ACTH test results and treatment ?

[Joan123]

Thank you for all your insight. I will see if I have any of his past blood results. He will get a new CBC on Tues. when he gets his remicade infusion. He is on a replacement dose right now of 5 mg Pred/5mg Cortef in the am and 10 mg Cortef in the evening. He certainly has been a complex case for his doctors. I was wondering too if the adrenal insufficiency would be more permanent since the last he was on Pred. was in Sept. He is on a lot of other meds right now too for his Crohn's. He is currently on Asacol, Bentyl, Prevacid, Pancrecarb MS-8, Zofran as needed, Cortef, Pred., Amitriptyline (sp?) and Remicade...I think that is all!

I know when he has been hospitalized and on IV steroids, his glucose has been elevated but last time it was tested when fasting it was in the normal range. I do worry about diabetes with him. I will see what I can find on past blood work. One more thing, does tingling in the hands relate to anything with AI?

[Hormoneman]

Everyone is different. Some can take steroid for a year or more and wean off and be ok and some can have premanently suppressed HPA axis in as little as 3 months.

Amitriptyline is bad for the thyroid, especially if one has hypothyroid.

Glucose ranges are very flawed. Upper number is usually 99. 100 to 124 is considered prediabetes. I look for fasting glucose of 50 in adults.

Yes, tingling in the hands is a symptoms of AI which can cause less blood flow to hands and feet. Low cortisol can lower body temp and make you feel colder.

[Joan123]

His glucose has never been even close to 50, usually around 90-110. My son does have a low body temp, usually 96.7-97.8 and is cold a lot. He also gets dizzy when moving suddenly which I assume is probably lower blood pressure when sitting or laying.

The thing I don't get is his GI doc. who regularly prescribes steroids for the imflammatory bowel diseases wouldn't think to look at cortisol levels, especially when he had all the symptoms and she couldn't tie the symptoms to crohn's in remission. I would think that would be something they would look for.

I found some of my son's labs from 11-29-06. At that time he was having severe nausea with headaches and hypoglycemia not quite so bad. Some that may have some meaning to AI--Glucose 84, BUN 12, Creatinine 0.7 (low), B/C ratio 17.1, GFR 166.8, Sodium 139, Potassium 4.2, Chloride 106, CO2 24 (in the past that has always been low but okay this time), Anion Gap 13.2,Calcium 9.6 and Osamolality 287. Hemoglobin 13.2 (low), Hematocrit 38.7 (low) MCV 76.6 (low), WBC 13.1 (high),Granulocytes 7.4. (high) Lymphocytes 3.8 (high). I don't know if these would point to anything, but ? One more test, in Oct. before Gall Bladder surgery a Urinalysis showed Glucose (negative), Bilirubin 1+, Ketone trace, Protein trace, Micro Mucous small, Spec. Grav. 1.025, pH 6.0, Urobilinogen 0.2 E.U./dL.

[Hormoneman]

He may have hypothyroidism also contributing to his low temp. Where there is AI, usually hypothyroid is present.

I have yet to hear of a GI doc who knew anything about hypoadrenal or hypothyroid.

Always include ranges for any test. What are the ranges for his sodium and potassium? Those numbers look suspicious to me. 95% of those with hypoaldosteronism are in range on sodium and potassium. I've seen enough of these tests in combo with aldosterone test, I am pretty good at predicting who will have low aldosterone by just sodium an potassium, but I also look at symptoms with these tests.

Does he crave salty foods? His dizziness may be related to salt depletion. Ask him if when he stands if sometimes his eyesight goes dark and his ears give a wierd noise. Try him on salt water (real sea salt which is brownish) when he wakes, maybe in the afternoon and when he gets dizzy. I bet that will help. If he gets a headache or migraine give him salt water. Low aldosterone can do this, but very low aldosterone, you may not get headaches.

Does he have LDL or HDL cholesterol you can show?

[Joan123]

Potassium range 3.5-5.1 his is 4.2
Sodium range 136-145 his is 139

He says he doesn't get faint or lose vision or hear things when he gets up suddenly. His hands get tingly. He also has blurred vision a lot but we have blamed that on his meds. Its funny you ask about the salt because just earlier this evening he made a comment about liking that I bought some salty chips. Just now I asked him if he ever craves salt and he said sometimes he really wants salt and he feels a little better after he eats salty food. Interesting, I had never thought to ask him about the salt.