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  • Is Adrenal Insufficiency severe enough to warrant Short-Term Disability leave @ work?

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    Old 05-08-2008, 06:12 AM   #16
    TheAntiEndo
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    Re: Is Adrenal Insufficiency severe enough to warrant Short-Term Disability leave @ w

    Quote:
    Originally Posted by anna1970 View Post
    I was off for two weeks for short-term disability after I was diagnosed because I had missed so much work in the mornings before the diagnosis. It depends on your employer. It qualified me based on what my doctor submitted to my supervisor. ...
    Was your Doc an Endo or just a GP?

    Quote:
    Originally Posted by anna1970 View Post
    ... I would talk with your employer. ...
    I've already had a few discussions with various managers and HR, and they are waiting for me to get something from my Dr. stating my official diagnosis and approving Short-Term Disability.

    However ...
    Quote:
    Originally Posted by anna1970 View Post
    ... What is your doctor saying? ...
    Doctor isn't saying anything yet, (and it takes weeks for them to get back to you when you leave a voice-mail message). I don't fit a clear-cut profile for Primary AI, but my ACTH is elevated so it looks like that rules out Secondary AI.

    He wants to run the ACTH Stim test again. I get the feeling he's looking to say the first one was a fluke and everything is "Normal", even though I have 3 different tests run at 3 different times, (4 if you look closely at the patterns of my Thyroid tests), that point to Adrenal problems. I've also looked at a list of things that can throw off the various tests, and I don't do/take any of them.

    I'm looking for another Endo (who doesn't think Saliva adrenal testing is snake oil) to get a 2nd opinion based on what I already have.

    Last edited by TheAntiEndo; 05-08-2008 at 06:24 AM.

     
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    Old 05-08-2008, 11:10 PM   #17
    orion
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    Re: Is Adrenal Insufficiency severe enough to warrant Short-Term Disability leave @ w

    Sounds like pituitary problems which a stim test will not detect.

     
    Old 05-09-2008, 05:05 AM   #18
    Cat2008
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    Re: Is Adrenal Insufficiency severe enough to warrant Short-Term Disability leave @ w

    If you have Addison's Disease or Pituitary problems you need to get the blood tests done to check...and then be prescribed the appropriate medication and you will not need leave from work...having a disorder such as Addison's Disease does not stop you from working if you are on the correct medication

     
    Old 05-09-2008, 05:58 AM   #19
    TheAntiEndo
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    Re: Is Adrenal Insufficiency severe enough to warrant Short-Term Disability leave @ w

    Quote:
    Originally Posted by orion View Post
    Sounds like pituitary problems which a stim test will not detect.
    I guess it could be my Pit on the way out. My FSH and LH are pretty low compared to my T levels, which I believe are the first things to go with Pit problems. I have no experience with ACTH in HypoPit problems, but since my first ACTH stim test showed my adrenal reserves couldn't get hight enough, and since I had a high ACTH compared to my Cortisol I would think it was more Adrenal then Pit.

    There is the CRH stim test, which takes a step back in the feedback look and makes the Pit think the Hypothalamus is giving a big order for Cortisol, but it's not a very popular test and I doubt my Endo would go for it.

    Quote:
    Originally Posted by Cat2008 View Post
    ...having a disorder such as Addison's Disease does not stop you from working if you are on the correct medication
    True, but what about an untreated condition that is on no medication?

     
    Old 05-09-2008, 07:26 AM   #20
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    Re: Is Adrenal Insufficiency severe enough to warrant Short-Term Disability leave @ w

    That's what I mean...but you are still alive and so whatever gland it is pituitary or adrenal has not completely packed up....its just a simple blood test for the pituitary and adrenal glands...there is no need to wonder, why can you not get the tests done?

     
    Old 05-09-2008, 08:04 AM   #21
    TheAntiEndo
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    Re: Is Adrenal Insufficiency severe enough to warrant Short-Term Disability leave @ w

    Quote:
    Originally Posted by Cat2008 View Post
    ...its just a simple blood test for the pituitary and adrenal glands...there is no need to wonder, why can you not get the tests done?
    What other tests would you suggest, and what tips do you have on getting my Endo to do them, (when he would more then likely feel they are not warranted because I get the feeling he's one of those that thinks the Adrenal problems are an all-or-nothing affair).

