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Dora55 11-10-2008 12:55 AM

potassium& sodium levels in secondary hypo???

Just a quick question. My ACTH and Corticotrophine are normal low, 2.20
( range 1.6-13.9) and Cortisol is normal high 537.00 nmo1/1 ( range aprox 200-660, at time taken) The conclusion is secondary hypo, either from the pituitary or Hypothalamus ? Which one I wonder ? Taking T4 and have ordered T3 as T4 went up with meds but T3 remained low. ( TSH is low too,have not tested TRH)

My main question is my salty food craving. I can just pile it on, never seem to have enough and obviously I am drinking much more water then I ever did.

my sodium level is 139 nmo1/1 ( range 134-146) and my potassium level is
5.0 nmo1/1 ( range 3.6-5.0). These levels were measured before the salt craving became so intense, ok was always needing to add salt but now it's ridiculous.

the thing is that I read that in some cases were people have hypothyroidism due to the pituitary or hypothalamus ,then they should take cortisone acetate( a stress hormone) together with the T stuff to prevent a so called addisonian crisis??

Looking at the graph, that is Low CRH ( hypothalamus), then Low ACTH ( Pituitary), well the next stop is the adrenal gland. Would not that be low too if the two before it are low?

Sorry, this wasn't so short after all.

thanks a lot for always answering my questions. This site is the best thing that has happened to me in a very long time.

Dora55 ;)

mkgb 11-10-2008 07:39 AM

Re: potassium& sodium levels in secondary hypo???
[I]As you know by now I am very technical. I have experience with the salt cravings of which you speak. They used to be REALLY bad prior to treating my hypoadrenalism. Low potassium and sodium are strongly tied to your aldosterone. Cortisol does effect them.. but aldosterone is the main regulator of the minerals na and K in your body. If your aldosterone is low you will not be able to regulate and retain your k and Na in sufficient supply and you will CRAVE Na and K constantly. My FAMILY are big salt cravers. My husband jokes that I like white food. If he only new how my family and I have to fight the urg to fight cows and horses for their salt licks.. he might stop joking and RUN AWAY! ;) You are not alone in this feeling and need. Your body is telling you it is out of balance and has NEEDS! If you are adrenal dysfunctional and in need of the salt going on a salt free or LOW salt diet would be VERY BAD. I did it for about a week and about dropped!

While in the midst of a situation of acute adrenal fatigue or adrenal dysfunction, people may crave salt because of the imbalance of the hormone aldosterone. YOU can have normal cortisol and still have an adrenal issue. Cortisol is one of MANY hormones made by the adrenals and used by the body. People with adrenal issues have difficulty retaining salt and thus crave salt due to the inherent imbalance.

Explore this issue. I did a journal search on salt dependence in adrenal dysfunction patients. Here are a few of the best articles that came up for my review. The abstracts do not always target the salt craving, but you can see the variety of issues that result in it.
Journal: New Englang Journal of Medicine, Volume 345:1689-1697, December 6, 2001, No. 23
Title: Aldosterone in Congestive Heart Failure
Author: Karl T. Weber, M.D.
Abstract: Aldosterone was isolated from blood and urine, its adrenal origin elucidated, and its steroid structure identified nearly 50 years ago. Actions involving the reabsorption of sodium and the release of potassium by epithelial cells in the kidneys, intestine, and sweat and salivary glands led to its designation as a mineralocorticoid. The physiologic importance of aldosterone in preventing the loss of salt and water during periods of dietary sodium deprivation is now clear. Its contribution to the retention of sodium in patients with congestive heart failure, cirrhosis, and the nephrotic syndrome has also been established.
Summary in laymans terms: Salt is needed to regulate the heart function and blood pressure. In normal funcitoning adrenal patients too much salt aggravates hypertension. In adrenal dysfunctional patients the resulting salt imbalance aggravates the system. Imbalance in these patients can cause heart failure and those MDs that do not note the adrenal dysfunction and place a patient on a low/no-salt diet aggravate the issue. it is the whole MD working on too little information again. I hate when they do that!

Journal: Critical Care Clinics , Volume 17 , Issue 1 , Pages 25 - 41
Title: Hypothalamic-Pituitary-Adrenal Insufficiency .
Author: G . Zaloga , P . Marik

Abstract: The adrenal glands produce four major classes of hormones: glucocorticoids, mineralocorticoids, sex hormones (i.e., estrogens, androgens), and catecholamines (primarily epinephrine). Catecholamines are produced in the adrenal medulla. Synthesis is impaired by disease processes that destroy the adrenal glands. Catecholamine synthesis requires cortisol (They are leaving out the salt (K and Na need that goes with this as well) and may be decreased in patients with hypothalamic–pituitary disease. Loss of sex hormone production is not required for recovery from critical illness. Thus, this article concentrates on disease processes of the adrenal cortex that decrease production of glucocorticoids and mineralocorticoids (These are heavily K and Na dependent in synthesis).

