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    Old 06-09-2014, 07:34 PM   #1
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    I could use some help - adrenal fatigue?

    So i've been on a 3 year journey of struggling and numerous doctors appointments. I believe I have adrenal fatigue. I have seen several MD's and have an appointment with an Endo but it is not for a while. I wanted to post my backround, labs, and symptoms and see if someone can give me some feedback. This has been a real struggle for me these past few years and its so hard to find a doctor that will take you seriously unless you have Addisons or Cushings.

    Labs: All labs have been done by Quest Diag.

    I did the saliva cortisol test based on my personal sleep schedule.

    Morning: 0.20
    Noon: 0.03
    Evening 0.04
    Night: 0.03

    8am-10am: 0.04 - 0.56
    4-6pm: < or = 0.15
    10-11pm: < or = 0.19

    Based on Quest's range I am "normal". However aother sources show the range as

    Morning: 0.25 - 0.60 mcg/dL (30 mins after awakening)
    Noon: 0.08 -0.20 mcg/dL (right before lunch)
    Evening: 0.04 - 0.13 mcg/dL (right before dinner)
    Night: 0.02 - 0.07 mcg/dL (right before bedtime)

    This makes more sense because there is no lower limit for the later parts of the day. So I could be at 0 and that be "normal". Also my cortisol goes from .20 and then drops way down to .03 and levels out for the day / night. My noon level shouldn't be the same as when I goto bed. So using the ranges above, I am low across the board. But at least my morning cortisol isn't extremely low.

    Here is what is confusing:

    24hr Urine Free Cortisol: 59.0 Range 2.0-50 mcg/24hr HIGH
    Creatinine Urine: 2.75 Range 0.63-2.5 g/24hr HIGH

    The urine contradicts the saliva and my symptoms. Is it possible for me to have weight loss and hypoglycemia if I have HIGH cortisol? Also, my creatineine has been tested in blood numerous times and never been high. Could it be a lab error? I did have to use a second pee jug instead of the normal single jug for the test.

    Aldosterone: 6 Range: < or = 28 ng/dL

    Once again no lower limit but from my research 6 is a fairly low number.

    Cortisol, serum: 17.3 Range: 4.0-22.0

    Hemoglobin A1C: 5.3

    TSH: 1.11 Range: 0.40-4.50 mIU/L
    T4, Free: 1.2 Range: 0.8-1.8 ng/dL
    T3, Free: 2.9 Range: 2.3-4.4 pg/mL

    Dihydrotestosterone: 100 Range: 16-79ng/dL HIGH
    DHT Free: 8.37 Range: 1-6.20 pg/mL HIGH
    DHEA-S: 559 Range: 110-510 mcg/dL HIGH
    Progesterone: 1.7 Range:<1.4 ng/mL HIGH

    Testosterone, Total 687 Range: 241-827 ng/dL
    Testosterone, Free 109.2 Range 46-224 pg/mL
    Androstenedione: 136 Range: 50-220 ng/dL
    Estrone: 60 Range: < or = 68 pg/mL
    Estradiol: 30 Range: , or = 39 pg/mL
    FSH: 4.3 Range: 1.6 - 8 mIU/mL
    LH: 5.2 Range: 1.5 - 9.3 mIU/mL

    Cholesterol, Total: 119 Range: 125-200 mg/dL LOW
    HDL: 41 Range: > or = 40mg/dL
    Triglycerides: 54 Range: <150mg/dL
    LDL: 67 Range: <130 mg/dL

    Vitamin D: Low
    B12: Was low now normal with supplements
    Ferritin: Low end of range 47 Range: 20 - 345

    Hypoglycemia- This is probably my worst symptom. My fasting glucose is always normal in my labs but it seems to be more of a reactive hypoglycemia for me. I have a glucometer so I check my sugar often. It dips into the low 60's and I don't let it go below that because I just feel too crappy. It never goes very high even right after eating. Maybe the highest is has gone is 110. I ate 5 smaller meals a day. I eat low glycemic. I do all the things you are suppose to do as far as diet is concerned and it is still an issue. Up until a few years ago I could eat whatever I wanted with zero blood sugar issues.

