Adrenal Insufficiency Testing?

[roxie60]

Can these results vary day to day. I just dont understand how nothing is showing up. I know I'm not a hypocondriac, I hate wasting my money on Drs visits and tests. I'd much rather be pursuing my old hobbies and obtaining my retirmentt benefit.

 

[Ema]

Are those steroids?

Yes. Treatment for AI is physiological replacement of cortisol.

Seriously, this is nothing to screw around with...you need to get a doctor to test you properly in the very near future.

Ema

 

[Ema]

RT3 is reverse T3. It's the inactive form of thyroid hormone, T3. When your body is trying to slow down metabolism, it will often be high.

Ema

 

[Ema]

I dont know what RT3 is. ith these results once again it appears to the Drs there is nothing wrong with me

Throid Antibodies:

B1 Plasma    8-30 nmol/l    01/02/13    12       
Vit E Gamma Toco    0.0-6.0 mg/L    01/02/13    1.3       
Vit E Alpha Tocoph    5.5-18.0 mg/L    01/02/13    11.5       
Anti-microsomal antibody    <60 u/ML    01/02/13    42       
Thyroglobulin antibody    <60 u/ML    01/02/13    <15       
Thyroglobulin antibody    <20 IU/mL            08/20/09    <20 
Tyroid Perox antibody    <35 IU/mL            08/20/09    <10

Here is the TSH figures from another thread

Sushi said: ↑

My latest thyroid test has the TSH range as follows: .358 - 3.740. This is likely the lab standard now.​

​

Sushi​

My last TSH test range was .350-5.00. This is my gripe why are these ranges not statardized for all lab results??? How friggen hard is it to standardize. All the money wasted at the FDA and other govy money sink holes and they cant spend some funds to come up with standardized lab test ranges.....?????

Here are the results from my 5 TSH tests and the range at the time of test.
12/20/08 2.82 range 0.465-4.68
08/20/09 1.61 range 0.465-4.68
06/01/10 2.56 range 0.465-4.68
03/30/12 2.578 range 0.350-5.00
01/02/13 1.920 range 0.350-5.00 - interesting - this was during a 2 week period I actually felt a little better and had some energy

I wonder what it is now since I have had no energy the past few weeks. The lack of energy seems to be a chief complaint for many of us....how many things can contribute to lack of energy.....are we being tested for the right things (I know that question has been brought up by many).

TSH is really of limited value for most of us. It's a pituitary hormone not a measure of thyroid output. What is more important are the level of the free hormones T3 and T4. Unfortunately most endos still treat the TSH as the gold standard test for hypothyroidism though current thinking seems to be moving forward. There are certainly more doctors now that will look at free hormone levels and symptoms over the TSH.

Ema

 

[Ema]

How was your resting heart rate before getting treatment? Did you get occasional heat flushing? (where you feel your internal temp rise quickly from torso to head)

It's always been low for me...in the 60s.

I have a hard time regulating my temperature. I'm a chameleon. If its hot, I'm hot. If it's cold, I'm cold.

Ema

 

[rlc]

Hi Roxie, all Cortisol tests are unreliable unless they show complete failure, levels under 3. Cortisol levels are highly responsive to any kind of stress so if you are stressed about something as simple as doing the test, your adrenals will quickly pump out more Cortisol and make your results look better than they would be if you had no stress. Cortisol results are also affected by sleep patterns. Staying up all night reverses the patterns and you end up with low results in the morning and high at night.

So they are only any good for diagnosing AI if your results are fewer than 3.

However what the article means when it says “and levels between 3-19 are indeterminate.” Is that results in this range mean don’t know, so further tests must be done if the patients symptoms indicate AI.

The article also says “blood cortisol levels higher than 19 generally rule out the possibility of adrenal insufficiency.” And “Regardless of the cortisol level, if adrenal insufficiency is highly suspect, an ACTH stimulation test is performed.”

Basically Cortisol tests be they serum or saliva are not very useful for diagnosing AI unless they show complete failure. Cortisol tests are only the first step in diagnosing AI unless your results are under 3.

If results are between 3-19 and you have AI symptoms then more testing must be done. Even if results are above 19 and the patient has AI symptoms further testing must be done.

