Adrenal Thread

[Dopamineloveaffair]

If the ranges of cortisol aren't indicative of a healthy population then what can we conclude about other lab results? Perhaps the ranges for total and free test are inaccurate as well. Thoughts anyone?

 

[Matt Muscle]

Bump for an answer to my question above.
thanks.

 

[marianco]

Marianco,

Do you agree with what many are saying in this thread in regard to the lab ranges for Cortisol being incorrect? That a healthy AM Cortisol level for males, should be around the high 20's low 30's, not within the specified range of 5-22?
I believe this information has come from the book "Safe uses of Cortisol" by Dr Jeffries.

The problem of using the term "healthy" for Cortisol level or any other lab test is that "healthy" depends on what the physician is looking for.

Endocrinologists are looking for Adrenal Insufficiency or Cushing's Syndrome. These are conditions where the Cortisol levels are clearly outside the usually used lab reference ranges for blood or urine lab tests for Cortisol. Anything within the range is "healthy" to them.

As a behavioral neuroendocrinologist (e.g. psychiatrist), I correlate mental function with hormone/neurotransmitter activities. What I find is that there is a whole range of mental and physical dysfunction within the reference range which endocrinologists cannot recognize because they do not study behavior, brain function, mental illness. They don't know how the hormones affect brain function except in at a very basic level of understanding. Soon RU486 (the abortion pill), for example, will be available to treat psychotic depression by shutting down adrenal function, e.g. the production of cortisol. This is not an endocrine treatment. It is a psychiatric treatment - recognizing that adrenal hyperfunction (which is not at the Cushing's syndrome level) may cause psychosis. Adrenal fatigue is not a condition that endocrionlogists recognize because it has lab findings within the reference range.

Getting back to the Cortisol level, a problem with it is that it is not done several times in a day to correlate stress, behavior, and adrenal function. If that was done, a better picture of adrenal function may be found.

In response to stress, e.g. heavy exercise the day before, the morning cortisol level can be in the upper 20s or more. The brain is responding to the stress, demanding more output from the adrenals.

When assessing adrenal function, it is important to look at more than just cortisol level, particularly if only a single cortisol level is going to be obtained that day. Other labs affected by adrenal function include: sodium potassium, progesterone, DHEA-s, albumin, testosterone, etc. When multiple values are off, the history is consistent, and physical exam is consistent, then we have many clues to adrenal function impairment.

With any lab test, it is important to look at the value obtained, then choose a reference range which is important for the condition we are assessing for. The reference range the laboratory gives is not necessarily the correct one.

 

[love_en]

The problem of using the term "healthy" for Cortisol level or any other lab test is that "healthy" depends on what the physician is looking for.

Endocrinologists are looking for Adrenal Insufficiency or Cushing's Syndrome. These are conditions where the Cortisol levels are clearly outside the usually used lab reference ranges for blood or urine lab tests for Cortisol. Anything within the range is "healthy" to them.

As a behavioral neuroendocrinologist (e.g. psychiatrist), I correlate mental function with hormone/neurotransmitter activities. What I find is that there is a whole range of mental and physical dysfunction within the reference range which endocrinologists cannot recognize because they do not study behavior, brain function, mental illness. They don't know how the hormones affect brain function except in at a very basic level of understanding. Soon RU486 (the abortion pill), for example, will be available to treat psychotic depression by shutting down adrenal function, e.g. the production of cortisol. This is not an endocrine treatment. It is a psychiatric treatment - recognizing that adrenal hyperfunction (which is not at the Cushing's syndrome level) may cause psychosis. Adrenal fatigue is not a condition that endocrionlogists recognize because it has lab findings within the reference range.

Getting back to the Cortisol level, a problem with it is that it is not done several times in a day to correlate stress, behavior, and adrenal function. If that was done, a better picture of adrenal function may be found.

In response to stress, e.g. heavy exercise the day before, the morning cortisol level can be in the upper 20s or more. The brain is responding to the stress, demanding more output from the adrenals.