    Also any kind of exercise makes the hypoglycemia worse. If I go for a light paddle on the kayak I can feel my blood sugar dropping. I try to eat before and after but it doesn't help so much. Once again this has never been an issue for me.

    Sleep Issues - I don't have much problem falling asleep but staying asleep is a problem. I wake up numerous times throughout the night and wake up feeling not very refreshed. Many times I can tell im being woken up by the low blood sugar so I have a low GI snack and instantly fall back asleep. The food is like a sleeping pill for me. I have had a sleep study done and they found now sleep apnea just a "disturbed sleep pattern".

    Fatigue - When this all started I was DEAD tired all the time. Since removing stressors, eating better, taking vitamins, ect its not so bad. I still have crap for energy though. My 65 year old father has more energy than me and im 25. I assume its from getting a poor nights sleep. Also if my cortisol is low then I assume that would make me tired as well. It is not a struggle for me to get out of bed though. I wake up still tired but I can get up. Im assuming because my morning cortisol is not super low.

    PVS's aka Heart Palpitations - Since this all started I have had daily PVCs or heart palpitations. I have done a 24hr heart monitor and as I said they showed up as PVC's. I believe they are caused by the lack of sleep and fatigue. This can cause PVCs. The doc was not concerned about them but they still aren't comfortable.

    Low Libido - This one is pretty self explanatory. My libido is pretty low for a 25 year old. My testosterone levels are normal so I'm not sure if low cortisol can have an affect on this?

    Weight Loss - I am not losing weight currently but I am down about 5-10lbs from what I have always been. This was one of the first things I started getting comments from people about. They would say how skinny I looked. My diet had not changed what so ever. I ate as much as I can without making myself sick and I can't gain weight. Like I said, its not dropping which im happy about but I don't look a healthy weight.

    Excessive Thirst - I drink a ridiculous amount of water each day and in turn urinate frequently. Sometimes I feel like I just cannot quench my thirst. I am assuming this has something to do with my low aldosterone? I also don't seem to tolerate the heat well.

    Muscle Cramps and Injury - Any time I try to do light physical activity I end up getting muscle cramps and or injuring myself. One time I injured a muscle in my ankle simply from jumping up and down. I don't know if aldosterone can cause these kinds of issues. I know electrolyte imbalances can as well as dehydration and aldosterone is tied into that.

    Background: I will try to be brief. I have always been very healthy and very active and in great shape. My only issue was some GI problems that weren't ever really diagnosed but eventually cleared up on their own. 3 years ago I found out I had mono and was very fatigued. I should have rested but couldn't. I pushed my body very hard and was under tremendous amounts of stress. The fatigue continued and I started to eventually get low blood sugar symptoms. I was eating lots of simple carbs and sugars. A traumatic family event changed it all. My sleep went down the drain and hasn't been the same since. The low blood sugar and fatigue got worse. Heart palpitations began. Anxiety was horrible. Libido was in the drain and my muscles were sore everyday for no reason. I was having sensitivity to the light and my hands always were shaky. My heart rate would elevate easy and I had shortness of breath.

    It was all written off as stress. Well I graduated college, finished my internship, and all other stresses went away. I fixed my diet and began to take care of myself. Several symptoms went away but my body stayed in this "stress state". It is as if a switch had gotten stuck in the "ON" position. I have seen many doctors and the most recent conclusion is that I probably have adrenal fatigue. I have the causes, symptoms, and what seems to be the lab tests. I am still confused on some things though.

    Why do my saliva and urine cortisol contradict one another?
    Why is progesterone high but cortisol and aldosterone low?
    Why is DHT high but test normal?
    If adrenals are fatigued why is DHEA high?

