Adrenal Thread

[HeadDoc]

the divergence on the value of saliva testing is interesting. When I attended the A4M training in HRT, Dr. Suzie Schuder discussed the preference for the 24 hour urine and Dr. Wilson preferred the saliva method. There a good study to be had here. See which yielded more false positive or more false negatives.

 

[marianco]

Adrenal Fatigue and Cortisol Levels

If somneone cuts you off in traffic on the way to the draw point, that will falsely elevate your cortidol level. So may the sight of the needle.

From my point of view, that is not a falsely elevated cortisol level. It is exactly what you want.

However, it is important to take into account the patient's psychological status and stress during the day to help interpret the cortisol level - to help determine if an appropriate adrenal response to stress is occurring.

Under stress, it is important that the cortisol level be elevated. If it is not, then that certainly helps diagnose adrenal fatigue. If it is elevated, then one cannot for certain diagnosis adrenal fatigue unless there are more data points - i.e. more tests done.

Adrenal gland output is not static - it varies from moment to moment. The adrenal glands respond microsecond-to-microsecond to the signals received from the brain via the sympathetic nervous system and the hypothalamus-pituitary gland. The adrenal glands then produce the necessary neurotransmitters/hormones to rally the body's resources, to help the brain respond to whatever stress the person experiences. The adrenal glands provide on-demand energy to help a person respond to stress.

Stress is anything that breaks homeostasis. It can be as little as lifting a pen, to extremes such as repeated traumatic rapes in childhood (where the memory of which is indelible and is constantly involuntariliy relived like a movie overlying one's present experience).

In adrenal fatigue, with constant exposure to stress signals, the adrenal glands become unable to respond with enough of the neurotransmitters/hormones needed to help the brain respond to stress. It sputters. There may be times, usually short, where it is adequate; and frequent times when it is inadequate. There often is no on-demand energy generation.

The best test, then, for a sputtering adrenal gland, is continuous monitoring (such as with a cardiac Holter monitor, or portable EEG device) which would allow the clinician to correlate adrenal gland function with a person's psychological status and stresses during a day. This can then be drawn on a chart as three curves with the time of the day as the horizontal axis.

However, we do not have this yet. What we have are single points on the graph. Often we only have one point - the morning cortisol. That makes it difficult to determine what the adrenal status is.

I like the saliva test in that
1. It is fairly low stress (essentially - chewing on a cotton wad to saturate it with saliva) and thus itself does not interfere as much with the measurement process (The Heisenberg Uncertainty Principal comes to mind).
2. It can be easily done multiple times a day - thus providing more data points to help determine if adequate adrenal function is present.
3. It can be done where it matters most - where a person lives, works, etc. in whatever activity the person is trying to accomplish (similarly to how it is important to measure blood pressure at home, at work, and in whatever activities one has - to gain a better understanding of a person's hypertensive response. When my patients see me, their blood pressures, which are normal in their primary care provider's office, is high in mine - particularly since they have to talk about highly stressful experiences when they see me that they do not have to recount with their primary care provider).

With a patient journal of their activities and psychological status, one has a great correlation between adrenal output and stress at multiple times in a day - multiple data points to give one an idea of the adrenal response curve. Adrenal fatigue sticks out like a sore thumb when this is done.

Contrast this with a blood test, where a person has to go to a lab, get poked with a needle, and can probably only do this at most two times in a day. At least with a saliva test, you can get four data points easily - eight or more if you want to be obsessive. The stress of the blood stick is an artificial one and will vary depending on the person. With only one or two data points, other labs are important to help obtain clues if there is adrenal fatigue - e.g. DHEA-s, progesterone level, sodium, potassium, etc.

 

[1cc]

I had blood cortisol levels above the top of the range and yet when I did Saliva test it showed that my cortisol levels were low (below normal).

 

[marianco]

Saliva vs. Blood Test

I had blood cortisol levels above the top of the range and yet when I did Saliva test it showed that my cortisol levels were low (below normal).

When there is a divergence in a saliva vs. blood test, it may be necessary to obtain additional information.

A single series of low saliva cortisols, however, does give strong evidence of adrenal fatigue - since one is trying to find at least a single instance of inadequate adrenal output in response to stress - particularly when correlated with the history. When adrenal fatigue is severe enough, it may show up in all indicators.

A high test in one does not exclude a low test in another - they are not mutually exclusive. The results depends on additional factors.

Additional helpful information for the interpretation:
1. What is the person's psychological state at the time of the tests?
2. What is the stress faced at the time of the tests?
3. What are the additional test results: DHEA-S, progesterone, sodium, potassium level, urinary serotonin level, thyroid hormone level, etc.

Testing a quickly changing value to find an abnormal result can be difficult. For example, testing for the presence of seizures by EEG is often hit or miss. If a person is not actively seizing, no abnormality may be found. This does not exclude the diagnosis of a seizure disorder - however. Sometimes, some deep seizures need special techniques - such as probes inserted deep into one's nose - to catch the seizure - when normal EEGs show nothing. The diagnosis of a seizure disorder is thus often made by history alone.

