Adrenal Insufficiency Testing?

[roxie60]

Can AI or hypothyroidism affect heart? Can it be responsible for all the 'CFS' symps I have had for years? Can the daily ability/functionality vary w/ AI and Hypo TH?

 

[roxie60]

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.

Valentijn Not sure this is the right thread but wanted to followup on your suggestion. I decided to take my BP through the night (when I woke up, which is multiple times, I had the cuff on so just pushed the start and recorded results). Curious what you or anyone with BP knowledge thinks about the last 24hrs. Includes results above.

8/6/13
 
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)
7:26P    BP - 113/68  P-110 (30 mins after mowing)
 
8/7/13
 
2:42A    BP - 114/74  P-93  (just before going to bed)
3:25A    BP - 127/71  P-71  (flat in bed on back)
3:36A    BP - 110/67  P-69  (flat in bed on back)
4:40A    BP - 112/67  P-75  (flat in bed on back)
4:50A    BP - 106/68  P-60  (flat in bed on back)
6:43A    BP - 107/66  P-60  (on left side)
9:06A    BP - 101/59  P-57  (flat in bed on back)
10:10A  BP - 106/62  P-54  (flat in bed on back)
10:25A  BP - 109/52  P-75  (taken immediately after getting out of bed)
10:32A  BP - 115/76  P-75
10:35A  BP - 118/84  P-75
10:57A  BP - 109/77  P-83  (sneezed)
4:26P    BP - 131/93  P-109
8:07P    BP - 130/81  P-99  (standing after grocery shopping)
9:02P    BP - 109/72  P-102
9:30P    BP - 117/71  P-111 (after sitting on couch 20 mins; feel pressure in chest)
9:38P    BP - 113/71  P107  (still pressure, difficult taking breathe at times)
10:16P  BP - 107/74  P-98  (sitting updating PR :); pressure, back hurts, need to take break)

 

[Little Bluestem]

Both adrenal and thyroid problems can be secondary to a pituitary problem. That is why they sometimes occur together. You can also have iron problems with thyroid problems. I do not know why.

 

[Valentijn]

Valentijn Not sure this is the right thread but wanted to followup on your suggestion. I decided to take my BP through the night (when I woke up, which is multiple times, I had the cuff on so just pushed the start and recorded results). Curious what you or anyone with BP knowledge thinks about the last 24hrs. Includes results above.

Your pulse pressure and blood pressure look completely normal. Your elevated heart rate in the afternoon and evening is interesting though - mine makes a similar jump if I've been too active in the past few hours or days, accompanied by feeling icky until I lie down.

On your final reading your heart rate has started to fall and you're down to 33 pulse pressure, which is a bit low but not super low. So your symptoms might be due to an oxygenation problem which you eventually get too worn out/depleted/etc to compensate for with increased pulse pressure or heart rate, rather than a typical NMH/OI problem.

 

[roxie60]

Both adrenal and thyroid problems can be secondary to a pituitary problem. That is why they sometimes occur together. You can also have iron problems with thyroid problems. I do not know why.

There are thyroid tests, adrenal tests, are there tests for pituitary function?

 

[roxie60]

I know I can get a blood draw for the TSH, FT4, FT3 and RT3. I can also get a lab order for the plasma/serum Cortisol. Can I presume that the same lab can do the ACTH and aldosterone tests? I was reading a post above and it said the Corticol, ACTH and aldosterone tests should be done. I thought the ACTH was something (a hormone?) that was administered via shot then Cortisol and aldosterone retested. Is ACTH also something that is tested ?

 

[roxie60]

Your elevated heart rate in the afternoon and evening is interesting though - mine makes a similar jump if I've been too active in the past few hours or days, accompanied by feeling icky until I lie down. Yes, I often feel bad and the only relief is laying down, usually one to three hours to recover.

On your final reading your heart rate has started to fall and you're down to 33 pulse pressure ????, which is a bit low but not super low. So your symptoms might be due to an oxygenation problem which you eventually get too worn out/depleted/etc to compensate for with increased pulse pressure or heart rate, rather than a typical NMH/OI problem.

not sure where you see 33 or maybe not understanding your point.

 

[roxie60]

In past blood tests my Sodium levels are usually high (another clue?). Looks like based on that wiki Blustem that I should also ask for CHR, Potassium, renin(?), DHEA/DHEA-s, ACTH along with Cortisol and aldosterone. Now I feel I dont trust any Lab ranges and feel the need to find 'optimal' values for each of these in order to draw any useful conclusions and make a plan of action. I want to find more current lab values for these tsts, if someone has already identified updated values I'd appreciate th info otherwise as I find info I will post here. I am desperate and so hoping this will turn out to be an answer.....I appreciate everyone's imput.

