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  • Should AM Cortisol Level be a lot higher than PM level?

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    Old 12-07-2007, 08:01 PM   #1
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    Should AM Cortisol Level be a lot higher than PM level?

    If someone has normal blood cortisol levels for the morning and late afternoon but there is only a one point difference, is this significant? Should the morning level be much higher than the afternoon level?

    Thanks!

     
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    Old 12-07-2007, 11:54 PM   #2
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    Re: Should AM Cortisol Level be a lot higher than PM level?

    Morning should be significantly higher.

    If they are about the same, then the question is: are they both high or both low. Both high = Cushings, both low = Addison's, both moderate = needs more investigation.

     
    Old 12-08-2007, 06:52 AM   #3
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    Re: Should AM Cortisol Level be a lot higher than PM level?

    Orion, thank you for your response. Both are in the normal range. The morning was 12 (range 4-22) and the afternoon is 13 (range 3-16).

    The doctor thought that maybe there should be a bigger difference between the two. He was going to check with a colleague who is more knowledgeable about adrenals.

    I also have Lyme disease and Hashimoto's Thyroiditis.

    Do you have Addison's or Cushings?

     
    Old 12-08-2007, 06:50 PM   #4
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    Re: Should AM Cortisol Level be a lot higher than PM level?

    What time were the tests taken? That is significant.

    The body's normal rhythm should be at its highest at around 8am. It should fall to roughly half that amount by 4pm (the lab ranges usually show time periods from 8-10 and 2-4). Ranges are wide and doctors that are not experienced can just look at what is *normal* and not see what is really wrong so at least your doctor is seeing that you possibly have an issue with your diurnal rhythm. Another good test is at midnight, where cortisol should be at its lowest and some with Cushing's will be high.

    A variety of tests should be performed and you should keep in mind that they differ is both how and what. Blood tests are testing serum cortisol and are point in time tests so you may or may not be high at the time of the test. Saliva tests are point in time, but test free cortisol. Urinary Free Cortisol tests are done over a long period - usually 24 hours or 10 hours and will tell you if your cortisol was raised in that average. The pitfalls for that, for me, for instance, is that I was so high and then so low, that the lows cancelled out my high and I was largely average or just barely high. Another pitfall of free cortisol is that some people "bind" free cortisol through no fault of their own (and some drugs and even estrogen does this) so that no matter how high they really are, free cortisol will not spill so a test call cortisol binding globulin is useful but only a few specialty labs carry it and good doctors know about it.

    One test should not rule you in or out. Dexamethasone suppression tests should not rule you in or out. I suppressed on every test and had confirmed Cushing's disease. Get many tests to know the source of your disease. It is not straightforward.

    I had both pituitary and adrenal surgery. I have Hashimoto's too.

     
    Old 12-09-2007, 06:26 AM   #5
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    Re: Should AM Cortisol Level be a lot higher than PM level?

    Hi rumpled, thank you for your reply.

    The AM draw was taken at 10:00. It was supposed to be at 9:00 and I was there at 9:00, but they did not realize I was there for only blood work until 10:00 when I said something.

    The PM draw was done at 4:00.

    I wonder if it would have been better to have the morning draw done at 8:00.

    Thanks for all of your feedback on the testing. It is a shame that they are not more reliable. Do you think it is even worth doing the saliva testing? It is expensive and not covered by insurance from what I understand. Which doctors would be most up to date on adrenal problems?

    I am sorry you are dealing with so much. How are you feeling?

     
    Old 12-09-2007, 02:17 PM   #6
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    Re: Should AM Cortisol Level be a lot higher than PM level?

    Ticker, my endo uses the saliva test from Diagnostech labs, they send you the kit and you do it at home, you start on a Monday morning at 8 am, it takes 3-5 minutes to put the swab in your mouth, then you place it in a vial and refrigerate it, then you do the same thing at 12 (noon), 4 pm, and 11 pm, it is very simple, then you mail the kit to the lab, on Tues. morning, it costs $100.00, which you submit with the kit, my INS reimbursed me $75.00 of the $100.00. This test also includes DHEA levels. My doctor feels that this test along with symptom history is very significant. Sarah

     
    Old 12-11-2007, 10:17 AM   #7
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    Re: Should AM Cortisol Level be a lot higher than PM level?

    Saliva tests are recognized as valid tests and with a doctor's order and diagnsosis code, insurance should pay. The ones my doctors order are usually by ACL labs or esoterix labs (which is owned by *******).
    If you read up on the protocols for testing, many of them include saliva testing. Your test was done a bit too late to really be accurate and hopefully your doctor will re-do your testing. Get to the lab a lot earlier next time and try to get an 8am fasting draw next time.
    Thanks for the wishes...I have a lot going on.

