Cortisol Injection Instructions QR Code

An adrenal crisis is defined as a life- threatening, medical emergency caused by insufficient levels of the hormone, cortisol. It will lead to death if left untreated and must be quickly addressed with the administration of an emergency cortisol injection. Adrenal patients should always carry an emergency injection and administer it immediately in the event of an adrenal crisis. Patients should also wear an identifying medical alert bracelet that states they are steroid dependent.

Adrenal Alternatives Foundation has created a QR code which can be scanned to instantly access the lifesaving information on how to administer an emergency cortisol injection to treat an adrenal crisis.

How to Scan a QR Code

  1. Open the QR Code reader on your phone.
  2. Hold your device over a QR Code so that it’s clearly visible within your smartphone’s screen. Two things can happen when you correctly hold your smartphone over a QR Code.
    1. The phone automatically scans the code.
    2. On some readers, you have to press a button to snap a picture, not unlike the button on your smartphone camera.
  3. If necessary, press the button. Your smartphone reads the code and navigates to the intended destination, which doesn’t happen instantly. It may take a few seconds on most devices.

Inject Don’t Neglect!

Always administer an emergency cortisol injection in the event of an adrenal crisis.

This information was brought to you by the Adrenal Alternatives Foundation for educational use only and is not meant to provide medical care or legal advice.

More information on managing adrenal disease can be found on in the book A patient’s guide to managing adrenal insufficiency.

We appreciate all contributions which allow us to further our mission, Education, Encouragement and Advocacy for all adrenal disease.

Donate to Adrenal Alternatives Foundation

Announcement! The Future of Cortisol Replacement is here.

Despite its revolutionary success rate, treating cortisol deficiency with the cortisol pumping method has long been a difficult process to obtain. Access to infusion pumps and supplies for non-diabetics and also finding healthcare providers willing to manage adrenal patients on this method are just a few issues that have caused massive barriers to achieve this treatment.

Adrenal Alternatives Foundation is changing that. We are proud to announce our latest resources to help patients safely and successfully start the cortisol pumping method. The following resources were established to aid adrenal patients in their journey to cortisol pumping.

As a collaborative publication containing medical studies, clinical research and documented patient empirical evidence, this book includes everything you need to know about the cortisol pumping method.

Cortisol 101 contains the following information:

Chapter 1: Introduction

What is Adrenal Insufficiency?

Important Terms

What is Cortisol Pumping?

Common Myths

Frequently Asked Questions

Chapter 2: Assessments

Testing

Pre-Pump Planning

Steroid Options

Hydrocortisone Injections

Post Pump Testing

Chapter 3: Starting the Cortisol Pumping Process

Finding a Pump Friendly Physician

Choosing a Pump System

Obtaining Insurance Approval

Chapter 4: Creating a Care Plan

Prescriptions & Items Needed

Choosing a Solu-Cortef Ratio

Setting Basal Rates

Updosing and Sick Rates

Sites and Absorption Factors

Chapter 5: Life with the Pump

Exercise

Showering

Traveling

Intimacy

Surgery Protocols

Chapter 6: Resources

Appeal Letter

Adrenal Alternatives Foundation

Sources

  • Cortisol Pumping Interactive Website. Adrenal Alternatives Foundation is proud to release the website, cortisolpump.org to provide an easily accessible, free resource on cortisol pumping available internationally. Click the link below to access the website.
  • Pumps for Purpose Program.   Adrenal Alternatives Foundation is proud to have partnered with the non profit, CR3 to create a program specific to adrenal disease patients to provide them with affordable pumps and supplies, with or without insurance coverage.
  • Physician Guidance. Our clinical team is proud to guide physicians on the necessary protocols that must be taken to safely and effectively create a care plan for adrenal patients seeking to manage their cortisol deficiency via the cortisol pumping method. Though we are not a replacement for medical care or advice, we are proud to help guide physicians on the proper lab testing and prescriptions needed to begin the cortisol pumping method.

If you need assistance on the cortisol pumping method, please fill out the contact form and we will have a team member contact you to schedule a free consult.

You can also download a One pager on the cortisol pump here.

This content has been brought to you by Adrenal Alternatives Foundation, a 5o1c3 non profit organization. We appreciate all contributions which allow us to further our mission, Education, Advocacy and Awareness for all adrenal disease. EIN: 83-3629121.