 

[roxie60]

ACTH and CRH study. Highly technical.
http://jcem.endojournals.org/content/87/4/1640.full.pdf

 

[roxie60]

info on Renin

http://labtestsonline.org/understanding/analytes/aldosterone/tab/test

 

[ukxmrv]

When I had the ACTH test it was a stimulation one. No food that morning and a blood draw to start with, then an injection, a wait and then another blood draw.

 

[Valentijn]

not sure where you see 33 or maybe not understanding your point.

Your last result was:

10:16P BP - 107/74 P-98

The difference between your systolic (107) and diastolic (74) is your pulse pressure. Most of the day yours was looking great (40-45), but then it's dropped at the same time that your heart rate dropped while you were having symptoms.

Pulse pressure shows how forcefully your blood is being moved around your body. 40 is about normal, and 25 is very low. It's been my experience that anything under 35 feels not-good.

 

[Ema]

In past blood tests my Sodium levels are usually high (another clue?). Looks like based on that wiki Blustem that I should also ask for CHR, Potassium, renin(?), DHEA/DHEA-s, ACTH along with Cortisol and aldosterone. Now I feel I dont trust any Lab ranges and feel the need to find 'optimal' values for each of these in order to draw any useful conclusions and make a plan of action. I want to find more current lab values for these tsts, if someone has already identified updated values I'd appreciate th info otherwise as I find info I will post here. I am desperate and so hoping this will turn out to be an answer.....I appreciate everyone's imput.

Sodium levels are often low in AI due to decreased aldosterone. Potassium levels are often high. However, if you don't have decreased aldosterone, your levels may be fine.

Generally I shoot for sodium 142-144, potassium from 4.2-4.4, DHEAs (women) around 150, ACTH really only matters where it is in the range more than the absolute value. Cortisol should be at the top of the range for an 8AM draw (ideally around 20) and aldosterone should be greater than 14 ideally (after following the appropriate testing protocol for aldosterone).

Ema

 

[Ema]

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

It seems to have turned out now almost 3 years later that my AI was caused by infection. And now that I've gotten my infectious load (EBV, CMV, HHV6, Lyme etc etc) under better control, I have been able to come off steroids. I'm hoping that there hasn't been permanent damage to my adrenal axis but only time will tell.

So to answer your question, yes, steroids did make me feel better again but only as a part of a treatment that also included antibiotics, antivirals, Hizentra and methylation support.

People with "simple" autoimmune AI generally feel better much more quickly after starting cortisol replacement.

Ema

 

[rlc]

Hi Roxie, RE

Can AI or hypothyroidism affect heart? Can it be responsible for all the 'CFS' symps I have had for years? Can the daily ability/functionality vary w/ AI and Hypo TH?

Ai effects the heart Aldosterone controls sodium levels which controls blood pressure hence the low blood pressure often found in Ai patients. Hypothyroidism also effects the heart see http://heartdisease.about.com/od/lesscommonheartproblems/a/thyroidheart.htm

Yes they certainly can be responsible for all CFS symps, and AI and Hypothyroid patients often have fluctuating symptoms.

So, yes to all questions.

RE

There are thyroid tests, adrenal tests, are there tests for pituitary function?

T4,T3 and TSH show how the pituitary is working in relation to what the thyroid is doing, but other tests may be needed to get a full picture of what is going on, it’s all part of what is known as the Hypothalamic–pituitary–thyroid axis which is explained here http://en.wikipedia.org/wiki/Hypothalamic%E2%80%93pituitary%E2%80%93thyroid_axis

Serum ACTH tests pituitary function in relation to adrenal function. How it works is you also have a Hypothalamic-pituitary-adrenal axis. The Hypothalamus produces a hormone called CRH this tells the pituitary to release ACTH which tells the adrenals to produce Cortisol. This is explained here http://en.wikipedia.org/wiki/Hypothalamic%E2%80%93pituitary%E2%80%93adrenal_axis

The serum ACTH test is important because if the result is low this shows that the problem is in the Hypothalamus or pituitary. The lack of ACTH means that the message to produce Cortisol is not getting through to the adrenals to make Cortisol, even though they are undamaged and capable of making enough Cortisol.

If the problem is in the adrenals ACTH is often high, because the pituitary is picking up the message that not enough Cortisol is being produced so it makes more ACTH, but when the adrenals are damaged more Cortisol cannot be made even though the levels of ACTH are high.

RE

I know I can get a blood draw for the TSH, FT4, FT3 and RT3. I can also get a lab order for the plasma/serum Cortisol. Can I presume that the same lab can do the ACTH and aldosterone tests? I was reading a post above and it said the Corticol, ACTH and aldosterone tests should be done. I thought the ACTH was something (a hormone?) that was administered via shot then Cortisol and aldosterone retested. Is ACTH also something that is tested ?

