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For example, cortisol deficiency is rarely taken into account in a medical or psychiatric work\u2010up, so persons with mild to moderate cortisol insufficiency are for the most part relegated to receiving a psychiatric diagnosis when, in fact, the same disorder is represented. However, the symptoms of cortisol insufficiency appear to closely parallel such psychiatric disorders as post traumatic stress disorder (PTSD) and addictions. There has been some question of whether substance abuse <jats:italic>causes<\/jats:italic> a hypocortisolemic state. In reviewing the literature and obtaining detailed histories of addicted patients, it appears that childhood trauma, also known as \u201cearly life stres\u201d (ELS), instead may elicit a hypocortisolemic state. This leads some to self\u2010medicate with an addictive substance to quell the pain of a cortisol insufficiency, both physical and emotional. In fact, the literature supports the concept that addictive substances increase cortisol in predisposed patients. Patients with a variety of psychiatric disorders including addictions were found to have signs and symptoms of mild or moderate hypocortisolemia. Generally, an appropriate comprehensive examination supported a diagnosis of cortisol insuffiency. For the most part, these patients were succesfully treated with physiologic doses of bio\u2010equivalent hydrocortisone, along with replacement of any other deficient hormone. By correcting underlying hormonal insufficiencies, many patients improved, with some patients having a total reversal of psychiatric symptoms. It is therefore reasonable to evaluate and treat hormonal insufficiencies with hormones prior to using psychotropic medication.<\/jats:p>","DOI":"10.1196\/annals.1356.036","type":"journal-article","created":{"date-parts":[[2006,1,6]],"date-time":"2006-01-06T20:33:18Z","timestamp":1136579598000},"page":"466-478","source":"Crossref","is-referenced-by-count":9,"title":["Stress\u2010Induced Hypocortisolemia Diagnosed as Psychiatric Disorders Responsive to Hydrocortisone Replacement"],"prefix":"10.1111","volume":"1057","author":[{"given":"SUZIE E.","family":"SCHUDER","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2006,1,23]]},"reference":[{"key":"e_1_2_2_2_2","first-page":"85","article-title":"Creating an infrastructure for the productive sharing of clinical information.Top","volume":"20","author":"Neame R.","year":"2000","journal-title":"Health Inf. 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