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  • Blood Work, Addison's?

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    Old 08-06-2013, 08:46 AM   #1
    uknown
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    Post Blood Work, Addison's?

    I'm still waiting on my visit back to my endocrinologist (Friday the 9th). I've been having issues for several years now bouncing back and forth between different doctors. I finally have a doctor to take me seriously.

    Typical Symptoms
    Nausea almost daily (mostly without vomiting)
    Lightheaded 1-2 times in a 48hr period, almost a vertigo like sensation, worse when accompanied by nausea - more likely in the mid/late afternoon time frame (3-6pm)
    Sweating accompanying the nausea and lightheaded feelings
    Persistent diarrhea, almost NEVER a normal bowel movement
    Stomach pain usually a couple hours after eating, 1-4 times per week
    Anxiety and general unwell feeling awaiting the next nausea/dizzy spell
    Diagnosed PVC (premature ventricular contractions) regularly, a few times an hour - cardiologist said they are harmless
    weakness and mild balance issues usually in the morning and late afternoon, typically accompanied by lightheadedness and nausea
    Extremely dry skin on hands and arms (never had before this all started 3 yrs ago)

    Recent bloodwork (blood drawn at roughly 11am):
    Albumin 5 range 3.5 - 5.0 GM/DL
    Alkaline Phosphatase 82 range 38.0 - 126.0 U/L
    ALT 50 range 13.0 - 69.0 U/L
    AST 31 range 15.0 - 46.0 U/L
    Bilirubin-Total 0.5 range 0.2 - 1.3 MG/DL
    BUN 23 range 7.0 - 20.0 MG/DL
    Calcium 9.6 range 8.4 - 10.2 MG/DL
    Chloride 104 range 98.0 - 107.0 MMOL/L
    CO2 25 range 22.0 - 30.0 MMOL/L
    Cortisol 4.3 range 1.7 - 22.7 uG/DL
    Creatinine 0.9 range 0.7 - 1.5 MG/DL
    Estradiol 14.3 range pg/mL
    Ferritin 275 range 17.9 - 464 NG/ML
    Free Testosterone 40 range 47.0 - 244.0 pg/mL
    Free Testosterone% 2.6 range 1.6 - 2.9 %
    Glucose 89 range 74.0 - 106.0 MG/DL
    Insulin-Like GF-1 157 range 155.0 - 432.0 ng/mL
    LUTEINIZING HORMONE 1.1 range 1.7 - 11.2 MIU/ML
    Potassium 5 range 3.5 - 5.1 MMOL/L
    Prolactin 10.4 range 3.7 - 17.9 NG/ML
    Sex Hormone Binding 12 range 11.0 - 80.0 nmol/L
    Sodium 142 range 137 - 145 MMOL/L
    Total Protein 7.9 range 6.3 - 8.2 GM/DL
    Total Testosterone 154 range 300.0 - 1080 ng/dL
    Vitamin B12 762 range 211.0 - 946.0 PG/ML

    I've had a general brain MRI that discovered no abnormalities. I just had a pituitary specific MRI done and I'm waiting on results.

    I am 28, male, overweight (not obese). The weight gain started when all my unwell feelings started. I feel like I eat when I'm feeling good because I have no idea when the next 'attack' will happen where I'm nauseated and refuse to eat. My diet is typically high protein low carb as it is the only diet that makes me feel better while allowing me to maintain my weight. Adding in lots of sugar/carbs tends to make my symptoms worse. I am thirsty all the time. I have mild sexual dysfunction and inability to put on muscle which is why I initially went to visit the endocrinologist. I've been tested for diabetes using glucose meters as well as the A1C test all negative, though I believe I am sensitive to sugars based on weight gain.

     
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    Old 08-10-2013, 12:53 PM   #2
    uknown
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    Re: Blood Work, Addison's?

    Friday's appointment - my endocrinologist said that a mid morning cortisol reading like that is not too far out of the realm of normal. He did say that he wanted me to get an ACTH stimulation test though. I am awaiting scheduling.

     
    Old 08-27-2013, 12:52 PM   #3
    uknown
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    Re: Blood Work, Addison's?

    I had my ACTH study done. I did it at a local hospital away from my endocrinologist's normal area as I have to travel a couple hours to see a real endocrinologist (rural living, aint it fancy?).

    Evidently the hospital did not know how to properly administer the test. Instead of every half hour like my doctor said it should have been, they drew blood every hour.

    In either case, the highest reading was 1 hour after stimulation, it was at 14ug/dl, up from 4.1ug/dl in my initial baseline reading. The doctor said that was enough to start treating me with prednisone at 7.5mg a day for the first 2 weeks and 5mg/day after.

    I've been on the prednisone now for a week. The first 3 days were GREAT. After that, I started back to similar symptoms. Lightheaded, dizzy, nausea, and other similar feelings as before.

    Any advice, give it time? Talk to my doctor again?

     
    Old 08-27-2013, 08:29 PM   #4
    luvthesun
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    Re: Blood Work, Addison's?

    Hi there...

    I'm sorry you're having such a difficult time.. nonetheless, you will get better at this because as you embark on this journey into the world of Addison's Disease/Adrenal Insufficiency, you will find that most doctors have very little knowledge of this extremely serious condition. (don't get me started - has been huge source of frustration for me) You will have to do a lot of self-educating, blogging on these forums, and perhaps make some crucial lifestyle changes, in order to live the best life you can with compromised adrenal gland function.

    So, now to respond to your immediate concerns. As you probably know, the adrenal glands produce a number of life-sustaining hormones. The most important ones being cortisol and aldosterone. So Addisonians must take replacement steroids for both of these hormones. To replace cortisol, you will either take Hydrocortisone or Prednisone. They're a little different from each other in that Hydrocortisone is fast-acting and Prednisone takes a bit longer to kick in, but remains in your system for a far greater length of time. And to replace aldosterone, you need to take another steroid (a mineralcorticoid), called Fludrocortisone. This controls the amount of sodium and fluid in the body, therefore, your blood pressure and your blood volume are both controlled by aldosterone.

    Now here's the cetch... Hydrocortisone already contains some mineralcorticoid activity, but Prednisone contains close to none. Soooo, if you're taking Prednisone, you also need to be taking Fludrocortisone. This is crucial, especially given some of the symptoms you're experiencing; dizziness/vertigo, nausea, fatigue, etc. And given that you have diarrhea so often, I can almost guarantee that you are lacking adequate minerals, especially sodium. Without enough sodium, you will feel very lightheaded and nauseous. Salt is KEY for me when I'm feeling the nausea. I encourage you to add sea salt to your food, and even to your drinking water. And be sure to stay well hydrated.

    So get in touch with your doc as soon as you can, and talk to him about Florinef, or Fludrocortisone. Usually .1 mg/daily. And in the meantime, increase your sodium intake and see if that helps.

    Lastly, there's a great book you ought to read...
    Adrenal Fatigue - The 21st Century Stress Syndrome. By James Wilson

    Extremely helpful with lots of lifestyle tips for US!! Lifesaving...

    Take care & hang in there

    Sincerely,
    Mollie

     
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