When assessing adrenal function, it is important to look at more than just cortisol level, particularly if only a single cortisol level is going to be obtained that day. Other labs affected by adrenal function include: sodium potassium, progesterone, DHEA-s, albumin, testosterone, etc. When multiple values are off, the history is consistent, and physical exam is consistent, then we have many clues to adrenal function impairment.

With any lab test, it is important to look at the value obtained, then choose a reference range which is important for the condition we are assessing for. The reference range the laboratory gives is not necessarily the correct one.

You and Dr Crisler are the only physicians I know of who look at lab values with this point of view. It is very ironic when a physician finds a patient with hormone values low, but within reference range and blames any problems the patient has on "psychiatric" issues. It is now clear to me that it is often the other way around. I also have the answer as to why endocrinologists treat low testosterone so dismissively. When searching for something else on the web, I came across this article:http://www.aafp.org/afp/20060501/1591.html. The significant point of this piece is a man with a total T above 200 ng/dl is not hypogonadal according to the AACE. That is 10 points above the reference range for the lab in Hawaii. Matters not to me.

 

[pmgamer18]

This was posted at one of the Yahoo groups I sent this poor guy to this site to see if Chris could help him. I was shocked at what he had to say about testosterone and cortirol levels. That if T is to high it will drive cortirol down anyone want to give some input on this.
Here is a cut & past the post is last and the answer is first so read from the bottom up.

To: Hypopituitary_Support@yahoogroups.com
From: "Chris Jackson" <chrisgj@sbcglobal.net> Add to Address Book Add Mobile Alert
Date: Sun, 11 Jun 2006 19:17:18 -0000
Subject: [Hypopituitary_Support] Re: I think a Tumor is causing my hypothyroidism.."Chris Jackson"

You have an unsual group of tests. Your Thyroid tests obviously don't
point to pituitary cause, you are primary. You need to be tested for
thyroid antibodies. Your thyroid levels are low, most people with
hypo are in range on the free tests. Your TSH all by itself shows
there's a problem.

I'm going to assume your cortisol was tested in the morning here.
Your cortisol and ACTH would then point to primary adrenal
insufficiency. I recommend you ask to be tested for 21-OH adrenal
antibodies, especially if thyroid antibodies test positive. If
cortisol was tested in the afternoon, then could be acth producing
tumor causing high cortisol.

Hypothyroid can cause high prolactin. Some drugs can block dopamine.
Dopamine keeps prolactin from rising. A tumor can cause high prolactin.

Your FSH and LH being at the low end of the ranges points to secondary
hypogonad. If you were primay, your LH would be at the high end or
above range. Testosterone and cortisol balance with each other. To
much of one, pushes down the other. So maybe the TRT was pushing your
cortisol down further (assuming your cortisol tests were down in the
morning). It takes a while for gel, injections, HCG to build up which
is probably why you felt good and first, then as it built up more,
pushed down your cortisol. Getting cortisol replaced, may help with
your TRT. Your low cortisol should have been treated before starting TRT.

Your igf-1 looks alright. If in the lower third of the range, then
you would very likely have low growth hormone.

So basically there is a chance of a pituitary tumor for you, but an
MRI (with and without contrast, don't use a machine older than 2
years, new machines give more detail and can pick up smaller tumors
that older machines can't) should tell if tumor or not.

This is the order that HRT should be done

Cortisol
aldosterone
Thyroid
sex hormones
growth hormone

Your doc may help you get an MRI of your pituitary, but it sounds like
he doesn't know what he is doing with HRT, otherwise he would have
treated in that order. An osteopath would be your best chance for
getting your cortisol and thyroid treated, endos are terrible at it.

Please keep us informed and hang in there.