    Someone please give me some insight. As I stated above, I have an appt with an endo but it wont be for some time. I appreciate any help in advance.

    Last edited by nf1234; 06-09-2014 at 08:19 PM.

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    Old 07-10-2014, 01:59 PM   #2
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    Re: I could use some help - adrenal fatigue?

    You might have a cortisol deficiency.

    difficult to interpret but it does show the trend. You should be high in the morning and with decreasing levels throughout the day.

    8 am serum should be 20
    You are near this level, however I suspect you didn't have your labs drawn under sedentary conditions. Any excitement in the last 12 hours such as sex, commuting, training at the gym, work etc will elevate your cortisol. You should also have 8-16 oz of water 30-90 mins prior to your labs. If dehydrated your levels can be elevated.

    This should also be done under sedentary conditions. If it wasn't, then the number is elevated. Also the optimal range for most is 70 not 50. Generally less than 40 is deficient, however the data isn't really representative if you weren't fasting.

    Ask you doc to try:
    hydrocortisone 20 mg in the morning and 10 mg at noon
    DHEA 30 mg morning (always take DHEA with corticosteroids even if not deficient)

    Quick Edit
    A cortisol deficiency will cause excessive conversion of combined thyroid (t4) to free thyroid (t3). This is likely the cause of your heart palpitations.

    Last edited by Administrator; 09-06-2014 at 08:41 AM.

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    Old 07-10-2014, 10:20 PM   #3
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    Re: I could use some help - adrenal fatigue?

    Jl925 let me begin by saying THANK YOU for taking the time to reply! It's been so long I was beginning to think no one would. I have several questions and several comments to your reply.

    According to the ranges for saliva I am "in range" but I found a site for a Dr. Linder who specializes in hormones. He said he uses the following ranges for Quest.

    Morning: 0.25 - 0.60 mcg/dL (30 mins after awakening)
    Noon: 0.08 -0.20 mcg/dL (right before lunch)
    Evening: 0.04 - 0.13 mcg/dL (right before dinner)
    Night: 0.02 - 0.07 mcg/dL (right before bedtime)

    If that is the case I come up short for every measurement.

    As far as the serum goes. I was fasting and I did drink enough water. I didn't think I was too stressed but no one likes needles. I didn't have much activity the day prior. Either way from what I know a.m. serum levels aren't a good indicator.

    The urine was done on the best possible conditions. I stayed home for the full 24 hours and just relaxed BUT I think I actually did the test for 26 hours by accident. The directions were confusing so I am re-doing the test next week. In that case the number should drop.

    Now for my questions....

    I am OVERproducing both DHEA and Progesterone. Since those are both adrenal hormones how does my body have the ability to make way to much of those but not enough cortisol?

    Also can I have normal blood pressure with low cortisol? My BP is always 120/80 or maybe slightly elevated. NEVER LOW.

    I have seen an ENDO since posting this and it wasn't much help. We are doing more tests but she said my adrenals were "fine". Im not buying it though. Based on my symptoms and these strange results I know something is up.

    You seem extremely knowledgable, how did you mange to learn so much? Thanks again for your help. I hope to hear back from you!

    Last edited by mod85; 07-15-2014 at 03:36 PM.

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    Old 07-10-2014, 10:22 PM   #4
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    Re: I could use some help - adrenal fatigue?

    Also I will ask but I highly doubt she will give me hydrocortisone. If she won't what are my alternative options?

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    Old 07-11-2014, 04:30 AM   #5
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    Jl925 HB User
    Re: I could use some help - adrenal fatigue?

    A few points.

    The labs reference range is nothing more than the 95% confidence interval (2 standard deviations from the mean) of the labs reference group. The reference group is typically a group of the labs patients. Since physicians don't send patients in optimal health to the lab for testing, the reference group is skewed toward toward the elderly, ill or those suspected of illness.