You will have to ask the lab if they do serum ACTH and Aldosterone tests, Cortisol is done by most labs, but ACTH and Aldosterone tend to be more specialist tests that not all labs do.

ACTH is a hormone made in the pituitary that tells the adrenals to make Cortisol. The serum ACTH test measures this.

The ACTH Stimulation test involves injecting the patient with artificial ACTH and then measuring how the body responds to the ACTH, by testing Cortisol, Aldosterone and ACTH and seeing how they response to the ACTH injection over a period of time. This is the gold standard tests for adrenal function. It’s normally is done by an endocrinologist. In some people all the other tests don’t give a clear picture and the ACTH stimulation test will answer these questions. This is a very complicated area of medicine with many complications in diagnosis, if it is at all possible I recommend going to see a good endocrinologist to help decide what tests need doing and how to interpret them.

Hope this helps

All the best

 

[Little Bluestem]

There are thyroid tests, adrenal tests, are there tests for pituitary function?

I think that my doctor told me that there is not. Either that or she told me she did not recommend I do it.

 

[Ema]

There are thyroid tests, adrenal tests, are there tests for pituitary function?

Yes, you can test the pituitary hormones for an idea of pituitary function.

Ema

 

[roxie60]

Just heard back from my Drs nurse (they work so hard). Some new blood tests have been ordered and I will have them in the AM. There were a few that could not be ordered yet without some Lab research and something to do with getting the order on their computers (the entry for ACTH stim doesn't exist)

I'm trying not to be discouraged since most times my tests show nothing but I want the thyroid panel to be current before I give my Dr the Dr Rind thyroid scale and see if she thinks it has possibility for expalining my symps.

So tomorrow (going to have to have someone call me and set two alarms or not goto sleep at all for fear of missing the blood test time (7AM) so I have to be up by 6-615A (lately that is about the time I have been falling asleep). 10hr fast required.

Tomorrow's tests (I pray they show something)
Aldosterone
Cortisol
DHEA
Lythium
Manganese
Renin
FT3
FT4
TSH
RT3

The ACTH has to be done the same day as ACTH Stim test. Also they could not find a test for CRH. I decided to drop the NK cell activity test since most info I find is conflicting on the diagnositic value.

Dr also wants me to go see another integrative specialist to see if he can think of something she has not.

 

[Ema]

Tomorrow's tests (I pray they show something)
Aldosterone
Cortisol
DHEA
Lythium
Manganese
Renin
FT3
FT4
TSH
RT3

The ACTH has to be done the same day as ACTH Stim test. Also they could not find a test for CRH. I decided to drop the NK cell activity test since most info I find is conflicting on the diagnositic value.

Dr also wants me to go see another integrative specialist to see if he can think of something she has not.

What lab are you using?

The ACTH stim test is usually done in a hospital of clinic setting rather than a lab in my experience.

You can get a one time ACTH measure along with the cortisol and that can be helpful in distinguishing primary from secondary adrenal insufficiency.

You also need to have electrolytes (or a CMP) on that list as you will need sodium and potassium to properly interpret aldosterone and renin.

Aldosterone should ideally be tested after eating a low salt diet for 24 hours and in the first week of a cycling woman's cycle. Further, one should ideally be up for at least an hour prior to the testing and moving around. This will allow you to be producing the maximal amount of aldosterone to be measured so you know the top capacity of production.

Ema

 

[roxie60]

What lab are you using?

The ACTH stim test is usually done in a hospital of clinic setting rather than a lab in my experience.

You can get a one time ACTH measure along with the cortisol and that can be helpful in distinguishing primary from secondary adrenal insufficiency.

You also need to have electrolytes (or a CMP) on that list as you will need sodium and potassium to properly interpret aldosterone and renin.

Aldosterone should ideally be tested after eating a low salt diet for 24 hours and in the first week of a cycling woman's cycle. Further, one should ideally be up for at least an hour prior to the testing and moving around. This will allow you to be producing the maximal amount of aldosterone to be measured so you know the top capacity of production.

Ema

I am going to local hospital's lab. The problem is they need to find the ACTH stim test on the computer to order it and it was not there. Wiki indicated the ACTH baseline needed to be done at same time as ACTH stim so we took it off the list. My last sodium (july( was 145, just above range). Potassium was done some time ago but I did not see anything indicating that was needed. I feel I am the one directing the tests I need and I admitted I am not a Dr but the nurse did not know either. So this was what we came up with for tomorrow. Thanks for the info about being up for an hr prior to blood test. She had ACTH on the list originally but when I read the stim test has to be done soon after ACTH test decided it should wait to get the ACTH test. Did not know it would be valuable as a stand alone test.