Adrenal testing

[Jaylfc9]

Hi everyone I am considering having my adrenals tested via the saliva testing throughout the day, I have already been tested via the synacathen test but someone suggested that test is not the best for determining adrenal fatigue/exhaustion. Could anyone enlighten me about the best method of getting the adrenals tests.

Any help appreciated.

Jay

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[adreno]

The synacthen test will show whether your adrenal glands are able to respond to ACTH by outputting cortisol. If the test is ok, it means your glands are functioning as they should.

The test will not show if you have HPA axis dysregulation, and it will not show your baseline levels of cortisol throughout the day. A saliva test can show you this.

Let's say that the synacthen test shows that your adrenal glands respond to ACTH by outputting cortisol, but the saliva test shows low baseline cortisol levels. What does this mean? It means that you are not outputting enough ACTH to stimulate the production/release of cortisol. ACTH is produced by the pituitary gland in response to CRH.

The reasons for this could be many; hypopituitarism, low CRH, or perhaps desensitization of CRH receptors.

 

[Jaylfc9]

Hi adreno thank you for the response! I have had a synacathen test done which came back normal, however I am convinced adrenal fatigue is the reason for my insomnia. Would you suggest having the saliva test done?

 

[adreno]

I have never seen any evidence that supports the idea of "adrenal fatigue", i.e. that the adrenal glands gets fatigued. In fact, as I said earlier, when the synacthen test is ok, it means your adrenal glands function as they should.

 

[Ema]

The ACTH stimulation test is the gold standard for diagnosing primary adrenal insufficiency. Unfortunately, most of us with ME/CFS don't have primary adrenal insufficiency (otherwise known as Addison's disease). The test only catches about half of those with secondary adrenal insufficiency and does not say anything at all about the free levels of hormones available to the body throughout the day. That makes it a very poor screening test for most in our positions to determine anything about adrenal function or cortisol status.

The 4/x day saliva test is a much better choice if one wants to see the amount of free cortisol available to the body across the day and the rhythm of that production. Cortisol levels should be highest in the AM and then gradually taper down towards night to allow for sleep. Many people with ME/CFS have disturbed cortisol rhythms and this can cause symptoms and interfere with a good night's sleep.

Adrenal "fatigue" is a terrible name because the adrenals generally do not become fatigued. A better name (though it does not roll off the tongue easily!) would be HPA axis dysfunction (hypothalamus-pituitary-adrenal axis) because that is more descriptive of the issues faced.

You may find this thread from Dr Mariano's Definitive Mind forums to explain better:

http://www.definitivemind.com/forums/showthread.php?t=90

If you think you have low cortisol and/or adrenal issues, I would highly suggest a saliva cortisol test. That is the only way to know whether or not that is in fact a problem for you. The test can be ordered on your own in most US states without a prescription for about $125 through ZRT/Canary Club.

I personally have low cortisol and have benefitted tremendously from physiological cortisol replacement along with other hormone replacement.

 

[roxie60]

I just took the adreanal cortisol saliva test from neuroscience, gave the cortisol levels 4x thru the day. My cortisol is low in AM and high PM, and in range during day (12N - 5PM) which happens to coincide with the most times I am somewhat functional during a day. If you would like to see what NS test reports look like I posted my results here http://forums.phoenixrising.me/index.php?threads/new-and-overwhelmed.15892/page-7#post-275965

 

[jeffrez]

There can be adrenal gland hypertrophy over time, and MRI studies of ppl with CFS have even found the opposite: smaller adrenal size/volume. But the chicken/egg question is always pertinent when dealing with adrenal/HPAA dysfunction.

24-hr salivary cortisol testing will at least show the state of function, regardless of how it's conceptualized. Just be aware that standard endos don't lend any credence to salivary cortisol testing. They say the results are not indicative of anything or even conclusive when the numbers are below normal. If you have higher than normal results they might look into it further, but if your levels are below baseline, they pretend the test has sensitivity issues and isn't accurate.

 

[heapsreal]

My experience when testing dhea is that the blood test for that was alot more accurate then saliva. Good dhea levels are an important part of the puzzle.

 

[Sparrowhawk]

Great clarifications above on the different tests, not for the first time do i wish i had found this forum a year ago! Had to learn all that in bits and pieces.

I did the 4x / day spit test (three separate times over the past 18 mnths), and ACTH, and cortisol blood tests at three diff times of day (different days).

My ACTH was fine, and the side effect was that for an hour I felt "normal" eg not sick with CFS/ME. That in fact is what I keep going back to when I worry if I could ever feel better again. It is what I percieve folks are saying for instance on the antiviral threads about their recovery, makes me think it's possible. But I digress...

My cortisol curve was the same in all three tests, which were spaces out about three months apart: cortisol peaks early, goes quickly to low normal midday, and crashes around 3-4 pm to below normal, which is congruent to both my energy levels and emotional outlook/attitude. Blood tests confirmed a marked, significant drop from midday to 7pm. My MD raised his eyebrows and wanted me to start supplementing cortisol. Not ready to go there at this pont.