Question: I am on permanent cortisone and florinef replacement. I have heard that some people take their cortisone 3 times per day rather than twice. Is this beneficial and how would I divide my current dose of 25 mg into three doses?

Answer: Patients with primary adrenal insufficiency (disease of the adrenals themselves rather than in secondary adrenal insufficiency where the problem is with ACTH - the pituitary hormone controlling the adrenal glands) require both cortisone and florinef replacement. Cortisol is typically given twice a day with a higher dose given in the morning to mimic the natural secretion of cortisol by the adrenal glands. Although some people have divided their afternoon dose to take 1/2 in the afternoon and 1/2 in the evening, this is typically not needed. The total dose is very important to avoid becoming "Cushingoid" and having problems with excess cortisol.