Unfortunately most doctors don’t have a clue about this and see results like yours which are lower end of normal and go its fine it’s in normal range.

There isn’t really a normal range for Cortisol because it is so responsive to any stress and even very damaged adrenals can still quickly pump out a lot of Cortisol when someone is stressed by something as simple as going for the blood test.

So to best describe the range under 3 equals AI, 3-19 could be AI needs further testing above 19 unlikely but do further testing if symptoms indicate AI.

Serum morning Cortisol should as the article says be done with serum ACTH and Aldosterone. These help give a clearer picture of what is going on. There is a chart on this page that helps explain what all the different tests results mean and some other blood tests that can be done http://en.wikipedia.org/wiki/Adrenal_insufficiency

However no matter what these tests say the only way to be certain is a ACTH stimulation test. This test however needs to be interpreted carefully if it is secondary AI, measuring ACTH and Aldosterone at the same time as having the ACTH stimulation test can help to determine what is going on. It is explained in this article http://en.wikipedia.org/wiki/ACTH_stimulation_test#Interpretation_of_results

Once it has been determined that someone has AI, then more tests have to be done to find out what is the cause, many other conditions like Hemochromatosis, tuberculosis, amyloidosis can be damaging the adrenals.

Unfortunately this is a very complicated area of medicine which many doctors don’t understand. Leaving the patient unsure what test results mean and diagnoses missed. As your serum morning Cortisol is on the low side I think it would be appropriate to get further testing done to get this cleared up.

Hope this helps

All the best

 

[roxie60]

@rlcThanks rlc. After some of Ema's comments I decided to call my Dr today (left msg)and ask about having plasma cortisol, aldosterone and ACTH test. After your comments here I feel even more convinced this might be something that is getting missed and now a better understand what Ema was saying. Thank you both so much. Will let everyone know what happens. I have so little energy. I'm always trying to push thru but now only able to do so few tasks compared to a few years ago and I was struggling then at times.

 

[roxie60]

http://suite101.com/article/adrenalinsufficiency-a1543

Here is part of the AI article that was posted as a link. Link is above also but thought in case someone did not understand adrenal insufficency reading part of the info might encourage you to check the link if interested in the info.

Adrenal Insufficiency

This article describes the causes, symptoms, signs and changes
seen in adrenal insufficiency as well as the tests and procedures
used for its diagnosis.
Posted by Elaine Moore | Last updated: Mar 25, 2013


5
Adrenal insufficiency is a condition that occurs when the adrenal glands produce inadequate amounts of the adrenal hormones cortisol, and sometimes, aldosterone. This condition can occur as a primary or secondary disorder, and it can have congenital or acquired origins. Primary conditions occur in less than 1 per 100,000 persons. Secondary conditions are more common. Adrenal insufficiency, which affects slightly more women than men, varies in severity, ranging from a subclinical or mild condition to an extreme, sometimes fatal, form, which is known as an Addisonian crisis. Most primary adrenal insufficiency is autoimmune in nature and caused by Addison's disease, which is described in a separate article, or as the result of infection. Primary conditions may also occur in patients with autoimmune polyglandular syndromes (APS). In these syndromes one or more other autoimmune conditions, including diabetes, hypoparathyroidism, autoimmune thyroid disease, and other endocrine and non-endocrine disorders, are also present. These syndromes, which are classified as types 1-4 APS, are also described in a separate article.
Autoimmune disease accounts for about 80 percent of all cases of primary adrenal insufficiency. Most other cases result from infection (with tuberculosis, cytomegalovirus, the HIV virus, fungi, and other infectious agents), or as a complication of various metabolic and genetic disorders such as adrenal hyperplasia and adrenoleukodystrophy, or as a sequelae to certain metastatic cancers. Also, in some bleeding disorders, such as antiphospholipid syndrome or in trauma, adrenal insufficiency may result from thrombosis or hemorrhage. Secondary conditions are related to both long and short-term use of corticosteroids (prednisone, prednisolone and others) or megesterol acetate. Other causes include high doses of medications used to lower cortisol levels in Cushing's syndrome or as a consequence of surgery for pituitary tumors. Patients who have been on long-term glucocorticoid therapy in the past may develop adrenal insufficiency later if they are subjected to acute stress, trauma, or infection. Secondary autoimmune conditions in APS Syndrome occur in about 50 percent of patients with primary or autoimmune adrenal insufficiency. In only about five percent of patients with other autoimmune conditions, particularly diabetes, does Addison's disease later occur.