[B][I]Summary: Basically the adrenal system is dependent on salt when the hypothalamus and pituitary function stress/impact the adrenal function salt imbalances occur effect adrenal function further. Maintaining proper salt balance and intake in HPA dysfunction patients is integral in sufficient care.[/I][/B]

Journal of Clinical Endocrinology & Metabolism, Vol 79, 1328-1333
Title: Ovarian hyperandrogynism as a result of congenital adrenal virilizing disorders: evidence for perinatal masculinization of neuroendocrine function in women
Authors: RB Barnes, RL Rosenfield, DA Ehrmann, JF Cara, L Cuttler, LL Levitsky and IM Rosenthal

Abstract: Women with congenital adrenal hyperplasia due to 21-hydroxylase deficiency often have a polycystic ovary-like syndrome, consisting of hyperandrogynism, infertility, menstrual irregularities, and elevated LH levels. This is generally considered secondary to poor control of the congenital adrenal hyperplasia. However, our experience led us to suspect that ovarian hyperandrogenism occurs even when congenital adrenal hyperplasia is well controlled on glucocorticoid therapy. Therefore, we tested the hypothesis that congenital adrenal virilizing disorders result in ovarian hyperandrogenism. We studied eight women with congenital adrenal virilizing disorders, seven with well controlled classic 21-hydroxylase deficiency and one with congenital virilizing adrenal carcinoma removed at 1.7 yr of age. We also studied six women with late-onset 21-hydroxylase deficiency, without signs of congenital virilization. An ovarian source of androgens was assessed after suppressing adrenal function with dexamethasone and then testing pituitary-ovarian function by a GnRH agonist (nafarelin) test. Five women with congenital adrenal virilizing disorders (four with classic 21-hydroxylase deficiency and one with congenital virilizing adrenal carcinoma) and one women with late-onset 21-hydroxylase deficiency had ovarian hyperandrogenism as determined by subnormal suppression of free testosterone after dexamethasone and/or by increased 17- hydroxyprogesterone response to nafarelin while on dexamethasone. All women with congenital adrenal virilization and ovarian hyperandrogenism had elevated LH levels after dexamethasone or elevated early LH response to nafarelin, which suggests that LH excess is the cause of their ovarian hyperandrogenism. This was not the case for the late- onset 21-hydroxylase-deficient woman. Our data are compatible with the hypothesis that congenital adrenal virilization programs the hypothalamic-pituitary axis for hypersecretion of LH at puberty. This is postulated to frequently cause ovarian hyperandrogenism even when adrenal androgen excess is subsequently controlled by glucocorticoid therapy.

[B][I]Summary: I LOVE THIS ONE! I have PCOS and insulin resistance and hypoglycemia as well as hypoadrenalism.. well it turns out that the testosterone and estrogen imbalances that result in a different area of the adrenals that are in a hyperadrenal phase also cause a need for salt. SO you can have salt cravings as a result of the sex hormone issues of adrenal dysfunction in addition to the cortisol and aldosterone issues. Needless to say the adrenal glands are complex AND their impact is far reaching and diverse.[/I][/B]

Journal: European Journal of Endocrinology, Vol 137, Issue 1, 40-47
Title: Variability of endocrinological dysfunction in 55 patients with X-linked adrenoleucodystrophy: clinical, laboratory and genetic findings.
Author: GC Korenke, C Roth, E Krasemann, M Hufner, DH Hunneman, and F Hanefeld

