Adrenal Insufficiency Support Group

I just got out of the hospital yester becasue I have been having chest pain... all came back normal except I have an inverted t wave. Recent blood work from endocrinologist is this

TOTAL VOLUME 1500 mL CORTISOL,

FREE, URINE 64.0 4.0 - 50.0 mcg/24 h

Urine Creatinine (mg/24h) 1.53 0.63 - 2.50 g/24 h

CORTISOL, SALIVA,LC/MS/MS 0.03 mcg/dL

24 HR URINE VOLUME 1500 mL/24 h 5-HIAA,

24 HOUR URINE 5.0 <=6.0 - mg/24 h

TESTOSTERONE, TOTAL 10 2 - 45 ng/dL

TESTOSTERONE, FREE 1.4 0.1 - 6.4 pg/mL

Metanephrine <25 <=57 - pg/mL

NORMETANEPHRINE, FREE 112 <=148 - pg/mL

TOTAL METANEPHRINE 112 <=205 - pg/mL

ACTH, PLASMA 18 6 - 50 pg/mL

Hemoglobin A1c 5.3 <5.7 - % of total Hgb

Glucose 102 65 - 99 mg/dL

Urea Nitrogen 16 7 - 25 mg/dL

Creatinine 0.60 0.50 - 1.10 mg/dL

eGFR, Non-AA 120 > OR = 60 - mL/min/1.73m2

eGFR, AA 139 > OR = 60 - mL/min/1.73m2

BUN/Creatinine NOT APPLICABLE 6 - 22 (calc)

Sodium 138 135 - 146 mmol/L

Potassium 4.9 3.5 - 5.3 mmol/L

Chloride 105 98 - 110 mmol/L

Carbon Dioxide 21 21 - 33 mmol/L

Calcium 9.8 8.6 - 10.2 mg/dL

TRYPTASE 5 2 - 10 ng/mL

THYROID PEROXIDASE ANTIBODIES 637 <35 - IU/mL

DHEA S 434 40 - 325 mcg/dL

Component Your Value Standard Range Units Glucose 89 70 - 99 mg/dL

Urea Nitrogen 6 8 - 20 mg/dL

Creatinine 0.70 0.44 - 1.03 mg/dL

TRIIODOTHYYRONINE 1.16 0.80 - 2.00 ng/mL

Sodium 139 136 - 144 mmol/L

Potassium 4.7 3.6 - 5.1 mmol/L

Chloride 104 101 - 111 mmol/L

Carbon Dioxide 28 22 - 32 mmol/L

Calcium 9.2 8.9 - 10.3 mg/dL

Protein, Total 6.6 6.1 - 7.9 g/dL

Albumin 4.0 3.5 - 4.8 g/dL

Bilirubin, Total 0.3 0.3 - 1.2 mg/dL

Alkaline Phosphatase 94 38 - 126 U/L AST 20 15 - 41 U/L ALT 22 14 - 54 U/L

White Blood Cells 11.1 4.0 - 11.0 THO/uL

Red Blood Cells 4.63 3.80 - 5.30 MIL/uL

Hemoglobin 13.3 12.0 - 16.0 g/dL

Hematocrit 39 36 - 46 %

RDW 12.9 11.5 - 14.5 %

MCH 29 27 - 33 pg

MCHC 34 31 - 36 g/dL

MCV 84 80 - 100 fL

Platelets 314 150 - 400 THO/uL

FREE THYROXINE 0.85 0.93 - 1.70 ng/dL

DEHYDROEPIANDROSTERONE SULFATE 444 45 - 270 ug/dL

Can anyone tell me if there labs have ever been like this.... Thanks

I have been diagnosed with anxiety and panic. But nownot so sure

Well um...

Do you actually have AI symptoms? Chest pain is pretty vague and although one of the possibles for AI would be super rare by itself.

Some of your results seem way out of range though. Transcription errors maybe? (THYROID PEROXIDASE ANTIBODIES, DHEA, FREE THYROXINE, DEHYDROEPIANDROSTERONE SULFATE etc) You also have quite a few dupes and no time frame.

AI usually manifest as low serum cortisol. UFC isn't that reliable and you haven't indicated the ref range for the saliva test. You also generally see low BG and depending on whether it is primary or secondary ACTH off range and elevated K, lowered Na. Its better to start at the symptom, end though. Fatigue and low BP are common for example.