The adrenal glands are situated directly above the kidneys. Different hormones are produced in the gland's different layers. In primary disorders, damage to the adrenal cortex, the outer layer of the adrenal glands, is responsible for inadequate hormone production of both cortisol and aldosterone. Cortisol helps regulate the immune response, helps the body use sugar and protein for energy and helps the body recover from infection and stress. Aldosterone helps regulate the body's fluid balance, ensuring that we have adequate amounts of water, salt, and potassium in the body.
Normally, the production and release of cortisol and aldosterone are regulated by the hypothalamus in the brain via the pituitary gland. When the hypothalamus, which is the master gland, recognizes that the cortisol level is low, it secretes a hormone known as corticotropin-releasing-hormone or CRH. CRH, in turn, prompts the pituitary gland to secrete a hormone called adrenocorticotropin or ACTH. ACTH, in turn, stimulates the adrenal glands to produce and release cortisol. Normally, when cortisol levels fall, the pituitary secretes more ACTH to help correct the problem, and ACTH levels are elevated
In secondary or central adrenal insufficiency, the hypothalamus fails to respond to low cortisol and doesn't release CRH, or the pituitary gland fails to recognize the hypothalamic signal or is otherwise unable to produce ACTH. Without these signals from the hypothalamus and pituitary glands, the adrenal cortex does not get the message or order to produce more cortisol. Consequently, cortisol levels fall. Steroids, which elevate blood cortisol levels, decrease ACTH levels. Seeing adequate cortisol in the blood, the hypothalamus stops secreting CRH, causing ACTH levels to fall. This disruption of the pituitary-hypothalamic-adrenal axis continues to be disrupted even when steroids are stopped. In some cases, this can occur after only two weeks of steroid use. Without adequate ACTH, cortisol production is limited.

goto link for remainder of article

 

[roxie60]

this link has a nice chart of symps but u will recognize most of them


http://www.womentowomen.com/adrenalhealth/adrenalhormonedysfunction-symptoms.aspx

 

[roxie60]

I've only had one plasma Cortisol AM test and it was 7.5 (just above the starting range of 6).

If the value less than double after the stim test then I should receive dx of AI. If the value goes no higher than 25% (9.375) then likely Addisons

from Wiki
Interpretation for primary adrenal insufficiency and Addison's disease
The baseline cortisol level in people with adrenal insufficiency is usually near 15 µg/dl. An ACTH stimulation test that raises the cortisol concentration to 20 µg/dl would support the diagnosis of primary adrenal insufficiency. In Addison's disease, baseline cortisol is well below 10 µg/dl and rises no more than 25 percent.
Interpretation for secondary adrenal insufficiency
ACTH may dramatically stimulate cortisol from the low baseline value encountered in patients suffering from secondary adrenal insufficiency. Stimulation resulting in a greater than 14-fold increase in serum concentration over 30 minutes has been reported, although more typically serum cortisol levels will double or triple from baseline. The lower the baseline cortisol, the more likely it is that the patient's cortisol will increase by a large amount.[15]
In some instances, a second test can suggest primary adrenal insufficiency (cortisol value less than doubled). The diagnosis may be changed from secondary to primary adrenal insufficiency or to include primary adrenal insufficiency. In secondary adrenal insufficiency, if the adrenal glands lack ACTH for enough time, cortisol production can atrophy[16] and fail to rise to a value at least double the base cortisol value. It is proper to continue with the diagnosis of secondary adrenal insufficiency.
If secondary adrenal insufficiency is diagnosed, the insulin tolerance test (ITT) or the CRH (Corticotropin-releasing hormone) stimulation test can be used to distinguish between a hypothalamic (tertiary) and pituitary (secondary) cause, but is rarely used in clinical practice.[16]

 

[ukxmrv]

Not sure if this is useful to you Roxie, maybe worth a read here. It's about 2 UK CFS/ME patients and their journey to try and get proper testing for adrenal and pituitary symptoms.