Abstract: X-linked adrenoleucodystrophy (ALD) has been shown to be one of the most frequent causes of Addison's disease in men. It is characterized by an impaired peroxisomal beta-oxidation of very long chain fatty acids and is associated with mutations of the ALD gene resulting in a defective peroxisomal membrane transport protein. There is a striking variability of endocrinological and neurological symptoms in patients with ALD, with no clearly evident correlation between mutations of the ALD gene and the different neurological phenotypes. No data on endocrinological symptoms and the ALD genotype have been published so far. We report endocrinological, clinical, laboratory and molecular genetic data from 55 patients with ALD from 34 families. Endocrinological symptoms of adrenal insufficiency were observed in 33 patients, 20 of whom showed additional neurological symptoms of cerebral ALD or adrenomyeloneuropathy. Isolated neurological symptoms were seen in 12 patients; in nine patients there were neither endocrinological nor neurological symptoms. Mutations of the ALD gene (n = 28) were detected in 50 patients (including nine sets of brothers) from 32 families. No correlation was found between the ALD gene mutation and endocrinological dysfunction. However, we found that all sets of brothers were concordant for the endocrinological phenotype (cortisol synthesis was reduced in two sets and normal in seven sets), whereas four sets showed a discordant neurological phenotype. As yet unknown hereditary factors other than mutations within the ALD gene may interfere with the endocrinological phenotype more strongly than with the neurological phenotype of ALD.

[B][I]Summary: Adrenal issues cause that salt craving.. not seen in the abstract. What is seen in the abstract is that dependent on the adrenal dysfunction.. neurological symptoms may manifest as a result. DANG IT! Well it seems like the ENDOCRINE system as a whoole can put a damper on the brain. you can not blame just one piece. you need to check them all if you have side orders of nueral dysfunction. If you do not you can not definitively determine the source of your neurological issues.

SO in total your adrenal glands need salt K and Na for the synthesis of key hormones and steriods. Without proper levels and adrenal function your need for salt intake may increase, because you can not hold on to your K and Na properly. In such cases if the imbalance is left unchecked you can develope heart, brain, and sexual hormone/organ dysfunction as a result.

SO in my opinion it is important if you see any signs/symptoms or just can not explain why treating the thyroid isn't working for you.. to check your peripheral endocrine systems - pituitary, hypothalamus, and adrenal glands. ANY one of these can cause a WIDE impact on your health and endocrine function. [/I][/B]


mkgb 11-10-2008 07:55 AM

Re: potassium& sodium levels in secondary hypo???
Na 139 nmo1/1 ( range 134-146)
K 5.0 nmo1/1 ( range 3.6-5.0).
These levels were measured before the salt craving became so intense, ok was always needing to add salt but now it's ridiculous.
Here is my non-MD chemist's take:
Hypoaldosteronism can be caused by a poor adrenal function of secondary call dysfunction (pituitary/hypothalamus laziness ;) ).

Low aldosterone levels can cause low blood pressure and high potassium levels. This can be common in patients with cortisol deficiency, your kidneys will excrete too much salt, and it leads to low blood pressure; low blood volume; a high pulse and/or palpitations, dizziness and or lightheadedness when you stand; fatigue; and a craving for salt. Symptoms of low aldosterone can also include frequent urination, sweating, and a feeling of thirst, besides the craving of salt. Low aldosterone can also be independent of low cortisol. It can be a result of a rarer synthesis dysfunction and inability to convert cortisol and pregnenolone into aldosterone. These patients can take excess amounts of cortisol supplementation, such as 30-40 mg, and not getting good results in treatment of their issues.[/I][/B]
The thing is that I read that in some cases were people have hypothyroidism due to the pituitary or hypothalamus, then they should take cortisone acetate( a stress hormone) together with the T stuff to prevent a so called addisonian crisis??[/I][B][I]
WELLLLLL, yes and no. you take HC IF and only if your cortisol synthesis is not functioning. your cortisol levels were high normal without supplementation.. SO that would imply your cortisol needs no supplementation and your pit and hypothalamus agree. your not in dangeer of adrenal crisis as a result. NOW your aldosterone levels and your adrenals over all ability to synthesize hormone has not been evaluated. You need a complete adrenal stimulation test including aldosterone. Aldosterone is a funny bugger. It is a highly sensitive test and your results will not be true if you are on beta-blockers OR birth control pills/supplements. you will need to be of BCs for 6-8 weeks and off betas for 2 weeks to get the best aldosterone test results possible.[/I][/B]

[I]Looking at the graph, that is Low CRH ( hypothalamus), then Low ACTH ( Pituitary), well the next stop is the adrenal gland. Would not that be low too if the two before it are low?[/I]

[B][I]Possibly, your adrenal glands are very complex little guys. They are a multifacet factory for a VARIETY of hormones. In most cases low HP function calls either mean the adrenals are working well on all fronts.. or they are hyper adrenal in some and hypoadrenal in others.. causing the HP to tone down or be on low call to manage the hyperadrenal kick back.. thid leaves you with a mixed bag of symptoms. You are not a clear cut case and do require detailed evaluation.[/I][/B]

Sorry, I think I beat you on the length thing. ;)

Dora55 11-11-2008 04:33 AM

Re: potassium& sodium levels in secondary hypo???
Thanks alot for this info MG. AND for always answering me. I so appreciate it.
You are a pool of information and numbers!!! ;)

I have been reading what you wrote over and over so for it all to sink in. I am preparing a lot of info to give to my family physician.