Chris

--- In Hypopituitary_Support@yahoogroups.com, "jake harris"
<strawser81@...> wrote:
>
> I post at another hypothyroidism forum, and was directed here by a guy
> named philip georgian to talk to "Chris", or anyone else that could
> offer some guidiance.
>
> Recently I also have been sending emails to
> neurosurgeons/endocrinologists listed under "Pituitary Network
> Association", and I've got responses from two doctors who I pasted my
> lab results and some information about me and they said also that I
> should get an MRI done because a pituitary tumor is possible. I'm 24,
> I have low sperm count, no ability to grow a beard/mustache(dad has
> both), hypothyroidism, low testosterone (Normally my test is 400, free
> is pretty accurate here), high prolactin, ACTH, and TSH. My doctors
> say my thyroid levels are normal now but I still feel horrible(These
> blood test results were done 4 months ago).
>
> And something that has been confusing my doctors is whenever they try
> to give me testosterone(gel, injection,HCG) there are benefits for a
> week or so and then those benefits go away accompanied by even worse
> fatigue than I normally feel. I haven't got a straight answer on this
> yet, and another thing I want to point out is that my daily energy
> levels were 100% minus a sex drive when I first went to a urologist
> last year. I went in to fix my libido and within a month I had
> horrible energy levels daily. I stopped all testosterone treatment,
> but my fatigue was permanent and it's stil permanent. It's like
> taking testosterone triggered something in me.
>
> I've been reading up on pituitary tumors and it seems to click very
> accurately with me. Any knowledgable advice would be greatly
appreciated!
>
>
> ================================================================
> What is a pituitary Tumor?
>
> A pituitary tumor is an abnormal growth of pituitary cells. Pituitary
> tumors can either be nonfunctional (that is they do not secrete
> hormones) or produce specific hormones, such as prolactin (causing
> infertility, decreased libido, and osteoporosis), growth hormone
> (causing acromegaly), ACTH (causing Cushing's), TSH (causing
> hypothyroidism), or be nonfunctional (that is they do not produce
> hormones). These tumors behave according to their cell of origin and
> are named for the specific cell type affected. For example, if a tumor
> originates in a prolactin producing cell, the patient develops a
> prolactinoma-a prolactin secreting pituitary tumor that is common and
> usually treatable. High prolactin levels suppress production of the
> pituitary hormones (luteinizing hormone and follicle stimulating
> hormone) that stimulate production of estrogen or testosterone. Men
> with these tumors have low testosterone levels and lose their sex
> drive and eventually their masculine characteristics-hair, muscle,
> erections, and ability to produce sperm.
> ================================================================
>
>
> T4 Free - 1.71 (Average 0.8 - 2.5)
> T3 Free - 2.36 (Average 3-6) *LOW*
> IGF-1 Free - 55.94 (Average 20-80)
> Testosterone Total - 523.25 (Average 300-1000)
> FSH serum - 2.52 (Average 1-10)
> Estradiol - 37.83 (Average <40 )
> ACTH - 109.27 (Average 10-100) *HIGH*
> Prolactin - 12.78 (Average <10 ) *HIGH*
> Cortisol - 12.54 (Average 10-24 AM, 3-11 PM)
> LH serum - 2.64 (Average 0.4-5.0)
> DHEA-S - 2355 (Average 800-3500)
> Testosterone Free - 13.62 (Average 12-49)
> TSH - 7.43 (Average 0.54-3.70) *VERY HIGH*
>

 

[1cc]

I was shocked at what he had to say about testosterone and cortirol levels. That if T is to high it will drive cortirol down anyone want to give some input on this.

I think Marianco has said that T lowers the amount of cortisol required by the body in order to function. Lower T increases the amount of cortisol the body requires in order to function.

 

[pmgamer18]

I do think he said this but I do seam to be able to find it. I think when he said this I was not on to my problem. And when Chris said this a light went off so this is way I posted it here to get some input. I just got the Book Adrenal Fatigue by Wilson in the mail today. I can't stop reading it.

 

[1cc]

Since going on TRT, I have had to reduce my cortisol dosage because it felt too high.

 

[1cc]

I think Marianco has said that T lowers the amount of cortisol required by the body in order to function. Lower T increases the amount of cortisol the body requires in order to function.

