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Forum Name: Endocrinology Topics

Question: Low Cortisol level of only a 1. Advice on how to follow up?


 tjsb21 - Thu Oct 15, 2009 3:04 am

I am a female 38yrs old.
I have been suffering from severe vomiting, severe abdominal pain, occasional diarrhea.
I have been hospitalized 6 times in the last 3 months. The last one I went to Methodist in Houston, as I am wanting answers to these symptoms and others I have been having.
My last stay indicated a Cortisol reading of only 1 with blood test.

The Doctors came and explained to me that a normal reading should be anywhere from a 10-25. And that they wanted to inject me with something and then draw blood at different intervals.

We did this.
The first reading level went up to 23.
The second reading level went to 30.
The final {next morning blood drawing} revealed reading back down to a 2.

The Doctor on my case referred me to an Endocrinologist from Baylor College.

Let me back up a bit. I initially went to the E.R with severe, and I do mean screaming severe abdominal pain, watery stool movement, and dehydration. Vomiting also present.
When they began doing test, blood test and all sorts of CT,MRI, X-Ray, Endoscopy, Colonoscopy, they found the Low Cortisol levels.

The Endo Doc wanted to do a ACTH test. And MRI. I was released from hosp after 5 days and told to call the Endo Doc back regarding results from the ACTH test.

Well I did this only to be told that they were fine, and my low cortisol level were due to stress due to being sick from Gastro-bug and Gastrinitis.

I didnt get to give a full medical history, and after I came home and researched low cortisol did I then realize I have been suffereing from other symptoms as well.

I am fatigued
I have lost 20lbs in last 6weeks {not intentional}
If I get up too fast I get dizzy, nearly blacking out. Have to sit back down immediately.
This weakness\painful calf/ leg pain {this started within last 3 mths}
Mild depression
Sleeping excessively {most recently}
And inability to sleep at times
Diminished ability to fight infection { constantly going to the doctor for upper resp. infections, yeast infections, U.T.I's, bladder infections, and M.A.R.S}
Less alert in the afternoon-just too tired and a sugar drop feeling
Confusion
Can not stand the cool temps of my own home when all else is only comfortable
No sex drive
No skin pyg

The vomiting, abdominal pain, dearrhea and leg pain plus back pain {which I thought to be kidney infection related} has only been recently....started in July-2009.
I was referred to a upper G.I doctor my 1st or 2nd hospital stay. He did a endoscopy test and said my stomach was inflammed, and that I had a Gastro-bug then the next hospital stay said it was Gastrinitis, or something very close to that.

He doesnt know about the Cortisol levels yet, and I'm not usre that it would make much difference to him as he feels he has his diagnosis.

I feel the Gastro is secondary to whats going on.

Its extremely late and I know I am missing some info here that could or would be more helpful. I guess I will just wait until I have {hopeful} responses.

Thanks tjsb21
 endomess - Fri Oct 23, 2009 5:57 pm

You have many symptoms of low cortisol as well as hypothyroidism due to lack of cortisol to shuttle the thyroid hormone properly into your cells.

I would ask your endo to do a 24 hour urine test for cortisol.
Blood tests and multi-point saliva tests (better) and even the ACTH stimulation test (what you got), can miss sometimes. But the urine test is hard to trick. See how your total cortisol production for the day is. I wager its way too low.

Id be sure to remove proper cortisol levels as a variable before moving on to the next thing to test, which would be thyroid function if it were me.
 Dr.M.Aroon kamath - Fri Nov 13, 2009 10:45 am

User avatar Hi tjsb21,
Having gone through your post and the following post by endomess,let me add a few comments.

Most common cause of cortisol deficiency these days is perhaps, diets very rich in carbohydrates.Add to this mental and emotional stress and you have the perfect recipe for cortisol deficiency.

Hypothyroidism affects function of the adrenal gland cells just as lack of thyroid hormone affects cells in the rest of the body.As the adrenal glands are unable to function normally,cortisol levels drop.So, it is the thyroid function affecting adrenal function rather than vice-versa.Most of the thyroid hormone produced by the thyroid gland (93%) is T4 and only (7%) is T3(the more active form).

The conversion of T4 to T3 occurs MAINLY IN THE LIVER.

Some people are unable to convert T4 to T3 efficiently - why?
...perhaps a combination of genetics, sub-optimal nutrition and liver toxicity.

There is paucity of evidence that cortisol has any major role to play in this conversion or to shuttle thyroxin into the cells.
What is known however, is that INCREASED cortisol production due to stress does BLOCK the conversion of T4 to T3 by the liver.

Thus available evidence does not support the view that low levels of cortisol have any significant role to play in T4-T3 conversion than high levels of cortisol.

As far as your clinical picture is concerned, it is probable that some kind of liver toxicity (exact cause needs elucidation) could have caused the low cortisol levels.Pre-existing hypothyroidism has to be ruled out as well.
Best wishes!

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