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04/13/2012 04:59 AM

test results

fitdzin
fitdzinPosts: 21
New Member

I am new here, I have been lurking for quite some time while trying to figure out whats going on with me. You have some very smart, knowledgeable pepople on this board and I was hoping to get some advice. Long story short, I have been an athlete for many years. I have been having trouble with shortness of breath and low blood pressure for many years. I went to see the endo upon referral from the cardiologist, who suspected adrenals. At the time I saw the endo in 2010 I had been trying to get pregnant for a few years only to have two miscarriages. He did all of the standard testing,including 3 needle biopsies for my thyroid nodules. and I came back for a follow up and he said my nodules were all clear and did not mention the other results so I assumed they were fine. Fast forward a year, I finally did have a successful pregnancy. I had a lot of trouble with my blood pressure again during pregnancy, at a time it was supposed to go up, it was going down. It was 90/54 at the end of my pregnancy, which is where it usually sits, but being pregnant it did cause me to pass out. during delivery my pressure dropped to 80/30 and the emergency crew flew into the room and jabbed me with a big bolus of adrenaline. Now, I am 11 weeks post emergency c-section. I am so profoundly weak and am not improving. I am a fitbness trainer, and it is hard to get through work due to my weakness, low blood sugar and low blood pressure. I feel like I am going to pass out often. Out of curiosity I went and picked up my labs from the endo. Here is what I think is odd:

ACTH stim

baseline: 8

30 min: 11

60 min: 8

1 hour: 5

says the 60 minute value should double

Also, my aldosterone is flagged it was way high at 25.

Is it just me, or does it look like something is out of whack?

Any thoughts?

Thanks

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04/13/2012 05:34 AM
ITeach91
ITeach91  
Posts: 1872
VIP Member

It looks like, from the results you may have Addison's disease. It is important to not exercise until you get a diagnosis on this, you may push yourself into a crisis state. I got the following from the internet: Cortisol stimulation

In healthy individuals, the cortisol level should double from a baseline of 20-30 µg/dl within 60 minutes. For example, if the serum cortisol level was 25 ug/dl before the stimulation, it should reach at least 50 µg/dl.

Interpretation for primary adrenal insufficiency and Addison's disease

The baseline cortisol level in people with adrenal insufficiency is usually near 15 µg/dl. An ACTH stimulation test that raises the cortisol concentration to 20 µg/dl would support the diagnosis of primary adrenal insufficiency. In Addison's disease, baseline cortisol is well below 10 µg/dl and rises no more than 25 percent.

I am, however, curious about the high aldosterone. I would request a scan of the adrenals.

There is also a secondary situation that can arise out of pregnancy complications when the blood pressure goes too low. However, I think your primary situation began before your delivery from what you are explaining.

Don't delay. Follow up on this immediately and if you should feel worse (vomiting, extreme weakness, etc.) go to the ER because a crisis can be life-threatening.

Deb


04/13/2012 05:47 AM
fitdzin
fitdzinPosts: 21
New Member

Thanks so much Deb!

I am curious why an endo would dismiss results like these? And not even let me know my Aldosterone was so high?


04/13/2012 09:29 AM
Footprints11
Footprints11Posts: 391
Member

Fitdzin (love the name!),

Welcome! Regarding your last question.....my understanding, based on years of looking for and going to endos, is that it probably has a lot to do with economics of the field. In other words, while they are trained on the whole endocrinology field, the greatest number of patients they see-the moneymaking disorder-is diabetes. Addison's is still considered "uncommon" (tho I would argue that AI really isn't that rare....!). Therefore, the likelihood of endos who spend their days treating diabetics remembering the complicated HPA (hypothalamic-pituitary-adrenal axis), well......they simply often don't. I've come to accept it, frankly. And when I call around for a new endo (I've moved many times since diagnosis), I *always* say I need someone experienced in adrenal problems. Not that I always find one, but I try.

Here's a guess interpretation, but one for people to support or refute, because it truly is a guess. I don't have primary AI, so can't compare your results to mine, but there are PAI people here. First, do you know your baseline ACTH level? If it's elevated, that would support a diagnosis of primary AI. I would guess PAI especially if your ACTH is elevated; that your cortisol-producing cells are kaput. My thinking is that if you are not making enough cortisol, your brain tells your pituitary "MAKE MORE ACTH", which it does (so, should be an elevated level), which tells your adrenal gland "MAKE MORE CORTISOL" and "make more aldosterone".....at which point your adrenal gland makes more aldosterone (hence the high level) and goes "UGH" regarding the signal to make more cortisol (hence the pathetic cort baseline level and response to stim). Thoughts?


04/13/2012 11:07 AM
fitdzin
fitdzinPosts: 21
New Member

Makes total sense. I did have that test, I will look and see what it said when I get home. It was within the "rference range", but so was my a.m. cortisol of 7.

04/13/2012 11:22 AM
bob3bob3
bob3bob3Posts: 4213
Senior Member

Just a few notes.

Aldosterone isn't regulated by ACTH as such, but it does have a semi proportional response to it. ie ACTH has to exist. Most regulation actually more comes from potassium levels. What is important out of all this though is the knowledge of another input variable!

Also of note too is that the three base steroids made in the adrenal cortex come from different layers. Aldosterone more or less comes from the outer, cortisol from the next and androgens from deeper in. What I am getting at here is that primary AI causing damage could theoretically be layer dependent. Mind you this is only theory based on system knowledge. I've not heard of actual cases where cortisol is low and aldosterone is high. Most of us with secondary AI here are low/low and it gets worse (lower) on replacement dosing.

Perhaps the angiotensin/renin/aldosterone system is reacting to the low BP by itself the best way it can? It's horribly complex. Wiki has a nice diagram here if you really want to dig in.

http://en.wikipedia.org/wiki/Renin-angiotensin- aldosterone_system

What I find interesting too in your stim too is that the hour mark is less than the initial! Am surprised you don't have a primary DX from it too. Even if it was the low dose test (ie the final level defines success rather than doubling) it seems you have it.

Bob (Australia)


04/13/2012 11:27 AM
fitdzin
fitdzinPosts: 21
New Member

My dose of ACTH was .25....is that low dose?

again, thank you all for helping me.


04/13/2012 11:41 AM
bob3bob3
bob3bob3Posts: 4213
Senior Member

AFAIK 250ug is the "high" or normal test. 1ug is the low dose. In simple terms the high dose is meant to swamp the adrenal glands into a maximum output state, but the low dose is meant to give a proportional output to input. Adrenal gland insensitivity to ACTH for example would show up in a high dose test.

04/13/2012 01:03 PM
fitdzin
fitdzinPosts: 21
New Member

ACTH plasma was 8, ref range 5-27

04/13/2012 01:49 PM
bob3bob3
bob3bob3Posts: 4213
Senior Member

I'd actually question the whole test's validity then. There are a number of contradictions that can mean pituitary/hypothalamus OR actual adrenal gland damage. I can't think of a failure scenario that fits unless it's a complex autoimmune one or maybe kidney related. Not really in my knowledge set though.

Are you still 90/54 or lower? You can of course do a temporary fix on that by eating more salt.

Bob

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