How does oral cortisol affect acth hormone and aldosterone levels?

Poor correlation. Hi. Oral cortisol (aka hydrocortisone) does not reliably affect ACTH secretion nor aldosterone levels. That is somewhat unfortunate for those of us treated adrenal insufficiency, since determination of proper dose is based solely on clinical response, and not labs. Aldosterone is driven by the renin-angiotensin system bypassing the pituitary. UIHC is excellent, so you have great docs close at hand.