Here it is. I found it. The following excellent post is by marianco:

"13. TESTOSTERONE goes to the hypothalamus and pituitary gland where it reduces the production of ACTH. This then results in a reducted production of CORTISOL and other adrenal hormones.
14. TESTOSTERONE also goes directly to the adrenal glands and reduces activity of the adrenal glands. It particularly reduces the production of CORTISOL. TESTOSTERONE essentially acts as a governor, reducing the stress response and preventing the adrenal gland from becoming too active. If the adrenals are like a car engine, testosterone prevents the engine from overheating.
"

https://thinksteroids.com/community/posts/474962

 

[pmgamer18]

Thanks I will post this back to Jake. So do you feel if one is on TRT and there dose and levels are to high that there cortisol levels can go do after a time.

 

[1cc]

Thanks I will post this back to Jake. So do you feel if one is on TRT and there dose and levels are to high that there cortisol levels can go do after a time.

T levels within the normal range will benefit the adrenals. T inhibits an enzyme called 11 beta-hydroxysteroid dehydrogenase type 2 (11 beta HSD-2). 11 beta HSD-2 is the enzyme that converts cortisol to inactive cortisone thereby deactivating cortisol. By inhibiting this enzyme and slowing the deactivation of cortisol in the body, T is able to extend the bioactivity of cortisol. This allows the adrenals not to work as hard in order to maintain cortisol levels.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed

 

[1cc]

1: Gen Pharmacol. 1997 May;28(5):661-4. Related Articles, Links


Opposite effects of sex steroids on 11 beta-hydroxysteroid dehydrogenase activity in the normal and adrenalectomized rat testis.

Nwe KH, Morat PB, Khalid BA.

Department of Physiology, Faculty of Medicine, University Kebangsaan Malaysia, Jalan Raja Muda, Kuala Lumpur, Malaysia.

1. Sex steroids have been shown to regulate the biosynthesis of 11 beta-hydroxysteroid dehydrogenase (11 beta-HSD). 2. In vitro studies showed that oestradiol (E2) or testosterone (T) can interfere with the bioassay of enzyme activity, but not progesterone (P4). 3. For in vivo studies, the activity of 11 beta-HSD in the testis of normal and adrenalectomized (ADX) adult male Wistar rats was determined following a daily IM injection of sex steroids for 7 days. 4. The 11 beta-HSD activity was significantly reduced (P < 0.01) either by E2 or T in normal and ADX rats. The enzyme activity in normal rats given both T and E2 was even lower (P < 0.001) than when E2 was given alone. 5. P4 given to normal and ADX rats increased the enzyme activity higher than normal (P < 0.001). 6. The presence of corticosteroids influenced the effects of E2, but not of T and P4, on 11 beta-HSD activity. 7. E2 and T downregulate 11 beta-HSD activity, whereas P4 increased it. E2 did not act through lowering T level.

PMID: 9184798 [PubMed - indexed for MEDLINE]

 

[Matt Muscle]

I do think he said this but I do seam to be able to find it. I think when he said this I was not on to my problem. And when Chris said this a light went off so this is way I posted it here to get some input. I just got the Book Adrenal Fatigue by Wilson in the mail today. I can't stop reading it.

Phil.. Wilsons book is a good read! I'm half way through Dr Jeffries book now, "Safe uses of Cortisol", this one really is interesting.

 

[pmgamer18]

Phil.. Wilsons book is a good read! I'm half way through Dr Jeffries book now, "Safe uses of Cortisol", this one really is interesting.

My wifes new Dr. is on the ball with Adrenal Fatigue eveything he is doing I have read about so far. The only thing he is not doing yet is Cortisol meds. Her tests came back that she is Metabloic Type Slow #1 so he is putting her on supplements for Metaboilic Support, Adrenal Complex (Glandular Supprt),
Magnesium + Chromium + B6, Potassium Plus, Zinc + Magnesium + Vitamin C, A Digestive Support, Vitamin E Plus and DHEA. He cut her Armour back to 115 mgs. untill her Adrenal's come back. She was doing Prednisone with my Dr. so he needs her off this for 3 more weeks so he can test her Cortisol. My wife told him I feel I also have this and he said for me to take what he give's her that it will not hurt but help anyone taking this. If I don't feel better he will see me. I feel good about this new Dr. for my wife and her Thyroid problems.