     
    Old 05-09-2008, 08:26 AM   #22
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    Re: Is Adrenal Insufficiency severe enough to warrant Short-Term Disability leave @ w

    I'm not sure what the medical set-up is like in the US however here in the UK if you want a specific blood-test done than you can. I do feel that it is your adrenal gland and you do need that cortisol level check like I mentioned before. Your adrenal gland can be on the way out but still producing adrenaline but towards the lower level of normal.

     
    Old 05-09-2008, 08:27 AM   #23
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    Re: Is Adrenal Insufficiency severe enough to warrant Short-Term Disability leave @ w

    Even treated, sometimes people are not "stable". If you are still weak, vomiting a lot, fatigued... that shows instabiity. I was tossing my cookies at least twice a month until acupunture got me stable. Also, how much can you do? I was unable to do normal activities such as shower, shop, drive... but all that has to be documented.

    CRH is not a popular test as the CRH is difficult to obtain and expensive. Only a few places do the test now.

    What is your IGF-1? That hormone usually goes first among the pit hormones... for your doc to ignore that your pit hormones are spiraling down is sad bordering on stupid - can you find another?

     
    Old 05-09-2008, 08:31 AM   #24
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    Re: Is Adrenal Insufficiency severe enough to warrant Short-Term Disability leave @ w

    I was un-stable for years as I was on too high a dose, but now I am on a lower dose which I take 3 times throughoput the day I am fine. I have had Addisons plus other endocrine conditions for more than 20yrs and know that you can be stable and lead a normal life once you get the right balance of medication

     
    Old 05-09-2008, 10:44 AM   #25
    TheAntiEndo
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    Re: Is Adrenal Insufficiency severe enough to warrant Short-Term Disability leave @ w

    @Rumpled -

    Luckily, I think I have a milder case b/c I'm not "tossing my cookies" with any regularity.

    I'm able to shop, drive, sit at my desk at work, type, etc. Problem seems mainly to be that it takes tremendous effort to get going and stay going. Once I get to my desk, I'm pretty much fatigued and Zombie-like all day long. I can function, but just barely, and my memory, concentration, mood, drive, ability to handle stress, and quality of life are pretty much tanked.

    As far as my IGF-1, it was actually High @ 266 (106-255) - (107% of range). That's the confusing part. If it was Pit you'd think there would be more hormones (ACTH, TSH, IGF-1) low instead of normal or high, and if it was totally Adrenals you'd think my DHEA-S would be low instead of high.

    Maybe it's something like a mild case of CAH or rare like that... (and I'm not saying that because I want to be "rare" or "special", just because my lab patterns don't seem to fit any of the more common diagnosis).

    Last edited by TheAntiEndo; 05-09-2008 at 10:46 AM.

     
    Old 05-09-2008, 12:37 PM   #26
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    Re: Is Adrenal Insufficiency severe enough to warrant Short-Term Disability leave @ w

    When the pituitary is failing it can go through periods of over production trying to compensate for the previous low values. My ACTH would sometimes be high normal, my blood cortisol was always normal, as was my IGF-1. However hormones are in constant flux driving values high and low throughout the day and they interact with each other.

    In my case when I had the insulin induced hypoglycemia tests (ITT) it was inconclusive three times. On the fourth try the test clearly showed I had almost no growth hormone, no sex hormones and zero adrenal reserve. All that despite "normal" blood values during the day (except thyroid).

    You can't base a diagnosis on simple blood tests. If you are having unusual symptoms and strange hormone responses then the ITT is the only way to determine if your pituitary is functioning with a normal reserve.

