The Hidden Dangers of Cortisone

What happens when the medication that helps you breathe, walk, or calm inflammation also teaches your body to stop making its own life-sustaining cortisol?

In this episode, Jake and Rachel take a deep dive into the My Adrenal Life topic of iatrogenic adrenal insufficiency - adrenal failure caused by medical treatment, most often from glucocorticoids like prednisone, hydrocortisone, or dexamethasone.

They begin with the dramatic 1948 story of cortisone’s discovery at the Mayo Clinic, when "Compound E" transformed a bedridden rheumatoid arthritis patient almost overnight and launched the steroid era. But that miracle came with a hidden cost: over time, steroid medications can suppress the hypothalamic-pituitary-adrenal (HPA) axis, the body’s built-in cortisol signaling system.

Jake and Rachel explain how this works in plain language. When steroid medication is taken for long enough, the brain senses plenty of cortisol in the system and shuts down its own signaling. The adrenal glands stop being stimulated, begin to shrink from lack of use, and may no longer be able to respond when the medication is reduced or stopped. That is where the danger begins.

This conversation explores why iatrogenic adrenal insufficiency is now one of the most common forms of adrenal failure worldwide, and why it is so often overlooked. Many people assume the risk only applies to long-term high-dose oral steroids, but the discussion also highlights concerns with:

• oral glucocorticoids

• joint injections

• inhaled steroids

• topical steroid creams

• cumulative steroid exposure from multiple routes

The episode also unpacks why this condition is so easy to miss. Early symptoms often sound vague or familiar:

• severe fatigue

• dizziness

• nausea

• brain fog

• weakness

• low stress tolerance

Because these symptoms overlap with burnout, depression, aging, autoimmune disease, and medication withdrawal, many patients are dismissed before anyone considers low cortisol.

Jake and Rachel also clarify the difference between glucocorticoid withdrawal syndrome and true adrenal insufficiency. Withdrawal can make a person feel awful, but adrenal insufficiency carries a more dangerous risk: the body may no longer be able to mount a life-saving cortisol response during illness, injury, or surgery. That can lead to adrenal crisis, a medical emergency involving low blood pressure, shock, and collapse.

This episode is especially important for people who:

• have taken steroids for weeks or months

• receive repeated steroid injections

• use multiple steroid products from different specialists

• feel much worse when tapering

• have unexplained fatigue after stopping steroid treatment

It is also a powerful reminder that steroid medications are not "bad" - they are often essential and life-saving - but they deserve respect, monitoring, and careful tapering.

At its heart, this episode is about awareness. If you have a history of steroid exposure and feel like something is not right, you are not imagining it. And if someone you love is struggling after steroid treatment, their exhaustion may be more than simple recovery.

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