Adrenal Insufficiency Support Group

Can anyone help me interpret these results and give me information on it? My doctor isn't really being proactive about testing further.. she is pretty much set on what this ONE test says.. even though I'm still clearly exhibiting signs of all sorts of things.. salt cravings (literally licking the plate of salt), dizziness, extreme limb pain, headache and so fourth.. this is out of 7 pages of blood when I was in the hospital.. and 11 things were out of whack that four days!!

Okay, so I finally got my results from when I was in the hospital and I want to know what you guys are interpretations were on it.. all together 11 things were wrong that night out of the 7 pages of blood work that I have BUT my cortisol the night I was in was 1.3 and morning baseline cortisol was .6 at 6:15am I was given the stim test and then my cortisol at 9:28 was 19 then at 9:50 it was 18.8.. but my acth the next day was 10? Do you think they should have tested anything different or anything? And she told me she won't retest my dhea-sulfate.. that's for "infertitlity" specialists.. I was like that makes no sense dhea-sulfate is made by the adrenals which in return would mean I had this a while ago and she still won't do a ct scan on them either..

What were the other tests that were off? Do you have the ranges for your labs and the type of stim test that you were given? AND - what country do you live in?

Yes Hypomama is right, we need to know the country to understand these numbers. If you are in US that cortisol reading is extremely low and I would guess you were in a crisis situation. The ACTH would have risen after the stim test because the stim test gives you ACTH as part of the test. But that means someone really doesn't understand something if they are testing for that after the stim?

It all looks kinda confusing to me.

Deb

OK, I see that according to your profile you are in MA so I'm concerned. According to your test results you would be severely deficient in cortisol but it improved with ACTH stimulation. This points to secondary adrenal insufficiency. I seem to remember from a previous post that you had been diagnosed with central AI and given prednisone - 8 mg. This is a fairly standard dose. Are you still symptomatic? Is the issue that this previous diagnosis is now being rescinded?

Deb

Post edited by: ITeach91, at: 01/20/2012 02:32 AM

Caty

One further comment to others..

Once you have one major system out of spec, many blood tests will show up as out of range. ie they are subsequent not root causes.

DHEAS will be low if ACTH is low. Low ACTH is inferred by your low pre stim cortisol. There is no point rechecking DHEAS until you "fix" the root low ACTH cause. The common fix is to take Pred/HC etc to bring cortisol up. Importantly if you have secondary/central then as a result of this treatment your ACTH and DHEA will fall even more. This is how the regulation system works. You can't actually "fix" low ACTH (unless you have lots of $$$ or can manage to reverse the SAI damage), so you usually end up supplementing it. Since its OTC in the US that shouldn't be real hard to do. (Its a prohibited import/substance here with "no medical value".)

If you want to work through the path of steroid generation to figure what a "early" low level might affect an end use one, look up steroidogenesis. There is a rinky-dink diagram on wiki for example that shows where it all starts and branches. You'll see where DHEA limits testosterone and estrogens for example, but has no real direct effect on gluco-corticoids

Bob

Post edited by: bob3bob3, at: 01/20/2012 01:51 PM

what is central AI? the low dose stim they want me to do for that says it's for central

Central AI is another term for secondary adrenal insufficiency, or SAI, where the problem is in the Pituitary. Primary AI means the problem is in the Adrenals.

Low dose ACTH stim tests are usually used to narrow down iffy morning cortisol and ACTH levels. They can better point to either adrenal gland problems, or pituitary problems.

From what I understand, the low does ACTH stim test does not have to be done in the morning. They draw a baseline cortisol level, inject you with ACTH, and then look to see what the cortisol levels are 30, 60, 90, or 120 min later. It is the comparison of those levels to the baseline levels that is the crux of the matter. Is there a big jump in levels, or not so big, or just a little? Docs will like it it is either quite high or quite low, because that narrows things down as being very likley to indicate something. The biggest problem is when the numbers arein the middle, because they can't conclusively point to either direction. In that case, repeat the test, or try a different testing type.

In medicine, you can't view numbers as concrete yes's or no's, unless they are in the extremes of the 'normal' ranges given. Numbers have to be interpreted as indicating a probable likelihood. And test level numbers always have more credibility when on repeated testing they give about the same numbers.

Post edited by: DukeNLucy, at: 01/20/2012 07:31 PM

this doc said it has to be fasting and they draw a pre and 30 min cortisol only. It's a stressful drive there (eps with low sugar from not eating) I'm afraid my starting number will be higher, then I'll flunk th etest

It will be a comparison of cortisol from baseline to 30 min later. So even if your basline level is higher than usual and it is due to stress and low BP, it should not matter. The point of the test is to see see what happens after you're given ACTH.

Lets look at simple scenarios. The PIT more of less sends out ACTH, and that tells the adrenals to put out cortisol. What if the Pit is not putting out good ACTH? You'd have low cortisol. What will happen when you are injected with ACTH for the test? The adrenals would be starving for ACTH, be overjoyed with the massive dose of it, and pump out tons of cortisol in 30 min. The level at 30 min would easily double wahat it started from. Therefore, comparing low starting cortisol level and high cortisol level min level is usually indicative or secondary AI, or SAI. The pit has a problem.

Now what if the pit is working just fine and pumps out ACTH. But the adrenals are not working properly and can't process all that ACTH into cortisol. You'd have a low cortisol baseline level. You might even have a higher than normal ACTH level, because the pit would be trying as hard as it could to put out enough ACTH to prompt the adrenals to quit being lazy and do some good work. In the ACTH stim test, you'd be given a big dose of ACTH, and then had the cortisol level checked 30 min later. If the adrenals can't produce cortisol very well to begin with, it won't matter that you were given a mega dose of ACTH, the cortisol level won't rise much at all. So its an adrenal problem, Primary adrenal insufficiency, called either PAI or just AI.

It is always the comparison of the levels before and after that counts. Now I would think the biggest problem is when you get grey areas. What if you had both poor functioning pituitary AND poor finctional adrenals? In various levels for each? In that case, I bet a ACTH stim test would be inconclusive. You'd have low cortisol baseline, and maybe a sluggish cortisol rise 30 min after being given ACTH. It would be hard to point to the cause for the number comparison. But other tests could then be used to look further at the pit, and at the adrenals.

Docs will say, first things first - lets do a good ACTH stim test and see what that shows. Doing it fasting and in the am is good because if needed, the test can be repeated on the same likely conditions. Since you had very low cortisol before in the am, they can see if that will happen again when the baseline is taken. If it isn't, they will look to see if it is vastly different from before, or minorly different. They will take that into consideration when they do the compariaon of the baseline and the 30 min. But please remember - it is comparison of the levels that should count more than the numbers by themselves.

Post edited by: DukeNLucy, at: 01/20/2012 08:15 PM

I had the high dose one fall 2010, went from 14 to 28 I was SO stressed at the time, crying my eyes out, I was hypo and scared of the injection. My last endo said it proved I didn't have primary.

I have low ACTH but I also have dark skin spots and low aldostrone, so it's complicated.

treatment would be the same no? I'm just so sick and so frustrated.