Donate to Adrenal Alternatives Foundation

Adrenal Achievements Series- Voice of Silence Musician, Vinoj

Adrenal Achievements Series- Voice of Silence Musician, Vinoj

Adrenal Alternatives Foundation is proud to feature this month’s adrenal achievement article with musician, Vinoj of Voice of Silence music.

Vinoj was diagnosed with Addison’s disease and has recorded a song about his battle with adrenal insufficiency called “Temple to Castle.” We were proud to interview Vinoj about his journey managing adrenal disease and how it has inspired his music.

We are also proud to announce that Vinoj will be headlining our benefit concert hosted at the Alliance for the Arts in Fort Myers, Florida in December of 2021. (Details TBA)

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Vinoj of Voice of Silence – Artist Biography 

Scarborough-based spoken word and hip-hop artist Voice of Silence is well-known for twisting the way  everyday life is perceived with simple yet profound imagery. His style is constantly evolving, just like  himself, and his newfound approach to fuse musical elements from hip-hop and his South Asian  background with his poetic raps creates an experience that cannot be found elsewhere. 

While also working as an artist educator in schools and community programs, Voice of Silence has  performed at countless events, including opening for ¡MAYDAY!’s ‘Fire in the Sky’ tour, UNITY Charity’s  yearly showcases, and the third annual R.I.S.E. Edutainment ‘416RISE’ showcase. He is seven-times  published in various Canadian poetry collections, including Island Magic and The Tracery of Trees, and he  has released his debut poetry/hip-hop album, Befriending Silence, in April 2017. For his integration and  support of the Toronto arts community through his first album, Voice of Silence received the first ever R.I.S.E. Edutainment Community Development Award in 2016. He was also part of the Scarborough Arts  EAST Mixtape Challenge program in 2018, which allowed him to further develop his hip-hop craft through  a collaborative mixtape titled Time Waits for No One. His passion to tap into his full potential and to connect souls one song at a time keeps the ink flowing and  his pen moving. With his new album coming soon, he released a new EP, Roots, which is a three-song  journey of rekindling and redefining his relationship with his creativity. Roots is available now on all music  platforms!

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Q- Please introduce yourself?
My name is Vinoj, and I was born and raised in Toronto, Canada. By day, I am an engineer, working in rail and transit, and by night, I am an artist educator, a spoken word poet, and a hip-hop recording artist and performer.


Q- What form of adrenal disease were you diagnosed with?
I was diagnosed with primary adrenal insufficiency, more commonly known as Addison’s Disease, in September 2019.


Q- Can you tell us about your song you wrote about your Addison’s diagnosis?
The song “Temple to Castle” was born in the midst of the COVID-19 pandemic, about a year after I started to experience the more severe symptoms of Addison’s pre-diagnosis. I was in a very self-reflective space and was looking back on my journey with Addison’s and how it has impacted my life and shaped me over the past year. As most can relate, I was feeling more alone than before having to be cooped up inside during the lockdown. Poetry and music is my way of expression through which I’m able to connect with others, so I channeled the frustration I felt having these extra obstacles, having to rely on daily medication, and having to work harder to rebuild my physical health into writing this song.

Inspired by Pharoahe Monch’s verse on “The Fight Song”, I wanted to write the intro from the perspective of Addison’s, as if it was a living entity haunting me and wanting to be recognized just like other more common diseases. The following verses were inspired by “TFB” by King Iso, where he treated going to the gym as “training for battle”, and I wrote my verses as building my physical health and motivating myself to continue to fight the symptoms of Addison’s and continue pushing forward. The chorus became an anthem-style battle cry, where I “declare war” on Addison’s and flip the meaning of the phrase “your body is a temple”. I had to make my body a “castle” instead so I can have the physical and mental strength to accept and live with this disease.

I created this song in hopes of connecting with others with similar diagnoses, to show that we are not as alone and rare as health professionals say we are, and to inspire others to not let adrenal diseases hold them back from living their life to the fullest.


Q- Did you struggle to accept your diagnosis of adrenal disease?
Very much indeed. Being 25 at the time, I felt “invincible” and that I will never have to rely on any medications or have any health complications (at least not for a long time), so when I heard about my diagnosis, I wasn’t able to fully take in the gravity of it. It wasn’t until 2 months later, when I had to go back to the hospital because a fever left me completely weak and unable to function that I realized how serious of a condition I have. It probably took me a whole year to finally feel comfortable and accept that I need to live with Addison’s and not against it.


