My labs all came back in range but if anyone has some thoughts I'd appreciate it.
For a more accurate picture I'll give you a little background. My blood was drawn two months ago when I was very early into my second trimester; the baby had died only a few days before but we weren't aware of it at that point. I have Hashimoto's thyroiditis but at the time was hyperthyroid.
I posted earlier about my situation but only had my serum cortisol at that point. I wanted to add the rest of my labs.
Free Cortisol, U 45 (range 3.5-45)
Cortisone, U 96 (range 17-129)
As far as I can tell it is not reported anywhere on my labs that I was pregnant. Maybe these levels aren't affected by pregnancy but typically when I'm pregnant it will say on my labs so that the ranges can be properly adjusted (even on my CBCs it says that I'm pregnant even though the ranges don't change).
All I can tell you is that I all of my blood and urine are lower than yours and I am "perfect". I don't believe it at all though.
Tomorrow I am going to CA to see Dr Freidman and I will let you know what he says of my levels, then you can compare to yours...
Hello thanks for the reply. I'd be very interested in hearing what Dr. Freidman says about your situation.
Are you pregnant? I can't find much info online about whether or not pregnancy significantly alters adrenal testing.
I was under a lot of physiological stress due to the pregnancy, recent fetal demise (although I didn't know it at the time I'm sure my body did) and hyperthyroidism. I'm wondering if that would have skewed my results considerably.
I'm seeing a holistic dr several hours from my house within the next 6 months(Dr. David Brownstein...he's written a few books and follows Dr. Broda Barnes' philosophy of balancing the hormones). Hopefully he'll be willing to work with me to help regain some hormonal stability and balance.
In the meantime I'm hoping to gather as much info as I can on my own. I don't like to visit a new dr and not know what he's talking about.
I looked a few things up last night and am now wondering why my urine cortisol was at the very top of the range (45) but my blood cortisol isn't anywhere near the top of the range.
I also read that cortisol levels and ACTH can change in an instant. If the levels are so variable even within one person how can measuring them once give any kind of an accurate picture at all? I would think it would take several days of drawing blood several times a day before a clear perception would emerge. I'd appreciate it if someone could shed some light on this as well. Maybe I misunderstood what I read.
I learned the hyperT can increase cortisol levels, pregnancy increases cortisol levels and physical/emotional stress can increase cortisol levels. Why did my endo feel she'd get accurate results from a person in my condition. I'm hoping it's not as muddled as it appears to be to me.
My endo happens to rely heavily upon her labs and she won't run them again (she herself said it's tricky interpreting adrenal testing in a pregnant patient...so what was so tricky about her looking at the sheet, seeing their in range and declaring that I'm fine without further explanation??).
I'm very confused about things. I read things on these boards, the thyroid boards and online...then I go to my drs and they tell me something different. When I ask questions they either say they don't know or ask where I got that information (they've just been so helpful ).
Anyway, thanks for any help you can give!
P.S. I gave up caring for a while because I was feeling so well but now even though I'm feeling okay (only feel poorly during the week before and week of my period...I have terrible flare-ups at that time) I can't sleep and I'm having trouble with eating. I don't want to have to rely on meds to get to sleep and I don't know how long I can get by on less than 1,000 calories per day. I took Benadryl to get to sleep last night (pharmacist recommended it because everything else wires me due to the Hashimoto's). I slept for 14 hours; since I got up feel like I drank two pots of coffee myself...just so jittery! I'm glad I feel so well but I'm getting tired of the insomnia and no appetite/nausea.
Was just looking at your labs, and wondered exactly what your symptoms are? Will look further back on the board to see if you've listed them anywhere before! Am I right in understanding you have just gone through the loss of miscarriage? If so, I send my sympathy. I lost a child after carrying him/her for 9 weeks only, and it was hard. After the loss, I seemed to take longer to get back to "normal" emotionally than after I'd had my babies. The hormones didn't seem to gradually taper off. My theory was that they did a massive, immediate "dump" into my system. It was quite easy for me to cry at the smallest things, and I don't generally feel comfortable crying in public!
Now on to your labs -- I am certainly not an authority, but I would wonder about your pituitary gland in causation of any symptoms. The reason I say this is that though your cortisol was rather low at 14 --(IF IT WAS A MORNING CORTISOL DRAW), your ACTH did not spike higher to try to convince the adrenal glands to put out more cortisol! The ACTH comes from the pituitary, and should be on the HIGH side if your body isn't getting enough cortisol. If it isn't, you need to question the health of your pituitary gland. You might test for what is called secondary adrenal insufficiency, due to the malfunctioning of the pituitary. It IS hard to diagnosis adrenal problems with labs alone, but there ARE some telltale labs. The best is the ACTH stimulation test or the low dose ACTH stim test. When they do this test, they take a morning cortisol measurement at as close to 8:00 a.m. as possible (this is when your cortisol should be at its highest). Next they give you an injection of a substance that is similar to the body's ACTH, to see whether your adrenal glands will react by giving forth more cortisol, as "asked" to do by this chemical. What you should see is a morning, fasting cortisol in range (somewhere in the 20's is best). After 30 min. they measure the cortisol again through the blood, and finally after 60 min. again. At the end of 60 min. your cortisol should have DOUBLED if your adrenal glands are normal. But this just says the ADRENAL GLANDS are working, if it goes this way!! It doesn't tell you whether they pituitary gland is working! They should also get an ACTH plasma level before they begin the test, and measure of renin and aldosterone levels. For the renin test, you should lie down for 30 min. before they take your blood. Low aldosterone can be an indicator of waning adrenal glands, as well, as IT is also made in the adrenal gland, in the same zone the cortisol is produced in (same area of the gland). Dr. F (in LA) seems to feel renin and aldosterone are great indicators of adrenal distress! Also, ask for your potassium and sodium, fasting blood sugar, and your blood pressure lying down and standing up for 5 min. to be measured. Many times your potassium and sodium levels will look normal, even WITH adrenal problems, but if yours DON'T, you'll have another clue! When standing up, BP's miight fall, while pulse goes up (which would indicate postural hypotension, another symptom of adrenal insuf.). Low fasting blood sugars are another sign. Also, low, low resting BP's are a symptom of adrenal problems.
