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Adrenal Insufficiency Testing?

Discussion in 'Adrenal Dysfunction' started by roxie60, Aug 5, 2013.

  1. roxie60

    roxie60 Senior Member

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    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.
     
  2. Ema

    Ema Senior Member

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    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
     
  3. Ema

    Ema Senior Member

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    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
     
    roxie60 likes this.
  4. Ema

    Ema Senior Member

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    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
     
  5. Ema

    Ema Senior Member

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    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
     
  6. rlc

    rlc Senior Member

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    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 likes this.
  7. roxie60

    roxie60 Senior Member

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    @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.
     
    Ema likes this.
  8. roxie60

    roxie60 Senior Member

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    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.

    goto link for remainder of article
     
  9. roxie60

    roxie60 Senior Member

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  10. roxie60

    roxie60 Senior Member

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    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]
     
  11. ukxmrv

    ukxmrv Senior Member

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    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.
     
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  12. Valentijn

    Valentijn Activity Level: 3

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    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.
     
  13. Little Bluestem

    Little Bluestem Senescent on the Illinois prairie, USA

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    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
     
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  14. roxie60

    roxie60 Senior Member

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    Little Bluestem likes this.
  15. roxie60

    roxie60 Senior Member

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    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.
     
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  16. roxie60

    roxie60 Senior Member

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    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.
     
  17. Ema

    Ema Senior Member

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    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
     
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  18. roxie60

    roxie60 Senior Member

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    found the answer and it is yes.
     
  19. roxie60

    roxie60 Senior Member

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    also B12 will likely b low which it has been
     
  20. roxie60

    roxie60 Senior Member

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

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