Q- How has adrenal disease changed your life?
Having an adrenal disease has forced me to slow down and listen to my body more. Before all the symptoms and diagnosis, I was always “on the go” and filled up my days from morning until night with things to do. Looking back on this though, I felt that I had spread myself too thin and did not take the time to appreciate the simpler aspects of life. I’m now practicing a lot more self-care through meditation and yoga and learning what my body needs and how the medications affect it as well. Instead of trying to do as much as I can, I am focusing on what matters to me most and what my passions are. Although all of this seemed like a downfall at first and I did feel that I was not being as “productive” as I used to be, I am beginning to appreciate the slower pace and having a more grateful outlook on life.


Q- What goals do you hope to accomplish with your music?
My goal is to connect with others through relatable stories and themes that are captured through my music. I want to capture everyday life in poetic and refreshing ways that allow people to be more aware of themselves and appreciate the immediate world around them.


Q- What is something you wish the world understood about life with adrenal disease?
I wish the world understood that having adrenal disease does not mean we cannot live life to the fullest. I was often told through health professionals and online articles that Addison’s is rare and that it’s even more rare to meet others with it as well, and it’s not easy to regain your physical health, but through the release of “Temple to Castle”, I quickly learned there is a vast international community out there ready to support and inspire each other with their own life stories.


Q- How do you use your music to help you cope with adrenal disease?
Music is very therapeutic to me, as I can spend a whole day just listening to music and being carried away into the world the artists create through their lyrics and instrumentals. It inspires me to tell my own stories in creative ways through music so that I can get lost within the worlds that I create. It is both an outlet that allows me to escape the reality of having Addison’s and at the same time, a tool to allow me to express my journey with it as well. I consider my poems and music to be time capsules that capture what I’m feeling and experiencing in that specific moment, and when I look back at them in the future, it allows me to appreciate how far I’ve come and be inspired by my own experiences.


Q- What is something you wish you could tell all adrenal disease patients?
This disease is not a wall. Although there are some rough days and it feels like a burden, it is just another weight you carry with you on  your shoulder throughout life. It is most definitely possible to live the life you want to while adapting to the routines you now have, so keep pushing onward!


Q- What quote best motivates you?
This quote by Randell Adjei never fails to motivate me: “I am not my struggles, I am not my pain. They are just roadblocks that prove how far I came”

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Vinoj is an example of how you can still accomplish your dreams despite your disease! For more information, you can follow Vinoj at his social media links below-

Website: https://www.voiceofsilencemusic.com/ 

Instagram: http://instagram.com/voiceofsilencemusic

Facebook: https://www.facebook.com/voiceofsilencemusic 

Twitter: https://twitter.com/voiceofsilence_

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This content has been brought to you by Adrenal Alternatives Foundation, a 5o1c3 non profit organization. We appreciate all contributions which allow us to further our mission, Education, Advocacy and Awareness for all adrenal disease. EIN: 83-3629121.

Donate to Adrenal Alternatives Foundation

Myths about the Cortisol Pump


Myth #1 “It is not available.”

The cortisol pumping method is a relatively unknown alternative treatment for adrenal insufficiency. Most doctors have never heard of it, but that does not mean it is not available. The use of infusion pumps to deliver medication is a common practice, mainly in the management of diabetes. However, the use of cortisol in infusion pumps is considered “off label” use. Cortisol pumping is available wherever infusion pumps are available. All you need is a doctor willing to manage your care, which involves he or she writing a prescription for an infusion pump, supplies and solu-cortef. Adrenal Alternatives Foundation works with patients internationally with cortisol pumping advocacy and we educate healthcare professionals all over the world on how to safely and effectively start the cortisol pumping method. We also work alongside other organizations to repurpose pumps and supplies to adrenal patients with our Pumps for Purpose program. Cortisol pumping is available internationally, wherever infusion pumps are available.

Myth #2 “It isn’t safe.”

Research has shown that cortisol pumping is an effective alternative treatment to oral steroids for the management of cortisol deficiency. We have compiled a comprehensive list of evidence showing that this method is safe.

A recent poll done by Adrenal Alternatives Foundation revealed that 97% of the patients surveyed stated that cortisol pumping improved their quality of life.

Adrenal insufficiency requires adequate cortisol replacement in the form of steroid medications. With the cortisol pumping method, patients can bypass the gastric pathway and absorb their life-sustaining medication better. This treatment is revolutionary for hypermetabolizers and for those with gastro-intestinal problems or malabsorption issues. The cortisol pumping method truly puts adrenal patients in control of their cortisol distribution in a way that steroid pills cannot. In situations of physical or emotional stress where “updosing” is needed, the pump can immediately administer a bolus, which is extra cortisol administered through the pump canula at the amount you select. Instead of having to wait for pills to metabolize, the cortisol can be absorbed faster and can help prevent adrenal crisis. Cortisol pumping is not a cure for adrenal insufficiency and is not a treatment that is right for everyone. If you are well managed on steroid replacement pills, being on the pump method may not be necessary to achieve quality of life.

