I was wondering if anyone could let me know of any specific questions I should ask my daughters doctor, just in case I cant think of any. I have posted here before regarding her symptoms, and she finally has another follow up tomorrow afternoon... thanks..

I think the number one question would be how many patients has your doctor seen with adrenal problem?

I so agree with asking the endo how many addison patients he has.

I am assuming your daughter has not been diagnosed with addisons. If not she should have the following tests.


Diagnostic Testing for Addison's Disease

TEST 1: Electrolyte profile:

OBJECT: To determine if the patient exhibits a normal serum (blood) sodium and potassium levels.

THE TEST: A blood draw followed by automated determination of sodium and potassium levels as well as other standard blood markers.

NORMAL RESULT (will vary somewhat from lab to lab): Sodium 135-150 mEq/L; Potassium 3.5-5.2 mEq/L

PRIMARY ADDISONIAN: Will show significantly below normal values of sodium and a elevated (above normal) levels of potassium.

REASON FOR ABNORMALITY: Low or no production of aldosterone from the adrenal cortex. This steroidal hormone regulates our mineral balance and is called a mineralocorticoid. Primary Addisonians lose sodium and retain potassium. Abnormal values here, in additon to physical signs and symptoms, require the next test.


TEST 2: The ACTH stimulation test:

OBJECT: To determine if the patient's adrenal glands can respond to the ACTH message from the pituitary to increase cortisol production in the adrenal cortex.

THE TEST: The test is usually given first thing in the morning when normal cortisol levels are highest. Blood is withdrawn from the patient to establish a baseline (No instructions regarding necessity for fasting). The patient is given 250 micrograms (ug) of ACTH (Cortrosyn, Cosyntropin, or Synacthen) by injection in saline at one time. Blood is drawn at 30 minutes and/or 60 minutes and the serum cortisol level is determined.

NORMAL RESULTS: Normal pre-injection levels of cortisol are 5-25 ug/dL (138-690 nmol/L). The value should double at 30-60 minutes with a minimum of 20 ug/dL (552 nmol/L). PRIMARY ADDISONIAN: There will be no or little increase in cortisol levels upon ACTH injection. Notes: It is stated in several places that a single test of cortisol levels, or even 24 h urinary levels of cortisol and its metabolites, are NOT DIAGNOSTIC! In the normal individual cortisol levels are seen to pulse. Low cortisol production in either the serum or the urine after ACTH stimulation is diagnostic of Addisons disease.

SECONDARY ADDISONIAN (Pituitary malfunction): Low cortisol production can be seen if the patient has "functional adrenal cortical atrophy" due to prolonged absence of normal ACTH secretion. This type of patient would not show the typical hyper-pigmentation of primary Addisons.

REASON FOR ABNORMALITY: Due to autoimmune, or other destruction of enzymatic (biocatalytic) machinery of the adrenal gland, there is no response to ACTH and no production of cortisol and other adrenal steroids necessary for life. If this test gives normal results and the patient has other signs and symptoms then one of the following tests is required.

wow, thanks for all that advice! well, the doctor actually said she has never had an addison's patient, and one doctor there had one case, that she has ever heard of. She said it is very rare, so unlikely that my daughter has it. She did a manipulation, where she moved my daughters head quickly, to check for vertigo, said that was normal, but she wrote a rx for meclizine just in case. She said if that helps my daughter, that would confirm the diagnosis of Vertigo, and I dont need to bring her back. She said my daughter has gained 9 lbs since Feb, so that means all her hormones are working. She did say she will go ahead and do another blood test in 3 weeks, to check her hormones again. But, she thinks its just vertigo. well. I dont know. I have already tried meclizine for my daughter, and all that does is make her sleepy. I dont know what more to do. I researched the internet for specialist in AZ that are familiar with Addisons, but I cant find any. I will keep you all posted... thanks

Make sure her elecrolytes are checked also. Sodium & potassium. Because something is rare, is no way to rule something out. It is good that your daughter has gained weight. With addisons she would more likely loose weight.