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If someone has normal blood cortisol levels for the morning and late afternoon but there is only a one point difference, is this significant? Should the morning level be much higher than the afternoon level?

Thanks!
Morning should be significantly higher.

If they are about the same, then the question is: are they both high or both low. Both high = Cushings, both low = Addison's, both moderate = needs more investigation.
Orion, thank you for your response. Both are in the normal range. The morning was 12 (range 4-22) and the afternoon is 13 (range 3-16).

The doctor thought that maybe there should be a bigger difference between the two. He was going to check with a colleague who is more knowledgeable about adrenals.

I also have Lyme disease and Hashimoto's Thyroiditis.

Do you have Addison's or Cushings?
What time were the tests taken? That is significant.

The body's normal rhythm should be at its highest at around 8am. It should fall to roughly half that amount by 4pm (the lab ranges usually show time periods from 8-10 and 2-4). Ranges are wide and doctors that are not experienced can just look at what is *normal* and not see what is really wrong so at least your doctor is seeing that you possibly have an issue with your diurnal rhythm. Another good test is at midnight, where cortisol should be at its lowest and some with Cushing's will be high.

A variety of tests should be performed and you should keep in mind that they differ is both how and what. Blood tests are testing serum cortisol and are point in time tests so you may or may not be high at the time of the test. Saliva tests are point in time, but test free cortisol. Urinary Free Cortisol tests are done over a long period - usually 24 hours or 10 hours and will tell you if your cortisol was raised in that average. The pitfalls for that, for me, for instance, is that I was so high and then so low, that the lows cancelled out my high and I was largely average or just barely high. Another pitfall of free cortisol is that some people "bind" free cortisol through no fault of their own (and some drugs and even estrogen does this) so that no matter how high they really are, free cortisol will not spill so a test call cortisol binding globulin is useful but only a few specialty labs carry it and good doctors know about it.

One test should not rule you in or out. Dexamethasone suppression tests should not rule you in or out. I suppressed on every test and had confirmed Cushing's disease. Get many tests to know the source of your disease. It is not straightforward.

I had both pituitary and adrenal surgery. I have Hashimoto's too.
Hi rumpled, thank you for your reply.

The AM draw was taken at 10:00. It was supposed to be at 9:00 and I was there at 9:00, but they did not realize I was there for only blood work until 10:00 when I said something.

The PM draw was done at 4:00.

I wonder if it would have been better to have the morning draw done at 8:00.

Thanks for all of your feedback on the testing. It is a shame that they are not more reliable. Do you think it is even worth doing the saliva testing? It is expensive and not covered by insurance from what I understand. Which doctors would be most up to date on adrenal problems?

I am sorry you are dealing with so much. How are you feeling?
Ticker, my endo uses the saliva test from Diagnostech labs, they send you the kit and you do it at home, you start on a Monday morning at 8 am, it takes 3-5 minutes to put the swab in your mouth, then you place it in a vial and refrigerate it, then you do the same thing at 12 (noon), 4 pm, and 11 pm, it is very simple, then you mail the kit to the lab, on Tues. morning, it costs $100.00, which you submit with the kit, my INS reimbursed me $75.00 of the $100.00. This test also includes DHEA levels. My doctor feels that this test along with symptom history is very significant. Sarah
Saliva tests are recognized as valid tests and with a doctor's order and diagnsosis code, insurance should pay. The ones my doctors order are usually by ACL labs or esoterix labs (which is owned by *******).
If you read up on the protocols for testing, many of them include saliva testing. Your test was done a bit too late to really be accurate and hopefully your doctor will re-do your testing. Get to the lab a lot earlier next time and try to get an 8am fasting draw next time.
Thanks for the wishes...I have a lot going on.
Hi Sarah, thank you!

I saw my doctor this morning. He talked to a colleague about my results and the colleague recommended that I do the saliva test. The doctor is supposed to be calling me later with the other doctor's contact information. Hopefully, I can get some answers soon (one way or the other).

Do you have adrenal fatigue?
Hi Kim, thanks for your reply!

What are normal levels supposed to be? Highest in the morning and then steadily decreasing throughout the day? Should the noon level be somewhere in-beween the morning and afternoon level? Did you feel really fatigued because of what your levels were? When your levels were off, how did you feel in the mornings when you woke up?

How long do you think it will take for the dose increase to kick in? I hope it helps you soon. Thanks again.
Thanks rumpled.

I apprectiate everyone telling me that your insurance covered most of the testing cost. I had heard it was not covered. Hopefully as you say when a doctor orders it, insurance should pay.

I understand what it is like to have a lot going on. I hope you feel better soon.
Thanks Kim. I also do not feel rested when I wake up even though I do not have insomnia and seem to sleep. I am glad the replacement is helping you. Anything that can help is good!