Myth #3 “My insurance won’t cover it”

What your insurance will cover is completely dependent on your specific coverage plan and insurance company. If you are denied, you can always file an appeal. Visit this link to download the example appeal letter you can fill out with your information to appeal your insurance company’s denial.

Our foundation team also assists patients file insurance appeals has successfully battled countless insurance companies across the nation and can assist you in your fight for coverage.

It is also an option to cash purchase a pump and supplies specifically from companies such as Omnipod and Medtronic if you have a prescription from your overseeing physician.

Adrenal Alternatives Foundation has also aligned with the organization CR3 to help adrenal patients acquire pumps in a safe and legal manner. Visit this link to apply for pump assistance.

Myth #4 “My doctor said no.”

Finding a healthcare professional willing to work with this relatively unknown treatment option can be a challenge. You may have to “query” multiple physicians before you find one willing to manage your care on the cortisol pumping method.

In order to achieve this, it is best to prepare a compelling case and provide it to the physician before your appointment. Send research on the cortisol pumping method and your health records to the physician before your appointment so they are aware of your intentions before hand. We have created a pump proposal letter you can fill out with your information, explaining your diagnosis, failed treatments and desire to be on the pump. The doctor may or may not be receptive to your request and alerting them of your intentions beforehand may save you time, money and effort. Again, you may have to contact multiple physicians before finding one who is willing to manage the cortisol pumping method.

Our clinical team is also willing to speak with your current physician and provide them with guidelines on how to safely start the pumping method. If you would like our assistance, fill out our contact form and request a cortisol pumping consult.

Myth #5 “It isn’t legal.”

FDA approval is not necessary to safely and legally begin cortisol pumping under the care of a licensed physician. Use of the infusion pump for adrenal insufficiency is considered an “off label” treatment. Infusion pumps have long been approved for the administration of medications.

According to the Department of Health and Human Services Centers for Medicare and Medicaid Services Medicare Coverage Issues Manual Section 60-14 A: “6. Other uses of external infusion pumps are covered if the contractor’s medical staff verifies the appropriateness of the therapy and of the prescribed pump for the individual patient.”

In addition, according to the recently passed Right to Try Act, patients have legal rights to access to life-saving treatments which are not yet FDA approved.  

More information on cortisol pumping can be found on the cortisol pump advocacy tab on our website and also in the book A patient’s guide to managing adrenal insufficiency.

You can also listen to our podcast episode Everything you need to know about the Cortisol Pump! or download our Guide to the Cortisol Pump.

This information was brought to you by the Adrenal Alternatives Foundation for educational use only and is not meant to provide medical care or advice.

We appreciate all contributions which allow us to further our mission, Education, Encouragement and Advocacy for all adrenal disease.

Donate to Adrenal Alternatives Foundation

What is the difference between blood, urine and saliva cortisol testing?

What is the difference between blood, urine and saliva cortisol testing?

*This information is to be used for educational purposes only and is not intended to provide medical care or advice*

There are three forms of cortisol in the body:

1.Free cortisol

2.Bound cortisol

3.Cortisol metabolites

Bound Cortisol– Cortisol which is attached to a specific protein (CBG) is known as a bound cortisol. Metabolized cortisol evaluates how much cortisol is being made in total and cleared through the liver.

Free Cortisol- Cortisol which is not attached to any protein known as free cortisol. Free cortisol reveals how much cortisol is free to bind to receptors and allows for assessment of the circadian rhythm.

Cortisol metabolites– Metabolites of cortisol gives insight into the relative activity of 11b-HSD types I and II, which controls the activation and inactivation (to cortisone) of cortisol.

Approximately 90% of cortisol is bound to cortisol-binding globulin (CBG), also known as transcortin, and albumin.  Transcortin: corticosteroid-binding globulin (CBG) or serpin A6, is a protein encoded by the SERPINA6 gene and is an alpha-globulin. Albumin: main protein in your blood and carries substances such as hormones, vitamins, and enzymes throughout the body.

5% of circulating cortisol is free (unbound). Only free cortisol can access the enzyme transporters in the liver, kidney, and other tissues that mediate metabolic and excretory clearance.