     
    Old 05-09-2008, 01:14 PM   #27
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    Re: Is Adrenal Insufficiency severe enough to warrant Short-Term Disability leave @ w

    You refer alot to the Pituitary gland, do you have addisons disease too or just Pituitary problems, because the symptoms seem more associated with the adrenal glands and 'simple' blood tests can measure the cortisol level throughout the day which is more beneficial than a one-off blood test.

    I'm not suggesting that it is not the pituitary gland just that there are several other endocrine glands to consider and they do present similar symptoms...like the thyroid for example which can make you feel tired, mood swings, feel cold, depressed attitude if you have hypothyroidism

     
    Old 05-09-2008, 01:40 PM   #28
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    Re: Is Adrenal Insufficiency severe enough to warrant Short-Term Disability leave @ w

    As I am sure you realise, the process of getting diagnosed may be difficult. Assuming you are diagnosed with Addisons, is there any guarantee your physician will not just throw some HC etc at you and tell you to expect to be up and running in a matter of days?

    Does your physician even agree that some of the psychiatric features you have been experiencing are related to an endocrine dysfunction, i.e., addisons or some form of adrenal insufficiency?

    Although it is VERY clear in the literature - that people who have thyroid disease, adrenal disease and other endocrine diseases frequently expereience psychiatric manifestions - anxiety, depression, even psychosis, for some reason, the average dr seems to treat the psychiatric manifestations as though they are something entirely separate from the disease process. {Just re-rexperienced this at recent dr appointment with new dr...last time for him, of course)

    This is all to say, if you are diagnosed, and the dr see this as only a physical problem easily managed with the right dose of HC etc, and it turns out that your psych symptoms, and other less "classic", non "textbook" symptoms, do not remit upon treatment - say, due to inadequate levels of HC etc prescribed, or if you still need other hormones to be supplemented - then you are almost back at square one. You have a diagnosis, dr says it is entirely treatable, but you still are not well, he sees no explanation for it and won't agree to any disability since on paper you look "fine" with your treatment of HC...

    I am going to suggest that if you seem to have no hope of either a diagnosis along with dr supported short term disability in the near future, and the survival of your family is at stake that you consider trying the psychiatric treatment route. It is much easier to be diagnosed and provided with a respite from life (some kind of ST disability letter from a psychiatrist).

    I don't know how your boss would view this and if it would jeapordize your job should you get some short term disability...of course, employers are not supposed to discriminate ...

    I know how you feel, I suffered from lots of anxiety and depression for almost 10 years before I went quickly down hill. It seems that a dr in 1995 had not noticed my thyroid levels (hypo) on a blood test. It was not until I saw the records years later - I realized it correlated completely with when my anxiety, panic and depression really took root. I ended up seeking pyschiatric help a few years back. It took another two years for a dr to find I was hypo. Since I have been treated with thyroid meds, I am a bit better - but I have underlying adrenal problems which interfere with my thyroid treatment and ultimate recovery...but that is another story...

    Hope my brainstorming is of some help to you.

    best wishes

    Last edited by sparkles916; 05-09-2008 at 01:42 PM.

     
    Old 05-09-2008, 01:49 PM   #29
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    Re: Is Adrenal Insufficiency severe enough to warrant Short-Term Disability leave @ w

    Hi,
    I do think the psych problems are unrelated I have several endocrine disorders and have never experienced this however I do know that one can feel 'down' when you are not receiving the correct treatment.

    Being signed off from work though is not the answer as it will add to your depression...you need to get sorted medically...

     
    Old 05-10-2008, 07:58 PM   #30
    TheAntiEndo
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    Re: Is Adrenal Insufficiency severe enough to warrant Short-Term Disability leave @ w

    @Cat2008 -

    Was your job more of a manual / physical nature, scientific / research / development, or administrative / service related?

    I may still be able to physically move, but since my job is more mentally intensive, would I be eligible for Leave if I am unable to complete my job function because of interrupted memory / congative function / depressed mood caused by lowered cortisol and high ACTH, (did you know high ACTH has a direct effect on the CNS aside from stimulating the adrenals and can cause attention problems?)

    Last edited by TheAntiEndo; 05-10-2008 at 07:58 PM.

     
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