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Forum Name: Endocrinology Topics

Question: NEED HELP..... Strange Cortisol and Thyroid Results


 Lolanveda - Fri Dec 15, 2006 3:51 pm

I have been having many symptoms that indicate possible adrenal insufficiency so I ordered a cortisol saliva test from Diagnos-Techs, Inc. My results are as follows:

Time: Result: Ref Range:

7:00-8:00 AM: 2, (13-24 nM)
11:00-Noon: <0.3, (5-10 nM)
4:00-5:00 PM: <0.3, (3-8 nM)
11:00-Midnight: <0.3, (1-4 nM)

Cortisol Burden: 2, (23 – 42)
DHEA: 4, (Adults (M/F): 3-10 ng/ml)

As you can see these results are severely depressed so I went ahead and scheduled an appt with my doctor. He went ahead and ran a Cortisol Blood Serum test which was taken at 12:45PM. I had also taken 2 grains of Armour Thyroid prior to the test. The blood cortisol results are as follows:

CORTISOL: 5.9 ---- REF RANGES~ (AM) 4.3- 22.4 UG/DL , (PM) 3.1 - 16.7 UG/DL

My questions are~

1. Which is seen as more effective and accurate, the saliva or the blood cortisol test?

2.Should I have additional testing done, if so what? ACTH stimulation?

3.Would the fact that I had taken a dose of Armour Thyroid before my blood cortisol test have any influence on the result?

4.Even though the blood cortisol shows on the low end of normal, should I just accept that or should supplementation be an option?

Any thoughts or insight would be greatly appreciated. Thanks in advance!

~Kelly
32
F
Hypothyroidism
Current Meds: Armour Thyroid, Wellbutrin XL
 Dr. Safaa Mahmoud - Fri Dec 15, 2006 8:05 pm

User avatar Hello,

Cortisol is secreted in circadian rhythm with a maximum 5-25ug/dL in the early morning (8:00 am) and minimum values of 3-16ug/dL in the late afternoon.

These results are low, but you need to do more tests.

A high plasma ACTH level with a low or normal cortisol level are diagnostic for primary adrenocortical insufficiency.

Diagnostic Testing for Addison's Disease
- Serum cortisol at 8:00am , if the results are < 5ug/dL [SI:140nmol/L] (some authorities say < 3ug/dL [SI: 86nmol/L]) the disease is confirmed.
A result of > 20ug/dL [SI: 550nmol/L] excludes the diagnosis in an unstressed individual.

- Between these values a rapid ACTH stimulation test should be performed.
Low cortisol production in either the serum or the urine after ACTH stimulation is diagnostic of Addison's disease.

- A long ACTH stimulation test should be performed to differentiate primary from secondary insufficiency.

- Electrolyte profile: Sodium, Potassium :(in primary Addison's)significantly know levels of sodium and a elevated levels of potassium.

It is not clear how Armour Thyroid affects the results of the test since we do not know the level without the drug and we can not compare results from saliva with tat of blood analysis

Hope this information is useful.
Keep us updated.

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