A sputtering adrenal gland can show up normal or high in cortisol output under some stressful situations. It reminds me of one patient who had four cortisols and two DHEA levels in one day. The DHEAs were normal. The morning, afternoon and midnight cortisols were low. The dinnertime cortisol was sky high - correlating with the high stress dinner he had due to family arguments. The presence of low cortisols - e.g. the low morning cortisol- and his history and exam (e.g. pupillary constrictor strength fluctuations in response to oblique light) - supported adrenal fatigue as the diagnosis.

 

[1cc]

A single series of low saliva cortisols, however, does give strong evidence of adrenal fatigue - since one is trying to find at least a single instance of inadequate adrenal output in response to stress - particularly when correlated with the history. When adrenal fatigue is severe enough, it may show up in all indicators.

The presence of low cortisols - e.g. the low morning cortisol- and his history and exam (e.g. pupillary constrictor strength fluctuations in response to oblique light) - supported adrenal fatigue as the diagnosis.

I agree. The more indicators that point in the same direction, the better.

With adrenal fatigue, in many instances, the clinical symptoms themselves together with a persons history (Dr. Wilson's questionnaire's) are more than sufficient to make a diagnosis. In my case I was a textbook case for Adrenal Fatigue. Doing the Saliva tests was a nice confirmation of my clinical symptoms and history. It also allowed me to see at what times I would benefit most from hydrocortisone. I was low in the morning, afternoon, and before bed. I was normal at dinner time. My serum DHEA-s was very low normal. Taking hydrocortisone and DHEA helped tremendously, and so did TRT.

 

[SPE]

I agree. The more indicators that point in the same direction, the better.

With adrenal fatigue, in many instances, the clinical symptoms themselves together with a persons history (Dr. Wilson's questionnaire's) are more than sufficient to make a diagnosis. In my case I was a textbook case for Adrenal Fatigue. Doing the Saliva tests was a nice confirmation of my clinical symptoms and history. It also allowed me to see at what times I would benefit most from hydrocortisone. I was low in the morning, afternoon, and before bed. I was normal at dinner time. My serum DHEA-s was very low normal. Taking hydrocortisone and DHEA helped tremendously, and so did TRT.

I started taking Isocort about a week ago and so far I feel great. My cortisol drops between 11am and 4pm, and that's when I feel the worst. Thyroid meds only made it worse. I've been taking 4 Isocort, which is close to the equivelant of 10mg cortef and my symptoms have subsided greatly. I've also been able to increase my armour dosage and still feel good.

 

[Vforcer2]

I started taking Isocort about a week ago and so far I feel great. My cortisol drops between 11am and 4pm, and that's when I feel the worst. Thyroid meds only made it worse. I've been taking 4 Isocort, which is close to the equivelant of 10mg cortef and my symptoms have subsided greatly. I've also been able to increase my armour dosage and still feel good.

SPE, you are learning the same stuff that I am. I ordered some Isocort yesterday, but I was unaware that it could be of the same potency of Cortef. I read where some people are on both. They say what if you up your Armour that you should take the Isocort for 3 days to week to help the Adrenals deal with the new Thryroid hormones. I just joined the forums www.stopthethyroidmadness.com a couple of days ago. You can read my conversation there with Val, who is on Armour, Cortef, and Isocort. She recommended I try the Isocort before going to the more potent Cortef steriod.

 

[SPE]

SPE, you are learning the same stuff that I am. I ordered some Isocort yesterday, but I was unaware that it could be of the same potency of Cortef. I read where some people are on both. They say what if you up your Armour that you should take the Isocort for 3 days to week to help the Adrenals deal with the new Thryroid hormones. I just joined the forums www.stopthethyroidmadness.com a couple of days ago. You can read my conversation there with Val, who is on Armour, Cortef, and Isocort. She recommended I try the Isocort before going to the more potent Cortef steriod.

I agree about starting with the Isocort first, as that's exactly what I did. It's a natural form of cortisol, like Armour. It's not as potent as Cortef OR prednisone, but why use those if you don't have to? I have noticed a side effect from the Isocort. I'm always hungry! That's a good thing though as before that my appetite was kind of non-existent.

 

[1cc]

I started taking Isocort about a week ago and so far I feel great. My cortisol drops between 11am and 4pm, and that's when I feel the worst. Thyroid meds only made it worse. I've been taking 4 Isocort, which is close to the equivelant of 10mg cortef and my symptoms have subsided greatly. I've also been able to increase my armour dosage and still feel good.

Thats great! Glad you're feeling better. If you're going to take Isocort, then you might as well take hydrocortisone, because the only active ingredient in the Isocort is the cortisone. I think the generic hydrocortisone is cheaper as well. I have used Isocort before, and each pellet is supposed to contain approx. 2.5mg cortisol.

 

[Vforcer2]

Thats great! Glad you're feeling better. If you're going to take Isocort, then you might as well take hydrocortisone, because the only active ingredient in the Isocort is the cortisone. I think the generic hydrocortisone is cheaper as well. I have used Isocort before, and each pellet is supposed to contain approx. 2.5mg cortisol.