<snip>

ventually, we found an endocrine team who were prepared to conduct further investigations. The glucagon stimulation test [1], revealed deficiencies in both growth hormone and cortisol, a steroid hormone essential for life. Our diagnosis was changed from CFS to pituitary dysfunction caused by autoimmune disease.

<end>

http://www.investinme.org/Article-650 MECFS PITUITARY AWARENESS.htm

My own experience was that the Endocrinologist I saw (UK NHS) did not take my saliva tests seriously. He did an early morning blood cortisol test (which was low) then a short synacten test (which was blunted) but as neither was low enough for Addison's disease he discharged me and refused any extra testing or help.

 

[Valentijn]

I just looked up what orthostatic BP was, think I will test it and report back results. I have never been tested for this. Wouldn't it vary by day/hr? Or if you have orthostatic BP issues are they always present?

I have had times in the past when I would stand up from sitting I would get dizzy but it doesn't happen frequently. Just did the Ortho BP test based on this http://www.cdc.gov/homeandrecreationalsafety/pdf/steadi/measuring_orthostatic_bp.pdf

Results:

1:15P BP - 119/76 P-61 (after laying flat for 5 mins)
1:17P BP - 115/74 P-86 (after standing)
1:20P BP - 116/77 P-74 (after standing another 3 mins)

Some forms of orthostatic hypotension can take a while to hit. The best time to test might be in the evening after you've been up all day. And you might have to be standing for half an hour or more before it hits.

 

[Little Bluestem]

T3 and T4 seem to be 'in range' (not sure what the approriate range is since each lab test varies once again).

The Thyroid Scale Diagrammer that my doctor uses to evaluate thyroid test (TSH, FT4, FT3) result can be downloaded from this page: http://www.drrind.com/therapies/thyroid-scale

 

[roxie60]

The Thyroid Scale Diagrammer that my doctor uses to evaluate thyroid test (TSH, FT4, FT3) result can be downloaded from this page: http://www.drrind.com/therapies/thyroid-scale

Little Bluestem excellent write up, thank you. Easy to understand!

 

[roxie60]

The Thyroid Scale Diagrammer that my doctor uses to evaluate thyroid test (TSH, FT4, FT3) result can be downloaded from this page: http://www.drrind.com/therapies/thyroid-scale

I created that Thyroid scale and put my test values in and I have never been in the optimal range on any of them. Definitely going to print your link and discuss with my Dr. Thanks again. Not going to get my hopes up but who knows.

 

[roxie60]

Can you have AI without or in addition to thyroid issues. I'm trying to understand the Dr Rind thyroid scale that Bluestem posted but there seems to be overlap so not sure what tests to get. So it looks like I may have sub optimal thyroid values but could I also have AI at the same time or are they related? I think I should get a recent TSH, T3, T4 and RT3 to see where currently. But should I wait on the AI tests or are they mutually exclusive? I guess what I'm asking is it possible to have both AI and hypothyroidism? Sorry, my brain is a jumble.

 

[Ema]

Can you have AI without or in addition to thyroid issues. I'm trying to understand the Dr Rind thyroid scale that Bluestem posted but there seems to be overlap so not sure what tests to get. So it looks like I may have sub optimal thyroid values but could I also have AI at the same time or are they related? I think I should get a recent TSH, T3, T4 and RT3 to see where currently. But should I wait on the AI tests or are they mutually exclusive? I guess what I'm asking is it possible to have both AI and hypothyroidism? Sorry, my brain is a jumble.

Yes, it is not only possible but very common. When you have AI, most people also have hypothyroidism since cortisol metabolism and thyroid metabolism are so closely related.

I think you should have them all tested.

Ema

 

[roxie60]

Can you have AI without or in addition to thyroid issues. I'm trying to understand the Dr Rind thyroid scale that Bluestem posted but there seems to be overlap so not sure what tests to get. So it looks like I may have sub optimal thyroid values but could I also have AI at the same time or are they related? I think I should get a recent TSH, T3, T4 and RT3 to see where currently. But should I wait on the AI tests or are they mutually exclusive? I guess what I'm asking is it possible to have both AI and hypothyroidism? Sorry, my brain is a jumble.

found the answer and it is yes.

 

[roxie60]

also B12 will likely b low which it has been

 

[roxie60]

Ema Once you treated your AI did that make you well again, restore your health? If so how fast? TIA