Hope this has helped answer your questions a bit. If not, please write back!
Hello Tracy!! Thank you so very very much for the info!! I'm seeing a holistic MD soon and will request those tests. I have no doubt he's familiar with them as he deals specifically with the hormones.
It's hard to say which symptoms are due to what but the ones that have *not* gone away with thyroid treatment are:
hair loss (I don't have to shave my arm pits or legs for weeks)
Night time jitteriness (like restless leg syndrome but it's my whole body)
hyperpigmentation of skin folds and scars (this and the tremors is why my endo tested my adrenal hormones)
Bleeding throughout my cycle (I used to bleed for 21 days out of my 35 day cycle but recently I don't stop bleeding at all)
chronic sore throat (I've had it for four years and my tonsils have now been swollen and inflamed for over a month)
Headaches (migraines with my cycle)
Those are the ones I can think of. Of course when I flare-up around my cycle everything gets worse and I get muscle/joint pain, weakness, foggy brain, burning/urgency/hesitancy when I urinate, eyes ache and I feel uncoordinated.
Thanks for the reply!!
P.S. I forgot to mention that I have arrhythmias throughout the day. My pulse is usually somewhere between 40 and 50 when I get them. Normally my pulse is between 60 and 70 (although when I flare-up it's between 80 and 100).
I used to only notice them when I would go to bed. Then I started noticing them during the day when I would sit down. Now I notice them all the time...even during moderate activity. I haven't tried to notice them, it's just not possible to ignore them anymore (I may have been having them during activity before but not noticed because I was busy but now...like I said...I can't ignore them).
Last edited by ASDGRMama; 10-26-2005 at 06:16 PM.
Reason: wanted to add P.S.
I am glad you are going to see a doctor who will test your hormones for you! This is half the battle! Because of the heart and pulse issues, I am especially interested in finding out what your sodium and potassium look like on paper! I'm sure not as interested as YOU are, though!! ;o) Because it might be your pituitary that is malfunctioning, you might be wise to ask for the doctor to test your FSH, growth hormone, testosterone, and any other hormones produced BY the PITUITARY gland. Just a thought. I hope he is willing to do this for you! Keep us posted on your results! And good luck with finding an answer! ~ Tracy
You are right that serum ACTH and cortisol change frequently throughout the day and so they are not really the best tests for getting an overall view of things. But if you have primary Addison's disease (adrenal failure) then ACTH will always be high -- because the pituitary is vainly trying to stimulate the dead adrenals. So, you can rule that out in your case because of your lowish ACTH. It is the high ACTH that causes hyperpigmentation in Addison's disease. So, your hyperpigmentation must be due to something else (who knows what.)
The 24hr urine is a better test in some ways because it shows the entire day at once. Yours was high because of the pregnancy... although given that you were pregnant, both the urine cortisol and esp. the serum cortisol seem low to me.
I agree with Tracy that this could be a pituitary issue (secondary Addison's disease) and having your other pituitary hormones tested would be a good idea. It could also be something totally non-endocrine like epstein-barr virus, or a systemic autoimmune disease. The fact that you already have one autoimmune disease (hashimoto's) might mean you are predisposed to have others.
LOL, rollingstone, I think you misunderstood me . I don't drink coffee...at all...ever. I was saying that I *felt* like I had drank two pots of coffee (which I've never actually done...just exaggerating to make my point ).
I have never been able to tolerate caffeine very well and avoid it as much as possible. I don't tolerate sugar very well either and refrain from using it more than occasionally.
It's a good suggestion though for someone who does drink it and can't sleep.
That's cute. I was looking back to find where you said you drank that much coffee!! But actually, sometimes people are like that. When you feel fatigued, as my son does, you sometimes get tired of feeling that way, and want a short term "high". My son often begs me for energy drinks. They are not good for him, but I know his spirits are important, too. So sometimes I weaken and understand that he just wants to feel "normal" or anywhere closer to it, for a short bit, and buy one for him. Naughty Mom!!
I forgot to list LH as a pituitary hormone, Kelly. That was the other one. There may be others I'm omitting, but perhaps your doctor will suggest them, if she knows you're trying to test pituitary hormones for another clue!