    Endocrine disorders are primarily diagnosed based on the clinical picture. Lab testing is used to confirm a diagnoses and detect gross deficiencies and excesses.

    Some of the most common symptoms/complaints are:
    Suseptibility to ear nose throat illness
    Inability to handle stress
    Digestive illnes (ibs, chrones disease etc)
    Skin disorders (excema, dermatitis, cheloids, dark lines in palm folds, dark armpits/knuckles, suntans easily)
    Excessive sweating
    Inability to handle stress
    Fits of yelling and screaming followed by extreme fatigue requiring bed rest (this is associated with over production of adreneline in response to the signal to produce cortisol)
    Extreme hunger
    Low bmi with hollow cheeks
    Plus more...

    Your questions
    The adrenals release cortisol and dhea simultaneously. DHEA neutralizes the side effects of cortisol. This is why you always take both hormones. Under normal conditions dhea decreases first and is one of the fastest to decline as we age. Cortisol also declines with age but is the slowest to decline. You are over producing dhea in response to the signal to release cortisol.

    Your bp is normal. Cortisol and aldosterone are not low enough to decrease your bp.

    See a doc that specializes in bio-identical hormone replacement and cortisol therapy. Almost certainly you will be required to pay out of pocket.

    Last edited by Administrator; 09-06-2014 at 08:40 AM.

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    Old 07-14-2014, 06:54 PM   #6
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    Re: I could use some help - adrenal fatigue?

    Thanks again! I hope you don't mind all the questions but you seem to be more knowledgable than any doctor I have met so far.

    So if I understand correctly, because my cortisol is low my body is signaling the adrenals to make more. That signal also tells the adrenals to make more DHEA and Progesterone which is why those are both high.

    My question is why are my adrenal able to make DHEA and Progesterone in an over abundance but not make enough cortisol?

    I've just gotten back some more results let me know if anything sticks out to you.

    Aldosterone: 8 Range: < 28 ng/dl
    Renin: 1.25 Range:0.25 - 5.82 ng/ml/h
    Pregnenolone: 55 Range: 13 - 208 ng/dl
    Vitamin b5: <40 Range: <275ng/ml

    From what I have read, Pregnenolone is the master hormone that all others are synthesized from. Mine looks to be towards the low part of the range. From the info that I could find, you want to me up around 180 ng/dl for a male. Im far from that.

    Vitamin B5 is also very important for hormones and adrenal health from what I understand. Mine is very low. Mayo Clinic has their range from 37-147 ug/L. That would make me deficient in their range. I have just today started taking some B5 in the hopes that it will help support my adrenal glands.

    Random question: why does it say for some values <40 for example. If my value is less that 40 why don't they just list that value?

    Cortisol AM: 23.6 HIGH Range: 4-22 mcg/dl
    Cortisol Binding Globulin (CBG): 3.1 Range: 1.7 - 3.1 mg/dL
    ACTH: 22 Range: 6 - 50 pg/ml

    Since I know getting blood drawn can be stressful, could this cause my elevated AM cortisol? Also my CBG is almost out of range. Can this cause the elevated plasma cortisol? Not sure about the ACTH, couldn't find too much info on that. I did remember feeling much better than usual that day and maybe it was because of the elevated cortisol.

    Below are my AM Plasma Cortisol Levels over the past couple of years. They seem to bounce around a bit.

    7/23/12: 20.6
    2/7/13: 15.7
    2/6/14: 17.3
    6/23/14: 23.6

    I have an appointment with the endo next week and we are going to go over all of this. It might be a lost cause because she already stated my adrenals are fine so I might have to start looking for a doc that specializes in bio identical hormone replacement.

    If you could answer some of those questions when you get a chance I would greatly appreciate it. Also any feedback on the new lab results would be very beneficial. I've been dealing with this for years and seen so many docs and got no where. I finally feel like I am starting to get to the bottom of all of this though.

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