Adrenal Insufficiency Testing?

[roxie60]

#22. Has anyone had the ACTH test? The Cortisol (plasma) range mentioned starts at 9-25 mcg. However adrenal insufficency is not diagnosed unless at <=3. What happened to 4-9?? I get so frustrated since it seems these ranges that our Drs depend on to make diagnosis are not standardized. I have had consistently low AM Cortisol (saliva) but the one time I had a plasma test it was 7.5 on a 6-23 range. This article would suggest my Cortisol is low if using this articles reference range but not adrenal insufficiency since it is not 3 or below. Based on my fatigue levels if I were to register a 3 or lower I'd probably be in the grave or hospitalized. After reading this article I am thinking about asking Dr for Cortisol plasma, aldosterone and ACTH test. Just would like to know if someone was diagnosed with adrenal insufficiency how did your Dr make that diagnosis (what tests and the results w/ ranges)...TIA

 

[Ema]

#22. Has anyone had the ACTH test? The Cortisol (plasma) range mentioned starts at 9-25 mcg. However adrenal insufficency is not diagnosed unless at <=3. What happened to 4-9?? I get so frustrated since it seems these ranges that our Drs depend on to make diagnosis are not standardized. I have had consistently low AM Cortisol (saliva) but the one time I had a plasma test it was 7.5 on a 6-23 range. This article would suggest my Cortisol is low if using this articles reference range but not adrenal insufficiency since it is not 3 or below. Based on my fatigue levels if I were to register a 3 or lower I'd probably be in the grave or hospitalized. After reading this article I am thinking about asking Dr for Cortisol plasma, aldosterone and ACTH test. Just would like to know if someone was diagnosed with adrenal insufficiency how did your Dr make that diagnosis (what tests and the results w/ ranges)...TIA

Yes, roxie60. I've had an ACTH stim test.

And you're right, the ranges make zero sense.

My understanding from the articles I have read is that a level of 6 or below on an AM cortisol is diagnostic of adrenal insufficiency all by itself. Yet the range goes down to 4 typically. Similarly, one should have an AM cortisol of about 20 to be considered healthy in that respect and yet the range tops out at 19.4 or something like that.

My diagnosis was made based on all that testing, plus saliva testing and (the most important part) a complete review of my symptoms including orthostatic BP measurements. And some doctors would still disagree with it...I think most doctors would prefer only to diagnose adrenal insufficiency upon autopsy.

Ema

 

[roxie60]

Yes, roxie60. I've had an ACTH stim test.

And you're right, the ranges make zero sense.

My understanding from the articles I have read is that a level of 6 or below on an AM cortisol is diagnostic of adrenal insufficiency all by itself. Yet the range goes down to 4 typically. Similarly, one should have an AM cortisol of about 20 to be considered healthy in that respect and yet the range tops out at 19.4 or something like that.

My diagnosis was made based on all that testing, plus saliva testing and (the most important part) a complete review of my symptoms including orthostatic BP measurements. And some doctors would still disagree with it...I think most doctors would prefer only to diagnose adrenal insufficiency upon autopsy.

Ema

So I still would not be diagnosed as adreanal insufficiency since my result was 7.5. But if the top of the scale/range is 20, 7.5 seems pretty low. If I registered a 4 or < I think I would be in the hospital or 6 feet under.

 

[roxie60]

Yes, roxie60. I've had an ACTH stim test.

And you're right, the ranges make zero sense.

My understanding from the articles I have read is that a level of 6 or below on an AM cortisol is diagnostic of adrenal insufficiency all by itself. Yet the range goes down to 4 typically. Similarly, one should have an AM cortisol of about 20 to be considered healthy in that respect and yet the range tops out at 19.4 or something like that.

My diagnosis was made based on all that testing, plus saliva testing and (the most important part) a complete review of my symptoms including orthostatic BP measurements. And some doctors would still disagree with it...I think most doctors would prefer only to diagnose adrenal insufficiency upon autopsy.