Trust me to be a complicated case. ;) But I am leaning towards what you said about that it can sometimes be independent of low cortisol, since my cortisol
levels were high normal without supplementation. So what you said about
aldosterone levels and my adrenals over all ability to synthesize hormone has not been evaluated makes a hell of a lot of sense to look into.

I have looked into the symptoms and a diagnostic chart for hyperadrenalism and they just don't seem to fit me, however the symptom check list for hypoadrenalism seems much closer to me.

I will check this out. Hope the T3 will still make a difference in the meantime.

Can the low levels of aldosterone be a cause for "free flowing anxiety" ?

Thanks so much again

mkgb 11-11-2008 05:38 AM

Re: potassium& sodium levels in secondary hypo???
Your welcome. If I reply to a thread I check it whenever I see a reply has been made. I answer it if I can. I try to be thorough so that those that have not gotten the will up to post can read it and say, "Hey! I have those issues. I need to get that checked out." It is my round about way of getting the word out. I sometimes wonder if we flooded the A A C E or European equivalant with all the Endos names and errors in diagnosing thyroid issues... if those Endos and there society would finally take notice and get with the most recent levels and thyroid care regimes. I sometimes wonder if because we are going to a MD one at a time we are ignored. If we rise up in MASS it could be an impressive sight. With the majority of the sufferers hypothyroid and depressed due to undertreatment it could be hard to get a truly impressive international protest going. We just have to fight our individual battles.

As to anxiety and the cause?
Low T3, Hashimoto's, hypoglycemia, PCOS, hypothyroidism, hyperthyroidism can all cause anxiety. Given endocrine dysfunction it is a turkey shoot as to which is at fault. You got to catch it in the act. Until we have microchip chem labs on our wrists testing our blood continually for anomolies.. it is hard to pin down the exact source of anxiety. In many cases it is the whole process of knowing you are ill, not feeling well and having to FIGHT tooth and nail to get an MD to work with you. It sucks, but if you keep at it you will get to where you want to be.. eventually.

;) MG

tired47 11-11-2008 08:25 AM

Re: potassium& sodium levels in secondary hypo???
Read your post with great interest. I too have a "craving" for salt...never had before in my life.

What do you know about a high sodium diet "leaching the bones of calcium"? ( words of endo) . I have high calcium in my 24 hour urine, despite limiting my calcium intake and now the Endo wants me to go on a low sodium diet for 3 weeks and retest for calcium/urine. He says I will thank him when I am 60, but.... I miss my salt!!!


mkgb 11-11-2008 09:06 AM

Re: potassium& sodium levels in secondary hypo???
I say rule out an adrenal issue. Test the ACTH, cortisol, and aldosterone levels. If these are off they can be the reason you are leeching Ca, Mg, K and more. All very essential minerals in your body. Na itself is only an issue if there is a mechanistic flaw making it an issue... or you are licking the cow lick for the heck of it. BUT because you asked.. here is my WTMI sodium spill:

The normal concentration of sodium in the blood plasma is 136-145 mM. Where do you fall in this range? Are you normal? If so it is not your diet causing the cravings and issues. If the sodium level falls too low, it's called hyponatremia; if it is too high, it's called hypernatremia.

A sodium level in the blood that is too low is dangerous and can cause seizures and coma. Very high sodium levels also can lead to seizures and death. So you want a BALANCED Na level. ;)

What is sodium? It is an ionic metal that we eat in its crstalline form of NaCl (TABLE SALT). Sodium is an important mineral element in the human body. The main purpose is to control body fluid pressure and levels. As a result Na elps maintain the acid-base level of our fluids (blood, urine.. you get the gist). About 40% of the body's sodium is contained in bone, some is found within organs and cells and the remaining 55% is in blood plasma and other fluids outside cells. EXTREMELY high levels of Na may take up some Ca sights in the bone, but for such to happen you normally have to have HIGH Na levels in the blood to accompany the high CA levels. Sodium is also important in proper cellular processes such as nerve conduction, the various nutrients cell passaging, and the maintenance of blood pressure.

Our bodies are made to continually regulate all our minerals, sodium incluided. If you eat too much or too little sodium, the intestines and kidneys respond to adjust concentrations to normal. Excess salt tends to be flushed out of the urine. Daily the intestines absorbs sodium and the kidneys filter and excrete an approximately equal amount of sodium into the urine.

