lab results

[love_en]

No ACTH serum. But my knuckles, elbows, etc are darker than the rest of my skin. Any scars that I have are dark as well. People who have not seen me for a while notice my nice tan as well. No one else in the family has that odd darkening of the knuckles, not even my kid brother who goes surfing every weekend.

I am open to the idea that my base needs to be at 30+. What increases my suspicion, is how well I tolerated being on licorice for over 10 years. No hypertension or water retention. My tan also went away. I stopped the licorice after starting testosterone. Now the tan is back. The reference ranges are obtained by the values observed in the sick, but not yet dead. I got into the world's biggest pissing match with the endo about total T reference ranges.

 

[Chrisgj2]

What you have describe with the tanning is classic. I don't think I've heard of tanning in someone with numbers that high. My number at 10am was 20 stimmed to 24. That you have had it for so long and your numbers are not "very low", I suspect your problem may be low acth production, but I could be wrong. The tanning is related to ACTH. When ACTH climbs it can then stim melanocytes in the skin. ACTH is very close in chemical structure to a pituitary hormone called MSH and MSH is a byproduct of ACTH. I'm not sure if the ACTH stims melanocytes itself or if the extra ACTH is breaking down into MSH. MSH stimulates melanocytes in your skin to produce melanin (a hormone) and that causes the tanning. In secondaries, I don't think it is understood why low ACTH can SOMETIMES cause tanning. I've been on Addison's groups for over 2 years and I'd say 1 in 7 secondaries get some degree of tanning. Might be just 1 splotch on the face or neck. 1 in 20 secondaries, I estimate, get the severe tanning.

If your body tan even or splotcy? My tanning was on my forearms (perfectly even tan) with a perfect tan line just above my elbows. had this year round for 14 years. My legs were tanned (perfectly even, feet not tanned) to an undefined tan line about where the bottom of shorts (short not long shorts) would hit, also for 14 years. My face and neck had an uneven splotcy tan. This face and neck tan popped up the last 3 years before I started treatment.

I got the tan and shin hair loss 3 weeks after I left home and 1 week after I got married.

Do you get problem with your back severely hurting in something stressful? If I had a near miss on the road, my back would spasem and hurt real bad for a minute. This stopped after treatment.

Make sure you get the antibody testing. I've seen several with Hashimotos (antibody attacks the thyroid), that had low pituitary hormones like acth and MRI's showing no pituitary tumor to be the cause. In this case of no tumor, I suspect antibodies are also attacking their pituitary.

Unfortunately most docs won't touch someone with numbers as high as yours. You will likely need to find an osteopath. A DO is your best chance from what I've seen. And get the acth serum. The range is usually 10 - 60. I like to see in the upper third of the range. If in the middle, I start to supect secondary. Lower third I match definately with secondary. 95% of secondaries fall within that flawed range.

Chris

 

[Chrisgj2]

Acute adrenal crisis symptoms and signs

Gastrointestinal symptoms such as nausea and vomiting (vomiting or abdominal pain is a signal that an adrenal crisis might occur)
Other symptoms of adrenal crisis
(no one has every symptom)
headache
profound weakness
fatigue
slow, sluggish, lethargic movement
low blood pressure (falls when standing from a horizontal)
dehydration
high fever
shaking chills
confusion or coma
darkening of the skin (see skin, abnormally dark or light)
rapid heart rate
joint pain
abdominal pain
unintentional weight loss
rapid respiratory rate (see tachypnea)
unusual and excessive sweating on face and/or palms
skin rash or lesion may be present
flank pain
loss of appetite




Symptoms of primary adrenal insufficiency (secondary shares most of the above symptoms) — Most patients with primary insufficiency experience fatigue, generalized weakness, loss of appetite and weight loss.

Other symptoms can include (no one has all the symptoms)
Darkening of the skin (happens in Addison's - if you don't have darkening you can still have a lessor degree of adrenal insufficiency - and sometimes some tanning happens in secondary adrenal insufficiency)


Hypotension (low blood pressure with lightheadedness after standing up)
need for excessive amounts of sleep
chronic, worsening fatigue
Muscle and joint pain
muscle weakness
back pain
loss of appetite
lowered resistance to infection
Salt cravings
low stamina
weight loss
decreased tolerance to cold and subnormal body temperature
poor circulation
low blood sugar level (hypoglycemia)
allergies
apathy or depression
low self-esteem due to low energy output
low levels of gastric hydrochloric acid
tendency to constipation

21-OH adrenal antibodies (Addison's).

 

[pmgamer18]

When my Total and Free T levles are way off my cortisol E2 hell everything goes to shit. I have panic attacks feelings of Depression the works. Getting my T and F T. levels back up and my E2 down my problems go away. No more meds Xanax and so one. But this is me I do some relaxstion respone that gets me over the hump on bad days. I do this in the morning and after dinner everyday. When I wake up feeling panic I do it to fall back to sleep try it it takes practice to learn it but once you do you can do it anywhere on a bus in the bathroom at work. I would try going on TRT to see if you feel better. Then if the other problems don't get better do other meds to help.
http://www.ucop.edu/humres/eap/relaxationrespone.html

 

[rrcat]

, .
A few other tests you should do (also check swale's labs that he runs sticky for a comprehensive list):
Thyroid:
TSH
Free T3
Free T4

Adrenals:
DHEA
Cortisol (Saliva)

Testosterone:
Total T
Free T
DHT

Estradiol
Prolactin
IGF-1

T3-34 (24-39)
T4- 6.8 ( 4.5-12.0)
TSH-1.915 ( .350- 5.5) At least my thyroid is working good.