I am not complaining about the price. It requires no office visits to the doctor, and can be ordered at will. I just paid $25 including shipping here: http://www.naturalnutritionals.com/bz106.html

 

[love_en]

I know a overseas pharmaceutical broker who can ship hydrocortisone, prednisone, and Florinef to the US. The URL is at hand pending the results of my Adrenal test.. I think Cortef is only about $30 for 100 10mg tablets.

 

[trt4lf]

DHEA levels

Question for Chris and Swale:

I'm still evaluating salivary testing. Often there is quite a disparity between saliva, blood and urinary levels regarding cortisol and DHEA.

How would you explain low salivary cortisol levels and high DHEA levels (salivary 1200-1600) or DHEA-S in men not on DHEA supplemention. They all have uniformly low testosterone, estradiol and elevated progesterone levels. Thyroid function is normal based on FT3 and FT4 levels. Some men are hypertensive, 10-20 pounds overweight but are otherwise active. I don't know the plasma renin or aldosterone levels. Do you have any thoughts?

 

[SPE]

Hypopituitary

Judging by all of the tests I've had so far, I may be hypopituitary. My pre-treatment levels were:

Total T - 302 (241-827)
LH - 1.6 (1.2-8.6)
FSH - 1.6 (1.27-19.26)
Cortisol am - 17 (2-22) Range is skewed, cortisol should be upper twenties
DHEA - 262 (280-640)
FT3 - 3.1 (2.2-4.3)
FT4 - 6.3 (4.5-12)

ALL of the pituitary hormones are LOW. Could this be the cause of my hypogonadism. Could some cases of secondary hypogonadism actually be hypopituitary?

 

[pmgamer18]

Judging by all of the tests I've had so far, I may be hypopituitary. My pre-treatment levels were:

Total T - 302 (241-827)
LH - 1.6 (1.2-8.6)
FSH - 1.6 (1.27-19.26)
Cortisol am - 17 (2-22) Range is skewed, cortisol should be upper twenties
DHEA - 262 (280-640)
FT3 - 3.1 (2.2-4.3)
FT4 - 6.3 (4.5-12)

ALL of the pituitary hormones are LOW. Could this be the cause of my hypogonadism. Could some cases of secondary hypogonadism actually be hypopituitary?

Have you had an MRI on your Pituitary Gland.

 

[SPE]

Not yet.

 

[pmgamer18]

Not yet.

Next test what do you think.

 

[SPE]

Yes, I agree it's something I need to do soon. Especially upon figuring much of this is pituitary related.

 

[love_en]

I had a pituitary MRI done. Showed nothing that would convince the endo to help me. I have low T, low LH, low FSH, and a questionable response to an ACTH stimulation test. It was nice to know I do not have a pituitary tumor, but my symptoms should have caused doctors to question if my low-normal results are really adequate to keep me healthy.

 

[SPE]

I had a pituitary MRI done. Showed nothing that would convince the endo to help me. I have low T, low LH, low FSH, and a questionable response to an ACTH stimulation test. It was nice to know I do not have a pituitary tumor, but my symptoms should have caused doctors to question if my low-normal results are really adequate to keep me healthy.

Yeah I'm a little frustrated how two docs, one being an endo can take a look at my symptoms and NOT order a pit mri. It would definately explain my symptoms and numbers. I read something recently that said a study was done on many autopsy reports showing that as many as 1 in 5 people have pit tumors. SO I guess these things are MUCH more common than reported (1 in 10,000)

 

[marianco]

Albumin and TRT and Adrenal Fatigue

My FT level will not raise above the bare minimum, TRT, or no TRT. TT can be v high, but FT is always v low. It is not Estrogens causing the prob cause i have eliminated that. SHBG is v.v low also. Scientifically, the test must be going somewhere, or binding to something else, which must be high. My question is what else does test bind to? My Albumin is high normal 46nmol/l (35-50), however i dont think that would be causing this problem, what else could it be?

Total testosterone consists of:
1. Testosterone strongly bound to Sex Hormone Binding Globulin - inactive
2. Testosterone weakly bound to Albumin - potentially active
3. Testosterone which is free - fully active

Measuring Bioavailable Testosterone (free and weakly bound) is important when questioning the effectiveness of TRT, if free T is low.

Albumin makes up about 70% of the circulating protein in the blood. It is highly important to maintain blood pressure and to transport other substances.

By weakly binding Testosterone, Albumin protects Testosterone from being destroyed in the liver. Free Testosterone itself may last only about 70 minutes before being destroyed. Testosterone bound to Albumin may be considered the body's way to create a natural extended-release form of testosterone - just as medications often come in an extended-release version.

High albumin level is primarily associated with dehydration.

Dehydration and high albumin level is one possible clue that adrenal fatigue or insufficiency is occurring. In adrenal fatigue or insufficiency, besides cortisol and DHEA, not enough aldosterone is produced. Aldosterone is important in maintaining sodium level, fluid and salt balance in the body, maintaining blood pressure.

Adrenal fatigue or insufficiency may contribute to sexual dysfunction (and other conditions) and can lower testosterone production.