 

[marianco]

My wifes new Dr. is on the ball with Adrenal Fatigue eveything he is doing I have read about so far. The only thing he is not doing yet is Cortisol meds. Her tests came back that she is Metabloic Type Slow #1 so he is putting her on supplements for Metaboilic Support, Adrenal Complex (Glandular Supprt),
Magnesium + Chromium + B6, Potassium Plus, Zinc + Magnesium + Vitamin C, A Digestive Support, Vitamin E Plus and DHEA. He cut her Armour back to 115 mgs. untill her Adrenal's come back. She was doing Prednisone with my Dr. so he needs her off this for 3 more weeks so he can test her Cortisol. My wife told him I feel I also have this and he said for me to take what he give's her that it will not hurt but help anyone taking this. If I don't feel better he will see me. I feel good about this new Dr. for my wife and her Thyroid problems.

1. If the Prednisone dose is a sub-replacement dose (1 mg Prednisone = 5 mg Cortisol, approximately), then one doesn't need to wait three weeks to measure cortisol. One can measure it in a few days.

2. Adrenal Complex (glandular support) already has cortisol in it - albeit in a non-standardized amount (assuming it contains adrenal gland extracts).

3. DHEA is tolerable by women at a dose of at most 12.5 mg a day - assuming high quality DHEA. The low to medium quality stuff found in many drugstores may have highly variable amounts of DHEA, despite the labeling. The side effects in a woman include: hair loss, acne, oversedation.

 

[pmgamer18]

1. If the Prednisone dose is a sub-replacement dose (1 mg Prednisone = 5 mg Cortisol, approximately), then one doesn't need to wait three weeks to measure cortisol. One can measure it in a few days.

2. Adrenal Complex (glandular support) already has cortisol in it - albeit in a non-standardized amount (assuming it contains adrenal gland extracts).

3. DHEA is tolerable by women at a dose of at most 12.5 mg a day - assuming high quality DHEA. The low to medium quality stuff found in many drugstores may have highly variable amounts of DHEA, despite the labeling. The side effects in a woman include: hair loss, acne, oversedation.

Thanks Marianco her Dr. does Hair testing maybe this is way and the DHEA he put her on is a good quilty by http://www.myvitanet.com/dhea260capph.html
And he has her doing 25 mgs. 2 times a day. I don't have her blood test her but it was 105 ug/dl my test range is 80 - 560. She does not have the Adrenal Complex yet he was out of it.

I hope this Dr. is up on this he said to her he knows what is wrong with her and does not want to put her on a mess of pills so he is starting her off on just the DHEA and the Adrenal Complex and cutting back on her armour from 120 mgs to 102 mgs. She did say he can't up her Armour until he gets her Adrenals working better.

I just got back from my Dr.'s and we went round and round my morning cortisol came in at 8 this was done at 8:30 a.m. to me from what I have been reading is dam low he feels it is in range but low range. I am getting one upper Respiratory infection after the other now I have a sinus infection and inflamed lungs. My Total T is up at 1283 range 262 to 1593 he feels this is good. I got him to admit I am Hypopituitary and he is checking my Thyroid and doing Cortisol again but this test was at noon he feels it will be higher I don't think so. I asked him to give me some Cortef 5 mgs. so I can try and take upto 20 mgs. a day and see if I don't feel better he told me doing this will shit down my Adrenals and can cause more problems. I told him I read on the net you can take up to 20 mgs. a day and not do this. So this is were we are now. I have to see how the new blood test comes back. But my IFG-1 is low and my DHEA is low unless I take 25 mgs. a day. He tells me doing HCG should keep my IGF-1 up but it is 114 and keeps going down. My E2 came back good 25 up from my last test of 13. I think after my next test comes back for the Thyroid and it looks like it did last time and he still tells me I am good I am going to see Dr. John.

