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10/14/2011 09:02 AM

My recent saliva cortisol test----abnormal again

Pinkavenue
Posts: 4
New Member

This is my 2nd abnormal saliva cortisol test in 2 years.

3.8 am

2.4 pm

The lab director's comments basically stated that either my adrenals would continue to rise to meet the stressor demands or that my adrenals would eventually become exhausted. Last year my am level was only 1.1 and you know what the doctors did for me? Not a freaking thing. I am currently supplementing with Isocort, 5 pellets daily, as my thyroid group said I needed cortisol supplementation. I don't want to sound like a drama queen but I am scared of developing Addison's.........I've already experienced one adrenal crisis 3 years ago when I stopped Flovent too fast.

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10/14/2011 01:07 PM
bob3bob3
bob3bob3Posts: 4213
Senior Member

Not quite sure what you are asking for so I'll just make some general comments.

You have either a recoverable fatigue based condition or a more serious and permanent gland level problem. This group tends to concentrate on the more serious/permanent type, but we'll chat to anyone! Feel free to ask anything.

In simple terms a AI condition can be adrenal or pituitary/hypothalamus related. Supplementing cortisol at less than the total body need really only works well if the problem is adrenal gland based. If you take it for pit/hyp, that control system sees the supplementing as an excessive level and tries to regulate natural production downwards. Its common for example to feel good for a few days on Isocort then slide back to what it was like before.

Yes Flovent is a corticosteroid that no doubt contributes to your glucocorticoid budget. Excess use can actually cause AI, but you'd have to be badly ODing on it. Average Asthma steroid dosing for an AI person seems to contribute about 10-20% to the body glucocorticoid requirement.

In terms of valid testing you would have to have not had any Isocort within maybe 12 hrs (before) of the cortisol test. You also need to factor in any other glucocorticoids you may be taking. If your current test is valid it does in fact seem that the 1.1 to 3.8 shift is a good thing and your system is getting back to mid range. If however you have a history of AI symptoms then you may only get "so far" and will have to decide whether that is good enough.

If you have a real and bad AI condition the only treatment is usually replacement only. That's not always a good choice to make as quality of life may end up worse than your current marginal condition. Doctor's don't have many choices to go with.

You don't list your symptoms. Do you have any of the major AI ones? Exhaustion/fatigue is just one of many. Skin darkening, orthostatic hypotension, low BP, dehydration, cardiac misfires, allergy, bad emotional stress response like reactions etc are all worth looking at. Look at your history as well. Its also worth noting that what looks like Asthma is in fact low cortisol. I went off 30 years of Asthma treatment when I was found with AI for example.

If you don't do replacement the next level is to better regulate the needs of the downstream systems. Low blood pressure from mineralocorticoid action can be supplemented by more dietary salt. Low BG or energy effects can be regulated by lower glycemic and better foods and avoidance of allergy reactive substances. More proteins are important as are B6/B12/Folic and maybe D3. Some of these you have to be careful of OD levels though so testing isn't a bad idea.

I don't know the ref range of your labs cortisol test.

Bob (Australia)


10/14/2011 01:56 PM
Pinkavenue
Posts: 4
New Member

I have been Flovent free for well over a year--took it for 10 years and I just started using Isocort and adrenal supplements for a few days....my saliva test was done at the end of Sept. I have thyroid problems (Hashimotos) and always tired,unable to sleep well at night,wake up often,BP goes up and down,wide weight gain around the hips and middle,sugar cravings,loss of appetite (except for sugar cravings.) I also have IBS,anxiety,need coffee in the mornings to get the motor running. My hands tremble and I shake now when I am feeling stressed or under pressure.

Here's Sept cortisol results.

3.8 am Ref 3.7-9.5

2.4 pm Ref .04-1.0

2010 saliva results:

1.6 am

1.4 pm

Post edited by: Pinkavenue, at: 10/14/2011 02:42 PM


10/14/2011 02:29 PM
bob3bob3
bob3bob3Posts: 4213
Senior Member

Okay understood.

Make sure you spread the Isocort for the cortisol diurnal curve. Taking it too late in the afternoon/evening will keep you awake. As a guide when you do full replacement with hydrocortisone you take a minimum of three doses per day with the full dose size being split 1/2 at breakfast, 1/3 at lunch and 1/6 around 5PM with snack. If you are breaking your Isocort into 5 doses I suggest maybe 6AM, 7:30AM, 10AM, 1PM & 5PM.

Thyroid and adrenal are interdependent. Most of us with AI are also hypothyroid and take thyroxine as well as the AI steroid. I assume you take T4? Tiredness mainly comes from low metabolism (ie low blood sugar) and your sugar cravings kind of help prove that.

If your T4 is in the middle of normal range then it seems you might benefit from full cortisol replacement. It would be nice though to get another saliva test in maybe 2 months to see if any further improvement takes place. The big issue is that Isocort may be inhibiting natural improvement so it becomes more of a quality of life decision. ie can you put up with the (worse) pain and fatigue of a longer wait?

If you go mainstream medicine most endo's will assume you are "just" okay with the tests you have, plus they will also say to wait as I suggested above. It might be a good idea to say roughly where you are so others in the group nearby may be able to suggest a more forward thinking doctor! We often see complaints of ineffective or useless medical people here. Many are prejudice against saliva tests as well, even though blood has its own accuracy issues.

If your better feelings on Isocort fall off as I suggested in my last post you can see that as part proof of secondary (pituitary) AI.

Bob


10/14/2011 02:48 PM
Pinkavenue
Posts: 4
New Member

Thanks for the reply; I cannot find a useful doc (I've been fired from endos for asking for saliva test and Armour thyroid meds) and after going through 7 unhelpful endos who keep me undertreated, I am self-treating. I was not sure how to use the Isocort,so I have been taking 3 pellets in the morning,2 in the early afternoon. I do need my thyroid tested again but my last Free T4 in August was 1.7, which is borderline normal and the endo refused to adjust the meds and she thought I was a quack job when I mentioned I might have an adrenal problem. This is why I self-treat.

Kristina

Post edited by: Pinkavenue, at: 10/14/2011 02:55 PM


02/03/2012 09:14 AM
Pinkavenue
Posts: 4
New Member

Did the am/pm cortisol saliva test through ZRT last week. I did improve

since last tested in the fall---posted both results. Used Isocort until

December,then stopped all adrenal treatment.

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