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Addison's Disease Message Board

Addison's Disease Board Index

I have hashimoto's thyroiditis and am wondering if my adrenals are stressed or fatigued? My endo did several tests but don't know if he did the correct ones that really tell for sure. I am having trouble increasing my thyroid meds without raising my other words, sensitive to meds. My legs and muscles are weak and I have shortness of breath. Here are the only tests he ran:

Random cortisol 14.......................Range 2-25

Then he did the fasting test (don't know the name) where I took the "Dexamethasone" tablet the night before and they drew blood the next morning. That came back: 1 (out of range) ...........Range 2-25 He called it "normal".

The he did the 24 hr. urine to see if I had adrenal tumor. I did not see my lab reports on that but was told it was normal. Don't even know if that test could have told him if my adrenals were fatigued.

Now my gp just prescribed Cortef 1 mg morning and 1 mg. night without doing a test first, so I was concerned if I have had the proper test and if I really needed the Cortef. Then I had read somewhere that the saliva test was the only one that was accurate since you test 4 times a day. I would appreciate it if someone could enlighten me on this.
Here are the tests you need. The ACTH stim test must be done correctly. You need to get off the Cortef. It is "VERY VERY careless" of your doctor to prescribe this to you with out being diagnosed. The ACTH test is the best way to check for addisons. I don't know anything about the test they did with the Dex. Most docs know nothing about addisons so you will need to tell them what you want done & how it should be done.

Diagnostic Testing for Addison's Disease

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.

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