Ema

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)

 

[Ema]

No

So I still would not be diagnosed as adreanal insufficiency since my result was 7.5. But if the top of the scale/range is 20, 7.5 seems pretty low. If I registered a 4 or < I think I would be in the hospital or 6 feet under.

You should have a stim test at 7.5. I think it is doubtful that you would pass and likely that you would be diagnosed with AI.

One should have an AM cortisol around 20 and the result should double to around 40 minimum in 60 minutes to successfully pass a stim test.

 

[Ema]

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?

BP can vary so it is more important to look at trends. For example, if your BP always falls when you stand relative to sitting, it doesn't matter so much what the numbers are - it's the falling that is important. That said, diastolic BP under 60 usually always indicates some degree of orthostatic intolerance.

Ema

 

[roxie60]

No

You should have a stim test at 7.5. I think it is doubtful that you would pass and likely that you would be diagnosed with AI.

One should have an AM cortisol around 20 and the result should double to around 40 minimum in 60 minutes to successfully pass a stim test.

Thanks, after reading this article posted I was thinking about running the idea of another Cortisol/adolsterone/ACTH test by her to see if she agreed it was worth doing. Thanks for the info on expectations of the stim test. I would presume if I have AI that the result will not jump to 40.

 

[roxie60]

No

You should have a stim test at 7.5. I think it is doubtful that you would pass and likely that you would be diagnosed with AI.

One should have an AM cortisol around 20 and the result should double to around 40 minimum in 60 minutes to successfully pass a stim test.

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

T3
08/20/09 269 (range 230-420 pg/dl)
12/20/08 324 (range 230-420 pg/dl)
06/01/10 318 (range 230-420 pg/dl)


T4
08/20/09 1.1 (range 0.59-1.61 ng/dl)
12/20/08 0.76 (range 0.59-1.61 ng/dl)
06/01/10 0.90 (range 0.80-2.19 ng/dl)
03/30/12 0.90 (range 0.80-2.19 ng/dl) (very ill at this time)

 

[roxie60]

It seems when I look back at the Cortisol tets (saliva and plasma they are consistently low in the AM), DHEA is at lower end of range and Melotonin PM is low but over 22 in the AM. I have always thought my adrenals were shot, even had one Dr say so 30 years ago but I dismissed her diagnosis. I would be curious what others Cortisol, DHEA and Melotonin tests results were especially if you were dx with AI. Again the ranges are all over the place. This will take a few tries to get this reply complete. I save and edit a few times just so I dont lose my work.

Cortisol (Plasma)  12/09/11    7.5    (range 6.0-23.0 mcg/dl)
 
Cortisol (Saliva)
 
7AM-8AM
05/31/12    4.2  Low    (range 7.0-10 ng/ml)
12/30/08    8.7            (range 3.7-9.6 pg/ml)
02/16/13    0.42          (range 0.27-1.18 mcg/dl)
02/20/13    3.0 Low    (range 7.0-10 ng/ml)
 
12N
05/31/12    4.8        (range 3.0-6.0 ng/ml)
02/16/13    0.25      (range 0.10-0.41 mcg/dl)
02/20/13    2.4 Low  (range 3.0-6.0 ng/ml)
 
5PM
05/31/12    2.8        (range 2.0-4.0 ng/ml)
02/16/13    0.21      (range 0.05-0.27 mcg/dl)
02/20/13    2.2        (range 2.0-4.0 ng/ml)
 
10P
05/31/12    2.8 high  (range <1.5 ng/ml)
12/20/08    0.4          (range 0.4-1.0 pg/ml)
02/16/13    0.08        (range 0.03-0.14 mcg/dl)
02/20/13    1.8 high  (range <1.5 ng/ml)
 
DHEA (Saliva)
7AM-8AM
05/31/12    240.9      (range 57-615 pg/ml)
12/30/08      5.8      (range 2-23 pg/ml)
02/16/13      69 Low  (range 71-640 pg/ml)
02/20/13    323.5      (range 57-615 pg/ml)
 
