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Addison's Disease Message Board


Addison's Disease Board Index


I'm hoping someone can help me here, as I am at my wit's end with all of this....

I'm going to list my symptoms, and then the relevant tests that I have had and can you tell me if this sounds adrenal related? I'm hoping you can help me out because I can't get a doctor to test me properly. Also I am already hypothyroid (.05 levothyroxine for the last 5 years). My thyroid has just been tested and it is normal (TSH 1.36).

Here are my symptoms:

feeling like an ice-cube, especially hands, feet and nose, sometimes have to use hot water bottle all day, but can also get VERY hot in an instant. I sleep with 2 pairs of socks, nightgown and housecoat

Postural hypotension (very dizzy on standing up) confirmed by doctor

blood pressure has been as low as 76/37.

Rapid, pounding heart beat on standing up or going upstairs, or doing just about anything. Find if I eat alot of salt and drink 2-3 glasses of water, my heart pounding, lethargy and shortness of breath go away

shortness of breath

morning nausea and lack of appetite - mostly after period until ovulation

constipation and then I'll go 4 or 5 times in one day, diarrhea by the end of the day

lost 16 pounds over the last month and a half, and eat like a horse

EXTREME fatigue on some days, others it's better, very sleepy alot of times (which is UNUSUAL for me)

balance is off

brain is fuzzy

very thirsty, mouth is dry, tongue gets sore, eyes are VERY dry, skin is very dry (lotion 3 times a day)

seem to have a very dry throat - hoarse alot

peripheral neuropathy - burning in hands, arms, feet, legs and tinglies all over body including face

muscle twitching and cramps and weak muscles especially hand grip

roaming joint pain

on and off hypoglycemic episodes when I haven't eaten or when I've eaten something sugary

sorry (TMI) but I'm losing my pubic hair, some armpit hair and lots of hair on my lower legs. Also the private parts down there are quite dark and my husband doesn't call me pale anymore, used to be a standing joke with us

Not all of the above symptoms happen at the same time, they will come and go in groups.

Now, I have had a random cortisol blood test at around 4:00 pm (not fasting) and it was 483 Range was 170 - 540 which is in the high range.

Any ideas at all??? They've been testing me for Sjogren's disease because of the dry eyes, mouth and skin, but so far all tests are negative.

Please help me out here, I'm terrified of being lumped into a Chronic Fatigue Syndrome group where I don't get any help or medication, but only brush-offs.

Sherry
Hi Sherry, Sorry you are having so many symptoms. Some of it sounds like addisons & some like thyroid. Here is some info on testing for addisons.

[COLOR=DarkRed]Diagnostic Testing for Addison's Disease[/COLOR]


TEST 1: Electrolyte profile:

OBJECT: To determine if the patient exhibits a normal serum (blood) sodium and potassium levels.

THE TEST: A blood draw followed by automated determination of sodium and potassium levels as well as other standard blood markers.

NORMAL RESULT (will vary somewhat from lab to lab): Sodium 135-150 mEq/L; Potassium 3.5-5.2 mEq/L

PRIMARY ADDISONIAN: Will show significantly below normal values of sodium and a elevated (above normal) levels of potassium.

REASON FOR ABNORMALITY: Low or no production of aldosterone from the adrenal cortex. This steroidal hormone regulates our mineral balance and is called a mineralocorticoid. Primary Addisonians lose sodium and retain potassium. Abnormal values here, in additon to physical signs and symptoms, require the next test.


TEST 2: The ACTH stimulation test:

OBJECT: To determine if the patient's adrenal glands can respond to the ACTH message from the pituitary to increase cortisol production in the adrenal cortex.

THE TEST: The test is usually given first thing in the morning when normal cortisol levels are highest. Blood is withdrawn from the patient to establish a baseline (No instructions regarding necessity for fasting). The patient is given 250 micrograms (ug) of ACTH (Cortrosyn, Cosyntropin, or Synacthen) by injection in saline at one time. Blood is drawn at 30 minutes and/or 60 minutes and the serum cortisol level is determined.

NORMAL RESULTS: Normal pre-injection levels of cortisol are 5-25 ug/dL (138-690 nmol/L). The value should double at 30-60 minutes with a minimum of 20 ug/dL (552 nmol/L). PRIMARY ADDISONIAN: There will be no or little increase in cortisol levels upon ACTH injection. Notes: It is stated in several places that a single test of cortisol levels, or even 24 h urinary levels of cortisol and its metabolites, are NOT DIAGNOSTIC! In the normal individual cortisol levels are seen to pulse. Low cortisol production in either the serum or the urine after ACTH stimulation is diagnostic of Addisons disease.

SECONDARY ADDISONIAN (Pituitary malfunction): Low cortisol production can be seen if the patient has "functional adrenal cortical atrophy" due to prolonged absence of normal ACTH secretion. This type of patient would not show the typical hyper-pigmentation of primary Addisons.

REASON FOR ABNORMALITY: Due to autoimmune, or other destruction of enzymatic (biocatalytic) machinery of the adrenal gland, there is no response to ACTH and no production of cortisol and other adrenal steroids necessary for life. If this test gives normal results and the patient has other signs and symptoms then one of the following tests is required.


TEST 3: The insulin stimulation test.

OBJECT: The purpose of this test is to determine whether the patient's pituitary gland can produce ACTH in response to an insulin stimulus. Abnormally high insulin will drive the patient into hypoglycemia and stimulate the production of ACTH from the pituitary. This test is called by Dr. Krasner (JAMA, 1999, 282 671-676) the traditional test to determine the integrity of the messenger pathway between the hypothalamus, pituitary and adrenal gland. He stresses that it should be given by qualified medical personnel under the direct supervision of a physician, because insulin shock can result.

THE TEST: Baseline blood levels are taken. Insulin is injected into the patient until the blood glucose level falls below 2.2 mmol/L (40 mg/dL). Blood is drawn at intervals up to 90 minutes and the serum cortisol is measured. (This is simpler than determining the ACTH level).

NORMAL RESULTS: A normal patient will show an increase of cortisol production (due to increased ACTH production of not less then 550 nmol/L or (20 ug/dL).

DISEASED PATIENT (SECONDARY ADDISONS): If there is no or little increase in cortisol production as measured by several blood draws after this test is given, then, according to Dr. Krasner, the patient has significant hypothalamic-pituitary-adrenal (HPA) axis impairment.

REASON FOR ABNORMALITY: Basically, either the pituitary or the hypothalamus glands are not showing normal physiology. There can be several reasons for this. The pituitary may have lost its ability to make ACTH due to autoimmune impairment. The hypothalamus may not be sending the right signal to pituitary. There may be a pituitary tumor. Finally, the HPA axis may be suppressed due to sustained therapeutic use of steroids like prednisone which is given to those with chronic inflammation of various kinds. Asthmatics sometimes get in this situation.





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