 

[1cc]

And he has her doing 25 mgs. 2 times a day.

That is too high to start for a woman. She should start at 10mg per day and see how it goes from there after labs. Check the book "The Life Extension Revolution" - Dr. Philip Miller

I asked him to give me some Cortef 5 mgs. so I can try and take upto 20 mgs. a day and see if I don't feel better he told me doing this will shit down my Adrenals and can cause more problems. I told him I read on the net you can take up to 20 mgs. a day and not do this.

I have Adrenal problems and have not had to use more than 5mg per day. Make sure you actually do have Adrenal Fatigue before treating it. The only way to know 100% for sure is to have a saliva test done with 4 samples throughout the day. Also score yourself on James Wilson's questionnaire in his book "Adrenal Fatigue". Not everyone needs a full 20mg per day in order to treat Adrenal Fatigue. 20mg will shut down your Adrenals and you will need to slowly wean off the Cortef at the rate of 0.25mg every 2 weeks, in order to give your Adrenals a chance to restart again.

 

[magic8989]

I just got back from my Dr.'s and we went round and round my morning cortisol came in at 8 this was done at 8:30 a.m. to me from what I have been reading is dam low he feels it is in range but low range. I am getting one upper Respiratory infection after the other now I have a sinus infection and inflamed lungs. My Total T is up at 1283 range 262 to 1593 he feels this is good. I got him to admit I am Hypopituitary and he is checking my Thyroid and doing Cortisol again but this test was at noon he feels it will be higher I don't think so. I asked him to give me some Cortef 5 mgs. so I can try and take upto 20 mgs. a day and see if I don't feel better he told me doing this will shit down my Adrenals and can cause more problems. I told him I read on the net you can take up to 20 mgs. a day and not do this. So this is were we are now. I have to see how the new blood test comes back. But my IFG-1 is low and my DHEA is low unless I take 25 mgs. a day. He tells me doing HCG should keep my IGF-1 up but it is 114 and keeps going down. My E2 came back good 25 up from my last test of 13. I think after my next test comes back for the Thyroid and it looks like it did last time and he still tells me I am good I am going to see Dr. John.

That is interesting. I will have to mention something like this to him. We have the same doc correct? Dr. Stephens the one you referred me to? Well i said that was interesting because i got off the phone with him yesterday and he keeps basing my thyroid on my TSH. He told me to cut my synthyroid down to 88mcg 6 times a week. I told him once but he probably forgot that i added back in my cytomel. I have an appointment next monday and plan on having a good talk with him possibly about armour or what you were talking to him about. On the good side my T is up in the 1100's and free T is in around 420. Not sure of the reference range but if they went with quest labs this would put me in the upper 1/3 range.

 

[pmgamer18]

That is interesting. I will have to mention something like this to him. We have the same doc correct? Dr. Stephens the one you referred me to? Well i said that was interesting because i got off the phone with him yesterday and he keeps basing my thyroid on my TSH. He told me to cut my synthyroid down to 88mcg 6 times a week. I told him once but he probably forgot that i added back in my cytomel. I have an appointment next monday and plan on having a good talk with him possibly about armour or what you were talking to him about. On the good side my T is up in the 1100's and free T is in around 420. Not sure of the reference range but if they went with quest labs this would put me in the upper 1/3 range.

He is a dam good Dr. on low T but I am starting to wonder about this Adrenal and Thyroid. But he did run the Free T3 and T4 like I asked. We will have to see how it goes. You levels are good how are you feeling.

 

[love_en]

If one's adrenals do not put out what is needed to maintain health and wellbeing to begin with, shutdown is a moot point. Phil is lucky that his low adrenals manifest themselves as sub-optimum immune response. My low adrenals announce via orthostatic hypotension, heat intolerance and constant nausea. Marianco has mentioned that testosterone modulates cortisol output. Having said that, I hope no one gets the idea of cutting T just to raise cortisol. If all of these things are issues, methinks one is hypopituitary.