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Hypocortisolism Forums › General & Support › Question..Blood test vs Urine test?

05/01/2012 02:24 PM

Question..Blood test vs Urine test?

CanadianCat41

Posts: 138
Member

I have a question......why would a blood test (AM & PM) cortisol show that my adrenals have flat lined....and a 24 hour urine tests says normal?

I see an Endro doc May 7th and I'm wondering if I should be ready for another doc to tell me...nothing is wrong.

Thanks

July 16/12 - Officially diagnosed – Secondary Adrenal Insufficiency

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Catherine

05/01/2012 08:54 PM Top

LittleMissMerrySunshine

Posts: 1446
Group Leader

I'm posting some research here, because my knowledge on this one is limited...

the urine cortisol may be tested on three or more separate occasions to get a more accurate picture of average cortisol production.

**Sounds to me like the urine test is not so reliable.

A 24-hour urine test is used more often than a cortisol blood test to diagnose Cushing's syndrome. For more information on a cortisol blood test, see the topic Cortisol in Blood.

Other tests that can help determine if the pituitary gland or adrenal glands are working well include the adrenocorticotropic hormone (ACTH) and dexamethasone suppression tests. The ACTH stimulation test may be done when Addison's disease is suspected.

**I'm thinking the same thing here - urine is not so reliable with AI. It sounds like it is used more to diagnose Cushings than Addison's/Insufficiency.

I hope that helps.

Diagnosed PAI & SAI - 12/2009
PCOS - 7/2010 Hysterectomy - 6/2011
Propylene Glycol Allergy - 8/2012
20 mg/day HC
5mg/day prednisone

I always have an opinion or ten, but please consult a medical professional about your own situation. Advice on this board should never be a substitute for seeing a doctor!

Previous discussions I participated in:
Saw the GI Doc - As The Tummy Turns (update)
Emergency injection - carry or leave at home
Update - Tummy Troubles

05/01/2012 10:02 PM Top
bob3bob3 Posts: 4152 Senior Member	On the same day? Unusual, but not impossible. UFC is an average for the "day" but the usual serum tests are a snapshot in time. As an example if you have AI and had the blood draw before two 20mg pills AM and PM, those test would show close to zero, but UFC would look far higher. You also get "excess cortisol" ending up in urine which is why you never use it for dose setting. ie you might take a 20mg pill but half of it might be "wasted" because your blood reaches maximum saturation of CBG. (that's about 25ug/dL) Its also highly inaccurate for AI DX cases so much so that pathology texts warn about using it! In an undrugged or replacement state? Its possible your diurnal curve is wacky. You also have to consider that there are three basic cortisol blood tests, serum, CBG and free. Serum is the most common but for the life of me I cant remember if it is free+CBG or just CBG! An adrenaline flight/fight reaction happening on the same day will also elevate UFC but once again depending on timing not the blood. Cortisol has a half life of about 150 minutes so after 6 hrs its pretty well low enough to call insignificant. Oh "adrenal have flatlined" is not a very scientific expression! They produce far more than just cortisol! Its important to use science when dealing with doctors! Bob Post edited by: bob3bob3, at: 05/01/2012 10:04 PM Please remember that accurate answers often need detailed source information. Please considering putting your DX status, drug dosage and other information into your "About Me" or Signature Line. That also includes what country you are in because measurement systems and diagnostic methods vary around the world. Previous discussions I participated in: Feeling Poorly after ceasing treatment for AI Who Exercies? need help! DHEA and Pregnenolone

05/02/2012 06:01 AM Top

CanadianCat41

Posts: 138
Member

lol....adrenals have flatlined....was the doctor's term....lol

Medication: DHEA, progesterone, sleeping pills so I stay asleep at night, an anti depresent to control anger moments.

Vitamins: Multi Vit, D, C, B complex

Previous discussions I participated in:
Update - Tummy Troubles
Feeling Down & Out
Maintenance Dose

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Hypocortisolism › Hypocortisolism Forums › General & Support › Question..Blood test vs Urine test?

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