol. It is also thought that, providing cortisone to a patient, may lead to an inflammation of the pancreas, including the possibility of diabetes. This has been proven wrong. The general belief, now, with the educated healthcare professionals, is that the disease causes the pancreatic problems. It is not the cortisone replacement.

How do you know that an elevated amount of cortisol is active or inactive? An elevated, empirical, amount of cortisol, does not guarantee that it will work in that patient. You may be told that the cortisol level is elevated, so it may be important to give the patient a chemical to reduce the amount of cortisol that is being produced from the middle layer adrenal cortex. These levels may be empirical, and can only be proven viable, by looking at those levels, that active cortisol regulates. If these levels of high cortisol are bound or defective, the chemical, given to reduce these high, but defective levels, may really hurt the patient. Because my findings have not been accepted, do not mean they do not exist.

Empirical levels of cortisol will never be the answer to helping the patient. Even if your healthcare specialists do not relate to this, they can relate to the fact, that doing a complete blood count called a CBC, may show a deficiency in two types of white blood cells. Those deficiencies include a reduced number of lymphocytes and eosinophils. If these cells are present in normal numbers, this may be an inactive cortisol. If these cells, are in a reduced state, the elevated volume of cortisol is probably active, and the use of chemical intervention may be indicated and of value. If this chemical is used in a patient that has high, inactive, cortisol, could cause that patient to lose their life.

It sounds like it is time, to do comparative levels, before the chemical treatment is prescribed. By including total estrogen with Atypical Cortisol Estrogen Imbalance Syndrome (ACEIS) or as the public refers to it as Plechner’s Syndrome, this will give you much better insight as to whether the cortisol is active or inactive. If the total estrogen is high, then the cortisol is inactive. If the total estrogen is low, as well as the IgA, IgM and IgG, the high cortisol is active, and may be a true Cushing Syndrome. To do a cortisol stimulation test, if the cortisol is inactive, may be of little value in diagnosing while trying to diagnose this disorder.

Because the laboratory indicates that there is an over abundance of cortisol, does not mean the laboratory test is accurate. Also, are you seeing actual signs of an increased, active cortisol?

What are the signs you might expect to see, with an active excess of cortisol? You should see increased consumption of water and increased urination. There should be hair loss without inflammation and pruritis [itchiness]. Even though there may be calcification of the skin, this also occurs in other disorders besides with a high level, defective or bound cortisol. This can also occur with kidney disease, diabetes, irritable bowel syndrome, an IgA deficiency, a digestive enzyme deficiency, chronic intestinal parasites and a food, too high in oil based foods. Let's go from here.

Please check out, all, the above first, and if any of the above clinical syndromes are not involved, it is time to check to see if the high cortisol is really real. I have already indicated ways to determine this, but are there other things that can cause an elevated cortisol result which may be defective?

First of all, you need to guarantee, that the serum sample is spun down, and refrigerated immediately. The use of a temperature strip may be the thing of the future, to make sure the sample arrives refrigerated. The laboratory needs to also keep all these samples refrigerated. It is common practice at many laboratories to leave samples out, and to run them in batches. If this is done, all the cortisols plus other hormones and antibodies may be abnormally high. Again, this may lead to the use of a chemical, to reduce the elevated cortisol, which only occurred, because the serum was improperly handled, and reached room temperature or higher.

Why not use Plechner's Syndrome and receive the results that are comparative and not empirical?

If the blood sample is to be handled correctly, you need to send the sample to qualified laboratories, because many of these laboratories have neither the staff nor equipment to guarantee you and your healthcare professional accurate results. Improper handling of the blood plus inaccurate results, could lead to a catastrophe for either you or your pet. But if you are not sure of this laboratory, there is a laboratory listed on my home page that is qualified.

It is very important to realize, that even though there may be a large amount of inactive cortisol present, its presence may still cause clinical side effects. This is important to know, because, if active cortisol is given, a lower dose of the exogenous cortisol might be used, to reduce the possibilities of increased water consumption and increased urination.

If the IgA level is below 60, in you or your pet, administration of an active cortisol will not be absorbed and the problem will continue. Please do not accept any cortisol level, without considering the possibilities, this might lead to an inaccurate result that could cause you or your pet fatal damage.

Recent evidence from prominent schools of veterinary medicine, indicate that elevated levels of estrogen can mimic high, active cortisol. What kind of cortisol replacement will be efficient for you and your pet or pets?

If you have tried homeopathic, holistic and herbal replacement, with little to no response, you must realize this layer, of the adrenal gland, may be permanently damaged, and not merely fatigued. You need to realize, that you cannot enhance the integrity of tissue that is permanently damaged. To give to you or your pet embryonic or adult remnants of the organs that produce these hormones is naive. These remnants are digested by the enzymes that are present, and only enter the blood stream as proteins and amino acids, and not hormones! Western synthetics may be your only hope but in the early phases, only through injections and not oral supplementation.

It is thought by the medical profession, that on the water retention scale, Hydrocortisone is a two, which is the highest, and Prednisolone is a one. However Prednisone is preferred by most medical doctors. Interestingly enough, the doctors are afraid that a cortisone supplement may cause liver damage, yet they still use Prednisone, which needs to be converted in the liver, to Prednisolone! Why? The use of Medrol in dogs and in humans may provide the least water retention. Cats usually do very well on Prednisolone. Horses seem to do best on thyroid hormone, because their cortisol imbalances are often due to adrenal suppression that may be temporary or due to the use of feed with elevated levels of estrogen present. Different hays, throughout the country may be to blame. I do not believe this is recognized just yet.

The importance of this article is to be aware, and not fall into those tragedies that have occurred do to inaccurate laboratory results and an absence of realizing the difference between active and inactive cortisols.

Other hormones that occur in the body may also fall into this category. This is why salivary and 24 hour urine tests have been developed. These tests may distinguish between free and bound hormones, but what is the guarantee, that the receptor sights, for the use of these active hormones, are not blocked? There are no guarantees!

You must observe the clinical signs and symptoms of your patient, and decide the best way to heal that patient and not your wallet!

Additional Information

Safe Uses of Cortisol

William McK. Jefferies, MD

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