The blood serum Na levels is the result of the concentration of the total amount of sodium and water in arteries, veins, and capillaries (the circulatory system). If the body has too little sodium (called hyponatremia), the body has two options increase sodium levels or decrease water in the body. Oftimes the water is decreased by the body's triggering of natural diuretic hormone production. Too much sodium (hypernatremia), can be corrected either by decreasing sodium or by increasing body water both result in a thirst response.

There are many diseases that can cause abnormal salt levels, including diseases of the [B]kidney, pituitary gland, and hypothalamus.[/B] These should always be looked into before tampering with a dietary craving excessively. Dietary cravings are a natural response of our bodies expressing a need.

The hypothalamus and pituitary gland are the diuretic triggers used in sodium regulation. If we are too high and need water, the anti-diuretic hormone porduction is triggered and we make vasopressin. Vasopressin prompts the kidneys to reduce the amount of water released into urine. If there is something wrong with the HP production and the body produces too much vasopressin, it prompts the body to conserve water, causing a lower concentration of sodium in the blood. Your HP are not the only sources of Na, certain types of cancer cells produce vasopressin as well. Once again we need a balance of vasopressin.. too much or too little is harmful.

Another source of high sodium levels is diabetes insipidus. This disease causes too much urine to be produced and thus causes a Na imbalance due to dehydration and electrolyte disruption. In this type of diabetes, something causes the hypothalamus to fail to make vasopressin, or the kidneys don't respond to vasopressin. Either case is bad. A patient with this issue can keep normal Na levels if they drink enough water to keep up with urinary loss, which in some cases is as high as 10 liters per day. UGH! And I complain about getting my 48-64 oz of water a day.

SO I would look deeper if I were you. What were your last Na levels in correllation to your Ca levels. Has your Endo bother to look at your hypothalamus/pituitary/adrenal function as of yet? Your would hate my when in doubt rule it out analytical testing mentality. But I stand by my experimental chemistry diagnostic measures. They have helped me 10 fold over the weight and see MD tactics I accepted previously. Now I have my medical reigns the MDs get to ride shot gun. It is a fun and wild ride.


hypoT 11-11-2008 04:33 PM

Re: potassium& sodium levels in secondary hypo???
Try "[B]Thermotabs[/B]"--buffered salt tablets that only contain 8% of your daily salt limit but really do the trick. Can take up to 5 throughout the day if needed.

They killed my salt cravings (I used to eat salt from the shaker) and the dose is low enough so they shouldn't give you heart problems and hypertension. Cheap too!

Hope that helps!

tired47 11-12-2008 11:32 AM

Re: potassium& sodium levels in secondary hypo???
Thanks for the info on the salt tablets... I really do love the Baked Lays though... high sodium to satisfy my "salt cravings".:cool:

I really wish I could take you to my appts... you are so knowledgeable.
My endo has checked "everything" according to them. Normal cortisol stim test, renal panel, ACTH, renin, but slightly high aldosterone,normal mid range calcium/mag serum levels. Sodium-serum low normal range. Had some low potassium serum off and on, but usually mid- normal.
Just dump mag, calcium for unknown reasons... thought I had Gitelman's for a while, ruled it out because of normal mag serums.

I hate this low sodium diet which is so bizarre because two years ago NEVER owned a salt shaker!!!

Oh well thanks again... will keep searching for answers :confused:and one day soon.....!!

Dora55 11-12-2008 02:34 PM

Re: potassium& sodium levels in secondary hypo???
Hi tired47-
I don't have the same levels as you and different complications, but MG pointed out a few things re this "normal business". I had just been brushed off by both an endo and a neuro, saying I was "ok". BUT as I have found out, mostly with the help of MG is that there is such thing as " high and low normal". With her help my family physican and I have looked at all my blood results in a different way. YES, i would like to take you along too, MG.
Had a couple of days feeling slightly better then usual, and hey, thought , lets get some of these pending jobs done. BIG BURN OUT!!! Now I've been feeling like ****####!!!
for 2 days. Excuse the ###****. But I got really upset.
I loved the joke of us all going MASS, and the fact that most will not make it ,, got lost in the brainfog etc. We have to keep laughing, otherwise it's just downhill.
I got 2 boys, 13 and 17. AND we joke about me and my brainfog. It helps them too, having to see their mum a semi zombie half the time , and laughing about it kind of makes it soooo much more easier.

Best of luck

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