I am mainly concerned with inflammation, the role of cortisol to control inflammation.
The body has an absolute daily requirement for cortisol which the adrenals produce.
I cannot explain why when my difficulties first began (conditions exactly as described in the Jefferies SAFE USES OF CORTISOL, by the way. Knowledge unknown to today's experts. I stumped how many, 10, 15 specialists?) Anyway, when I was in the hospital - I did not have joint pain. I had all sorts of other reactions I now attribute to insufficient cortisol. And perhaps the joint pain did not set in right away for some of the reasons you describe johnwen, but I did have the shortness of breath, apparent respiratory infection (but no pathogen could be found!) and the heart sac filled with fluid.
insight added wrote: I think I may know what happened. Why I didn't get joint pain right away. When the brain wants cortisol, it really wants it, and when it doesn't get it, hormonal signals fly fast and furious. The brain was able to get enough cortisol, from extraordinary measures, but the hormonal imbalances that resulted are responsible for the other issues. This is very similar to what Jefferies described in many cases, and explained why giving a small replacement dosage to young women normalized breast development, because the hormonal signals trying to have the adrenals make cortisol had gone awry.
It was only later, after I got out of the hospital that the joint pain began in earnest, and thinking that it might be gout, I tried to treat that - to no avail.
My rescue was the med-pak of methyl prednisolone my (now fired) primary care physician gave me - to help me avoid a 3rd ER visit.) I learned on my own that no amount of IV/C had any real effect (unless solef cort?? was added - a form of cortisol!). I discovered that with 8 mg of methyl prednisolone, I was fine. No pain, etc. Only later did I learn that 8-10 mg is the "replacement" dosage.
As a thought experiment, lets reiterate, The body has an absolute daily requirement for cortisol which the adrenals produce. (No reason yet to confuse free/bound. The adrenals make it every day, and we know this from adernalectomized patients. People without functioning adrenal glands.)
Pick a number for a given individual. Lets say it is 9.5 mg of cortisol, on average, that this individual's adrenal glands produce, day in, day out, throughout his entire unstressed life.
Then one day, after a major stress caused the brain to request say 18 mg for several days, the adrenals lose their full capacity, and only produce 9 mg (not the requested 9.5 mg). (Note: According to SAFE USES OF CORTISOL, the exhaustion sets in about 2 months after the major stress in ones life.)
What happens? If day after day, instead of the 9.5 mg the brain is requested, the adrenals are only able to product 9 mg?
What if .5 mg of cortisol is missing for an extended time?
And what if it gets worse, what if only 8 mgs can be produced throughout the day?
We are talking about potentially very small changes in output.
The point is that because of the general variability in cortisol secretion, it is very difficult to create a test that will show this.
I maintain that doctors can make educated guesses that this is happening, as the number one symptom over time is pain in the extremities - especially fingers, knuckles and joints.
This is the condition generally unrecognized or diagnosed by modern medicine that is the cause of untold pain and suffering, and if it were not for Doctor Jefferies, I would be among that throng!