Cortisol-binding globulin (CBG) has a low capacity and high affinity for cortisol, whereas albumin has a high capacity and low affinity for binding cortisol. Variations in CBG and serum albumin due to renal or liver disease may have a major impact on free cortisol.

Standard Ranges for Cortisol:

A normal adult range for cortisol levels in urine is between 3.5 and 45 micrograms per 24 hours.

Reference ranges for salivary cortisol assay: <0.4–3.6 nmol/L at 2300 h & 4.7–32.0 nmol/L at 0700 h.

Standard 8 a.m. range for blood serum cortisol is between 6 and 23 micrograms per deciliter (mcg/dL)

Measuring both free and bound cortisol levels allows for insight into the rate of cortisol clearance/metabolism and clearance.

Urine and saliva cortisol testing are used to evaluate free cortisol levels. Morning saliva cortisol panels are done to measure the diurnal cortisol curve. Blood cortisol testing is used to evaluate total cortisol and also bound cortisol.

In patients with adrenal insufficiency, an evaluation of cortisol tested via blood, saliva and urine can all be beneficial in evaluating the efficacy of their cortisol replacement medication(s). Recommended protocols are a comparative assay of cortisol levels from urine, blood and saliva specimens. The patient’s quality of life, symptomatic complaints and also fatigue levels should also be used when evaluating a proper cortisol dosing regimen.

Sources:

Abraham, S. B., Rubino, D., Sinaii, N., Ramsey, S., & Nieman, L. K. (2013). Cortisol, obesity and the metabolic syndrome: A cross-sectional study of obese subjects and review of the literature. Obesity (Silver Spring), 21(1), 1-24. doi:10.1002/oby.20083

Dhillo WS, Kong WM, Le Roux CW, Alaghband-Zadeh J, Jones J, Carter G, Mendoza N, Meeran K and O’Shea D. Cortisol-binding globulin is important in the interpretation of dynamic tests of the hypothalamic-pituitary-adrenal axis. Euro J Endo. 2002;146

Hoshiro, M., Ohno, Y., Masaki, H., Iwase, H., & Aoki, N. (2006). Comprehensive Study of Urinary Cortisol Metabolites in Hyperthyroid and Hypothyroid Patients. Clinical Endocrinology, 64, 37-45. doi:10.1111/j.1365-2265.2005.02412.x

Taniyama, M., Honma, K., & Ban, Y. (1993). Urinary Cortisol Metabolites in the Assessment of peripheral Thyroid Hormone Action for Diagnosis of Resistance to Thyroid Hormone. Thyroid, 3, 229-233.

Tomlinson, J. W., Finney, J., Hughes, B. A., Hughes, S. V., & Stewart, P. M. (June 2008). Reducing Glucocorticoid Production Rate, Decreased 5alpha-Reductase Activity, and Adipose Tissue Insulin Sensitization After Weight Loss. Diabetes, 57, 1536-1543.

Bancos I, Erickson D, Bryant S, et al: Performance of free versus total cortisol following cosyntropin stimulation testing in an outpatient setting. Endocr Pract 2015 Dec;21(12):1353-1363 doi: 10.4158/EP15820

Petersen KE: ACTH in normal children and children with pituitary and adrenal diseases. I. Measurement in plasma by radioimmunoassay-basal values. Acta Paediatr Scand 1981;70:341-345

Hamrahian AH, Oseni TS, Arafah BM: Measurements of serum free cortisol in critically ill patients. N Engl J Med 2004;350;16:1629-1638

Ho JT, Al-Musalhi H, Chapman MJ, et al: Septic shock and sepsis: a comparison of total and free plasma cortisol levels. J Clin Endocrinol Metab 2006;91:105-114

le Roux CW, Chapman GA, Kong WM, et al: Free cortisol index is better than serum total cortisol in determining hypothalamic-pituitary-adrenal status in patients undergoing surgery. J Clin Endocrinol Metab 2003;88:2045-2048

Huang W, Kalhorn TF, Baillie M, et al: Determination of free and total cortisol in plasma and urine by liquid chromatography-tandem mass spectrometry. Ther Drug Monit 2007;29(2):215-224

Mayo Clinic Laboratories-  https://www.mayocliniclabs.com/test-catalog/Clinical+and+Interpretive/65484

The Adrenal Alternatives Foundation is registered with the IRS as a 501(c)3 nonprofit organization.

EIN: 83-3629121.

Donate to Adrenal Alternatives Foundation