Bob

All of these resullts are from jan to febuary. The symptoms im having are all of that of anxiety and panic disorder. Which is what I was my original diagnosis. These results are correct. High blood pressure feeling faint, light headed nervous all the time. anxious cant sleep well heart palpataions....etc

Well that's not a good AI symptom fit. Secondary AI does sometimes have periods of adrenaline release when cortisol gets too low, but its not constant. You kind of get more and more fatigued then "wham" you get a few hours of palps, anxiety and the like. This happens more when you have more overall system load. ie its less likely to happen if you just sit/lie around the house rather than being very physically active.

Well you have two DHEA tests 434 & 444 (45-270) that are far from normal. Glucose is a little high, TPA is off the chart and UFC is also high! If you have an adrenal problem it looks like the Cushings end (too much) than too little. The anxiety/palps/high BP symptoms dovetail with that. Keep in mind that I am not an expert in "too much cortisol" situations but it superficially looks that way.

are you male or female?

Helps for the dheas as it's a precursor to testosterone.

If female do you have any PCOS symptoms?

If male, nevermind.

Female amd was negative for PCOS. My endocrinologist cancelled my appointment with her and set me up with an adrenal specialist. It confusedme because of the TPA.

It sounds like cushings. Weight gain?

lost 30 lbs in a month

Adrenal gland growth? You'd expect ACTH to be zero though. Maybe a growth more in the androgen layer. T4 is a little low but T3 is good. Compensation for higher cortisol maybe? Isn't Metanephrine used to check for adrenal growths?

Progesterone/Estrogens? Low numbers there can led to anxiety/irritation. Low LH/FSH for example might leave the DHEAS high..

Sorry half guessing (Although wishing I could lose 30lb in a month!)

Hmmmmm....... I guess it's worth a shot at asking the doc what he's thinking, at least. That way, you can research his thoughts. It's awesome that you got so many of your test results, because that helps you go ask more questions. I like to do that. If he has suggestions on the Next Move, I would want to know why so that I could see if that all makes sense to me. First thought.

Secondly, like Bob, I'd wonder why he's zeroing in on adrenal. I would say you have Hashimoto's, at least, based on the test results.....although oddly, no TSH! That's usually the absolute first test a doc will run, often without any other thyroid measures. Kinda unusual, actually (tho I'm not saying that's a good thing, cuz I don't believe that. I think it's important to look at TSH, T4 and T3 at the same time to get a Big Picture look). Here's an interesting site to look through: http://www.stopthethyroidmadness.com/ Anyway, with the TPO antibody level so high, it's possible/likely that your thyroid is currently under attack, stressing that axis. My guess is that a TSH would be elevated, supporting the Hashimoto's diagnosis.

Are your nocturnal problems before your period, or in any way related to your menstrual cycle? Mine are, although I'm not quite sure why, yet. Still working that out. However, they *may* be less now that I'm not taking my cortef (ie cortisol replacement) at bedtime (apparently that's a no-no, but it took 8 years before a doctor pointed that out). So, maybe elevated cortisol at night (there's a circadian rhythm, so no way of knowing whether morning cortisol is related to nighttime levels) is contributing to problems. Just throwing that out there. My nights have been fabulous since I started taking my "night time pill" at lunchtime.......

Heart pain.......I've had that, too (two different kinds, maybe). But for me, I don't think it was heart pain. I went to the ER once for a clutching kind of pain that came and went......famdoc told me to go, just in case. Whatever the main measures of heart attack were, were normal (however, looking at the report after the fact, I see that one of the tests was actually *rising* while I was there, indicative of some kind of general muscle damage.....disturbing since it was never mentioned at the time. Er, if it wasn't heart attack, what else could've caused that? Sorry, I dont have it on hand, as it's in the car so I don't remember. Anyway, another great reason to get results asap so you can go over them with a doc!) A couple years later, I was experiencing intense chest pains, but I coincidentally was on a holter monitor so I knew for sure these weren't heart abnormalities. Turns out the pain was due to *swallowing* problems, causing things to get stuck midway down causing horrible pain. <surprised> So, I guess it's important to be as specific as possible, and keep looking and looking and asking and asking.....

Don't give up!