DHEA/Cortisol Ratio
02/16/13    164        (range 115-1,188 )
 
Melatonin (Saliva)
10PM
05/31/12      5.1 Low  (range 25-60 pg/ml)
02/20/13      <1  Low  (range 25-60 pg/ml)
 
8AM
02/16/13    22.66 high  (range <=10.50 pg/ml)
 
5PM
02/16/13    <0.50        (range <=0.88 pg/ml)
 
3AM
02/16/13    23.18          (range 2.53-30.67 pg/mL)

 

[roxie60]

I found this interesting

Salivary cortisol tests are more accurate when levels are elevated than in conditions in which cortisol is low.

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

Go figure, I suspect my cortisol is low but most of the tests have been saliva

 

[roxie60]

Another interesting comment from same article

Autoimmune disease accounts for about 80 percent of all cases of primary adrenal insufficiency.

 

[Ema]

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

T3
08/20/09 269 (range 230-420 pg/dl)
12/20/08 324 (range 230-420 pg/dl)
06/01/10 318 (range 230-420 pg/dl)


T4
08/20/09 1.1 (range 0.59-1.61 ng/dl)
12/20/08 0.76 (range 0.59-1.61 ng/dl)
06/01/10 0.90 (range 0.80-2.19 ng/dl)
03/30/12 0.90 (range 0.80-2.19 ng/dl) (very ill at this time)

It's really hard to make any current comments on results this old but...

First, AI has to do with adrenals and these are thyroid results. So one can have AI (adrenal insufficiency) with "in range" thyroid results. But most people with AI are also hypothyroid since thyroid requires sufficient cortisol to function properly.

I would say that your FT3 was too low in 09 and OK otherwise.

I would say that your FT4 is ridiculously horribly low except for in 09.

I shoot for a FT4 of 1.2-1.3 and a FT3 in the top third of the range.

I would definitely get new thyroid testing, specifically TSH, FT4, FT3, RT3 and thyroid antibodies (TPO Ab and TgAb) if you've never had those done.

Ema

 

[Ema]

I found this interesting



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

Go figure, I suspect my cortisol is low but most of the tests have been saliva

I would email her and ask for the reference. I do not believe that is true.

Ema

 

[Ema]

Another interesting comment from same article

That is probably true, but most of us with ME/CFS don't seem to be primary. We are usually secondary with a brain problem rather than a structural or antibody problem with our adrenals.

The ACTH stim test is not as good at detecting secondary AI as primary unfortunately. It misses about half of the people with AI. There is a low dose test that can be better if properly administered.

But with your AM cortisol results, I would be shocked if you would pass. Anything is possible when they hit your adrenals with 1000x the ACTH they could ever make on their own though...

Ema

 

[roxie60]

Just to minimize confision the #22 is a comment I made to the thread below. It grew into discussion about valid ranges, AI and TSH.

http://forums.phoenixrising.me/inde...-point-for-m-e-tests.24583/page-2#post-376341

 

[roxie60]

Ema If you dont mind sharing were you able to successfully treat the AI? How?

 

[Ema]

Ema If you dont mind sharing were you able to successfully treat the AI? How?

Yes, with physiological replacement doses of hydrocortisone and dexamethasone. It totally saved my life.

Ema

 

[roxie60]

Are those steroids?

 

[roxie60]

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)

 

[roxie60]

It's really hard to make any current comments on results this old but...

First, AI has to do with adrenals and these are thyroid results. So one can have AI (adrenal insufficiency) with "in range" thyroid results. But most people with AI are also hypothyroid since thyroid requires sufficient cortisol to function properly.

I would say that your FT3 was too low in 09 and OK otherwise.

I would say that your FT4 is ridiculously horribly low except for in 09.

I shoot for a FT4 of 1.2-1.3 and a FT3 in the top third of the range.

I would definitely get new thyroid testing, specifically TSH, FT4, FT3, RT3 and thyroid antibodies (TPO Ab and TgAb) if you've never had those done.

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).