     
    Old 12-11-2007, 03:05 PM   #8
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    Re: Should AM Cortisol Level be a lot higher than PM level?

    Hi Sarah, thank you!

    I saw my doctor this morning. He talked to a colleague about my results and the colleague recommended that I do the saliva test. The doctor is supposed to be calling me later with the other doctor's contact information. Hopefully, I can get some answers soon (one way or the other).

    Do you have adrenal fatigue?

     
    Old 12-11-2007, 03:11 PM   #9
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    Re: Should AM Cortisol Level be a lot higher than PM level?

    Hi Kim, thanks for your reply!

    What are normal levels supposed to be? Highest in the morning and then steadily decreasing throughout the day? Should the noon level be somewhere in-beween the morning and afternoon level? Did you feel really fatigued because of what your levels were? When your levels were off, how did you feel in the mornings when you woke up?

    How long do you think it will take for the dose increase to kick in? I hope it helps you soon. Thanks again.

     
    Old 12-11-2007, 03:13 PM   #10
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    Re: Should AM Cortisol Level be a lot higher than PM level?

    Thanks rumpled.

    I apprectiate everyone telling me that your insurance covered most of the testing cost. I had heard it was not covered. Hopefully as you say when a doctor orders it, insurance should pay.

    I understand what it is like to have a lot going on. I hope you feel better soon.

     
    Old 12-15-2007, 06:18 AM   #11
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    Re: Should AM Cortisol Level be a lot higher than PM level?

    Thanks Kim. I also do not feel rested when I wake up even though I do not have insomnia and seem to sleep. I am glad the replacement is helping you. Anything that can help is good!

    I have an appointment Thursday with a doctor who is supposed to be knowledgeable about adrenal problems. I hope it goes well. He is over an hour away, so I hope it is not a waste of time.

     
    Old 12-17-2007, 06:12 PM   #12
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    Re: Should AM Cortisol Level be a lot higher than PM level?

    Hi Kim & Ticker--Ticker, hope your dr's appt. goes well Thurs. I am doing my 24 Cortisol saliva test today, I only have the 11pm-midnight left to. I am hoping that my levels have come up from the spring, but I don't feel much better, so I don't know. I do not have problems sleeping either, but I don't feel rested when I wake up, I could just keep sleeping if I didn't have anything else to do. All day I have trouble staying awake. My doc said to eat protein every hour , such as cashews, pecans, even if I don't feel a slump, and to stay away from colas and coffee.
    Kim, I had the 2 hour glucose tolerance test done last month, I was surprised by my results, my doc thought that I had probably become diabetic, but actually at 2 hours I was down to 49 mg/dL the norm is 65-99, so I wasn't high, I was low. I almost passed out between the 1st and second hour and they had to let me lie down. I did mine at Quest labs and they just make you sit in the waiting room between blood draws, the receptionist noticed that I was becoming pale and putting my head down, so they put me in a lawn chair they had in the back. Funny, but sad!! I hope that your test goes well and that you have a good holiday--you too Ticker!! Kim, I am going to CT for Christmas, and NYC for New Years, I wish that I could meet you!! Sarah

     
    Old 12-19-2007, 03:09 PM   #13
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    Re: Should AM Cortisol Level be a lot higher than PM level?

    Thanks you guys. I hope it goes well also, I need it to!

    I have compared my symptoms to those of adrenal fatigue and will discuss this with the doctor. If you have suggestions for questions or other issues to discuss, I would love to hear them. Thanks!

    I will let you know how it went when I get back home.

     
    Old 12-24-2007, 06:09 AM   #14
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    Re: Should AM Cortisol Level be a lot higher than PM level?

    Hi guys. My appointment went great and I really liked the doctor! I did the saliva test and sent it out over the weekend. He is checking coritsol and three or four other hormones. It cost $240.

    What amazed me was this doctor told me that if he could not determine what was wrong, he had several other people he could consult with. He is from NY, so he knows about Lyme disease. That was refreshing also.

    I am cautiously excited. I have been trying for years to have this testing done.

    Kim, I am glad you had a good time in NC and that you were feeling okay on your son's graduation day. I am sure you are very proud of him

    Last edited by ticker; 12-24-2007 at 06:10 AM.

     
    Old 12-25-2007, 05:08 PM   #15
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    Re: Should AM Cortisol Level be a lot higher than PM level?

    Kim, thank you for your kind words! You have been a great help with adrenal information

    I was told it usually takes about 3 1/2 weeks to get results. Maybe mine is taking longer because they are testing several hormones. The doctor told me to send it out and then make an appointment for a follow-up in a month. So I will schedule it soon.

    I am glad you have seen some improvement since starting treatment. I know it is frustrating that it takes so long, but you are on the right track.

    I hope your Christmas was nice and that 2008 is a happy, healthy year for you!

     
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