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  • can you have Addisons & secondary adrenal insufficiency both?

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    Old 07-03-2009, 01:14 PM   #1
    sleepymommy's Avatar
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    low ACTH AND low cort stim--please help!

    Hello out there. I'm new here. Have some confusing results and have to wait 3 weeks before I can see my endo again. Can anyone out there help? I know of course I'll have to wait until I see the doc to know what's going on, just looking for what this it could mean so I can read up... I work in the medical field so I'm fairly knowledgable, but this is pretty complicated.

    I've had fatigue, hair loss, salt craving, marked lightheadedness/pre-syncope, amenorrhea, and low blood pressure. My initial (random) cortisol was normal at 9 (norm 5-23). On a stimulation test, my ACTH was only 5 (norm <10) and my cortisol stim'd from 9 to 15, so didn't quite double. Endo put me on hydrocortisone and ordered a brain/pituitary MRI, which came back normal. The on-call endo actually called and put me on 20 mg hydrocortisone morning and 10 mg at night, but my personal endo called back a week later to say that dose was too high and to cut it in half. I actually felt much better on the first dose lightheadedness-wise.

    Just over the phone prior to the MRI, the endo said it looked like secondary adrenal insufficiency and not Addison's, but I don't understand after researching why the cortisol after being stimulated would still be on the low side. Shouldn't it be high in secondary adrenal insuf? And why would I crave salt with secondary? It's not slight salt craving--I literally eat spoonful upon spoonful (which she said was OK to do) and have very low blood pressure (90/56 lowest recorded). And what could be causing it with the normal MRI? I have taken prednisone in the past, but not for many years and only a short (one week) course for asthma. Can prednisone permanently damage things? Never really had any major bleeding or head injuries...

    I'm a 29-yo female and also have hypothyroidism, had autoimmune thyroiditis, and my daughter has growth hormone deficiency...

    Is it possible to have both an Addison's problem and secondary adrenal insufficiency or do these labs point to something else entirely?

    Anyone else with results like this or know what it could mean? Thanks a bunch!

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    Old 07-20-2009, 12:54 PM   #2
    sleepymommy's Avatar
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    can you have Addisons & secondary adrenal insufficiency both?

    Hi out there. I'm a newbie here and would really appreciate any thoughts about what might be going on with my health.

    My question in a nutshell is: Can you have both Addison's disease AND secondary adrenal insufficiency?

    Basically my ACTH was very low, but my cortisol stimulation test also didn't quite double, so I don't understand. I don't meet with my doctor again until Friday. I was hoping to just do some research ahead of time to know what I might be dealing with and what questions to ask.

    Also, she has me on hydrocortisone 10 mg morning and 5 mg evening, but I'm still getting really lightheaded to where sometimes I have to lay down. I do have a home blood pressure monitor and have been getting readings anywhere from 94/60 to 115/75, usually around 110/70. That doesn't seem TOO low, does it? Could the hydrocortisone itself be causing me to be lightheaded or does it sound like I should be on more (the on-call doctor had put me on double that dose but my regular endocrinologist called back and said to cut it in half--I felt better on the double dose)?

    Thanks in advance for any thoughts!

    Last edited by moderator2; 07-21-2009 at 06:21 AM. Reason: brought the two posts together

    Old 07-21-2009, 10:50 PM   #3
    kmatthew's Avatar
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    Re: can you have Addisons & secondary adrenal insufficiency both?

    I am sorry that you are feeling poorly. But rest assured you cannot have both addisons and adreanal insuffiency. Adrenal Insufficency is called secondary addisons which means your problem is not autoimmune, which is good. Both diseases are treated with the same medications, and primary addisons can develop later in life so they keep a monitor on it with antibody tests and by monitoring your cortisol. If they told you to cut back your dose you are getting too much replacement which is as serious is not enough. You will feel poorly when taking less medication at first but you will adjust.

    If you are still light headed and having symptoms have them continue to run tests. I notice you also suffer form thyroid problems. Have yourself tested for Hashimotos, as you know You should have your thyroid checked as well with the full panels of Free T3 and Free T4 along with TSH make sure you are dealing with a competant doctor whoi understands patients with adreanl problelms usually an endocrinologist. They are very hard to come by, and i can tell you first hand that I nearly suffered a stroke due to a doctor who felt like he understood my problems four weeks ago, and it is very difficult once your body gets out of balance. There are other diseases that can cause light headedness and dropping blood pressure and fatigue, so be sure you cover all yiur bases.

    My thoughts and prayers are with you. It does get better. I have had this disease for two years and this has been my first serious flare up.

    Last edited by kmatthew; 07-21-2009 at 10:54 PM.

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