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Good case review of secondary adrenal insufficiency.  A common cause of low sodium and needs to be considered in elderly patients.  Also, low cortisol is associated with increased ADH.  In the case of adrenal insufficiency, the negative feed back of cortisol to the HPA is lost and recreation of CRH, which is an ADH secretagogue, will increase ADH secretion.

low dose hydrocortisone therapy (defined as 5-10 mg), in this study, was used to treat CFS.  This study found an improvement in symptoms in these patients.  Additionally, low cortisol was found in these patients with CFS.  Their conclusion, was that low adrenal function is a component of CFS and low dose hydrocortisone therapy is an effective treatment.   Now, is the low cortisol as the result of increased metabolism as well?

this study showed salivary cortisol to be an "excellent" means to evaluate both those with adrenal disease and adrenal dysfunction.  Salivary test is a good tool to evaluate the free active cortisol.

European Journal of Endocrinology finds that salivary cortisol can be used as a diagnostic tool for Cushing's syndrome and adrenal insufficiency.  Thus both hypercortisol and hypocortisol states can be followed using saliva.  This statement was using immunoassay.  Mass spectroscopy provides even better results

Salivary hormone testing again shown to gold standard.  This study looked at salivary cortisol levels in those with Cushing's disease, Cushing's syndrome, and with adrenal incidentaloma.   The results make one scratch their head.  The sensitivity and specificities of salivary cortisol were very high, exceeding at least 94% with most > 96 and 97%.  So, why the opposition?  Ignorance I guess.

low dose hydrocortisone therapy, 5-10 mg, shown to be effective short-term therapy in patients with chronic fatigue syndrome.  Additionally, and very important, this study found no adrenal function suppression at these doses.

long-term glucocorticoid therapy commonly produces long-term adrenal suppression.

Great review on over training syndrome and hypoadrenia.

Salivary cortisol testing shown to have sensitivity and specificity that exceeds 90%.  Final Quote: "salivary cortisol will become routine in the evaluation of patients with disorders of the HPA axis

European journal of endocrinology article compared serum to salivary cortisol and found them to be equal, but due to ease of collection, salivary cortisol to be preferable.  This article was using cortisol to assess HPA axis dysfunction.

salivary cortisol testing said to be "first-line" and preferable to serum cortisol evaluation