Prolactin-5.4 ( 2.1-17.7)


I am not sure if I should take hydrocortisone b/c isnt it a catabolic steroid? I dont want to further decrease my test levels. I do get dissy and lightheaded alot when I walk, but alot of other signs like hyperpigmentation or hair loss on shins I dont have. I really dont have many symptoms associated with addisons disease and adrenal fatigue. I think many of my symptoms stem from anxiety like rapid heart rate, sweating,etc.

It looks like from my results,that everything produced from my pitutary is hypo. I think I'll go get another blood test and then hopefully I can figure out something to do. I really appricate the help. This is a good group on here.

 

[Chrisgj2]

You didn't have the right thyroid tests (those are T3 uptake and Total T4). Most people with hypothyroidism have total T4 between 7 and 9. You need to get the free tests to tell what is really happening. You could ask for a random blood cortisol, but do it before 10 am.

Chris

 

[1cc]

T3-34 (24-39)
T4- 6.8 ( 4.5-12.0)

Is this Free T3 and Free T4? Is it pg/ml ng/ml?

 

[1cc]

I am not sure if I should take hydrocortisone b/c isnt it a catabolic steroid? I dont want to further decrease my test levels. I do get dissy and lightheaded alot when I walk, but alot of other signs like hyperpigmentation or hair loss on shins I dont have. I really dont have many symptoms associated with addisons disease and adrenal fatigue. I think many of my symptoms stem from anxiety like rapid heart rate, sweating,etc.

You don't want to go through the rest of your life not getting treated for whatever your ailment is. Dr. James Wilson author of "Adrenal Fatigue: The 21st Century Stress Syndrome" actually does do consults by phone. He is a little pricey, but well worth it if you should get better. I think it would be a good idea for you to see him and get a proper diagnosis. You can get him at http://www.adrenalfatigue.org/ .

 

[rrcat]

Is this Free T3 and Free T4? Is it pg/ml ng/ml?

Thyroid studies result units range
T3 uptake= 34 % 24-39
Thyroxine (T4)= 6.8 ug/dl 4.5-12
Free Thyroxine Index= 2.3 1.2-4.9
TSH= 1.915 uIU/ml .350- 5.5

 

[1cc]

Thyroid studies result units range
T3 uptake= 34 % 24-39
Thyroxine (T4)= 6.8 ug/dl 4.5-12
Free Thyroxine Index= 2.3 1.2-4.9
TSH= 1.915 uIU/ml .350- 5.5

I don't believe any of these are Free T3 or Free T4.

 

[love_en]

What you have describe with the tanning is classic. I don't think I've heard of tanning in someone with numbers that high. My number at 10am was 20 stimmed to 24. That you have had it for so long and your numbers are not "very low", I suspect your problem may be low acth production, but I could be wrong. The tanning is related to ACTH. When ACTH climbs it can then stim melanocytes in the skin. ACTH is very close in chemical structure to a pituitary hormone called MSH and MSH is a byproduct of ACTH. I'm not sure if the ACTH stims melanocytes itself or if the extra ACTH is breaking down into MSH. MSH stimulates melanocytes in your skin to produce melanin (a hormone) and that causes the tanning. In secondaries, I don't think it is understood why low ACTH can SOMETIMES cause tanning. I've been on Addison's groups for over 2 years and I'd say 1 in 7 secondaries get some degree of tanning. Might be just 1 splotch on the face or neck. 1 in 20 secondaries, I estimate, get the severe tanning.

If your body tan even or splotcy? My tanning was on my forearms (perfectly even tan) with a perfect tan line just above my elbows. had this year round for 14 years. My legs were tanned (perfectly even, feet not tanned) to an undefined tan line about where the bottom of shorts (short not long shorts) would hit, also for 14 years. My face and neck had an uneven splotcy tan. This face and neck tan popped up the last 3 years before I started treatment.

I got the tan and shin hair loss 3 weeks after I left home and 1 week after I got married.

Do you get problem with your back severely hurting in something stressful? If I had a near miss on the road, my back would spasem and hurt real bad for a minute. This stopped after treatment.

Make sure you get the antibody testing. I've seen several with Hashimotos (antibody attacks the thyroid), that had low pituitary hormones like acth and MRI's showing no pituitary tumor to be the cause. In this case of no tumor, I suspect antibodies are also attacking their pituitary.

Unfortunately most docs won't touch someone with numbers as high as yours. You will likely need to find an osteopath. A DO is your best chance from what I've seen. And get the acth serum. The range is usually 10 - 60. I like to see in the upper third of the range. If in the middle, I start to supect secondary. Lower third I match definately with secondary. 95% of secondaries fall within that flawed range.

Chris

Or high ACTH production because my demand for cortisol is high. I must not be one of those who gets by on a level of 20. I experienced the same thing with the testosterone. 388ng/dl in a reference range of 350-1000 was not enough to maintain my health. That 388 was obtained at the same time as the second blood draw for the ACTH stim test. I have heard from doctors that the ACTH can elevate T levels over baseline as weii.

I now realize that most of my childhood was spent sick. It was always something to do with my digestion. That list of symptoms you posted above sounds so familiar. The only reason why I am not incapacitated now is my current PCP is very good at suppressing symptoms. I have a supply of metoclopramide to take if the nausea becomes intollerable. TRT helps as well, for a long time, I had to deal with low T in addition to low adrenals. It seems that my father's side of the family also has signs of adrenal trouble as well. One that stands out is my cousin. Asthma and allergic to everything, but does very well on 5 mg prednisone per day.

I did have back pain often, however TRT relieved that for the most part. The tan is in places that do not see much sun. I normally wear pants and long sleeves outdoors. My cheeks are blotchy. I know what a person looks like if he gets to lay on the beach all day. That is not the kind of tan i am getting. I suspect it is more like the high ACTH MSH kind of tan.