I have an appointment Thursday with a doctor who is supposed to be knowledgeable about adrenal problems. I hope it goes well. He is over an hour away, so I hope it is not a waste of time.
Hi Kim & Ticker--Ticker, hope your dr's appt. goes well Thurs. I am doing my 24 Cortisol saliva test today, I only have the 11pm-midnight left to. I am hoping that my levels have come up from the spring, but I don't feel much better, so I don't know. I do not have problems sleeping either, but I don't feel rested when I wake up, I could just keep sleeping if I didn't have anything else to do. All day I have trouble staying awake. My doc said to eat protein every hour , such as cashews, pecans, even if I don't feel a slump, and to stay away from colas and coffee.
Kim, I had the 2 hour glucose tolerance test done last month, I was surprised by my results, my doc thought that I had probably become diabetic, but actually at 2 hours I was down to 49 mg/dL the norm is 65-99, so I wasn't high, I was low. I almost passed out between the 1st and second hour and they had to let me lie down. I did mine at Quest labs and they just make you sit in the waiting room between blood draws, the receptionist noticed that I was becoming pale and putting my head down, so they put me in a lawn chair they had in the back. Funny, but sad!! I hope that your test goes well and that you have a good holiday--you too Ticker!! Kim, I am going to CT for Christmas, and NYC for New Years, I wish that I could meet you!! Sarah
Thanks you guys. I hope it goes well also, I need it to!

I have compared my symptoms to those of adrenal fatigue and will discuss this with the doctor. If you have suggestions for questions or other issues to discuss, I would love to hear them. Thanks!

I will let you know how it went when I get back home.
Hi guys. My appointment went great and I really liked the doctor! I did the saliva test and sent it out over the weekend. He is checking coritsol and three or four other hormones. It cost $240.

What amazed me was this doctor told me that if he could not determine what was wrong, he had several other people he could consult with. He is from NY, so he knows about Lyme disease. That was refreshing also.

I am cautiously excited. I have been trying for years to have this testing done.

Kim, I am glad you had a good time in NC and that you were feeling okay on your son's graduation day. I am sure you are very proud of him :)
Kim, thank you for your kind words! You have been a great help with adrenal information :)

I was told it usually takes about 3 1/2 weeks to get results. Maybe mine is taking longer because they are testing several hormones. The doctor told me to send it out and then make an appointment for a follow-up in a month. So I will schedule it soon.

I am glad you have seen some improvement since starting treatment. I know it is frustrating that it takes so long, but you are on the right track.

I hope your Christmas was nice and that 2008 is a happy, healthy year for you!
Hi Kim. I am glad you enjoyed Christmas! It is great you see improvement over the past ones. Even slow improvement is better than no improvement right?

Have your blood sugar levels been normal? If they are normal and you have no symptoms, I don't know why your doctor would want the testing done. I suggest asking him/her.
Hi everyone. Finally, the results are in: severe adrenal fatigue [I]and[/I] low DHEA, low estradiol, low progesterone, low testosterone, and a very low ratio of estradiol to progesterone. I knew things were wrong, but I am amazed at what a mess I am!

I have a lot to learn. Does anyone else have low hormone levels?

I have a very complicated protocol to follow. I will do whatever it takes.

To those who are looking for an answer, never, ever give up. You know you better than anyone. If you cannot get help when you know something is wrong, see another doctor, and another until you find one. I know it is frustrating and you should not have to go through so much to get the help you need, but it is worth it to get one who can help you.
Hi Kim. I am sorry you have horrible fatigue. I know it stinks!

My doctor did not prescribe Cortef. He prescribed Wilson's protocol for severe adrenal fatigue. It is three different supplements taken several times a day. I have done very limited research at this point, but from what I have read people feel these supplements work. Supposedly this strengthens the adrenals. My doctor is also addressing the hormone deficiencies. The protocol I am following is quite complicated, but I will do whatever it takes.

I just got Wilson's book and will be reading it soon. I have always eaten very healthy and exercised throughout all of this (not always easy!). I am anemic also and take iron. The doctor prescribed a protein powder for me to take twice a day. I don't know if he did this because of the anemia.

What kind of doctor are you seeing for the adrenal issue or is your Lyme doctor treating you for it?
hi i am new to this board,
please could any one tell me if a 9am cortisol level of 266(lab range 190-720nmol/L) would be classed as low. my gp says its normal so isn,t botherd about the fact i have pa i am on monthly jabs but dont feel significantly any better, and am hypothyroid and am on thyroxine.i must admit i dont feel too confident in my gp has thers has been a bit of lack of knowledge and i got told my b12 level of 325 after loading doses was normal .but my consultant put me on to monthly jabs after i tested positive to parietal cell antibodies.i have asked to see an endo and have got an apt on 28th march.i so need to get sorted i am sick of being tired out (forgot to say i am on 3 iron tabs a day for the last 8month as my ferritin was 6.5)i have a large family and dont have the energy i need,our youngest is 1 and has had ill health and we have a little girl whos 5 who has downs syndrome,and another 9 children beside .(not all living at home,they range from 1-27yrs)so you can see i need to get myself well.sorry to moan on ,but i would value your opinions.

many thanks..

michelles 13
hi i am new to this board,
please could any one tell me if a 9am cortisol level of 266(lab range 190-720nmol/L) would be classed as low. my gp says its normal so isn,t botherd about the fact i have pa i am on monthly jabs but dont feel significantly any better, and am hypothyroid and am on thyroxine.i must admit i dont feel too confident in my gp has thers has been a bit of lack of knowledge and i got told my b12 level of 325 after loading doses was normal .but my consultant put me on to monthly jabs after i tested positive to parietal cell antibodies.i have asked to see an endo and have got an apt on 28th march.i so need to get sorted i am sick of being tired out (forgot to say i am on 3 iron tabs a day for the last 8month as my ferritin was 6.5)i have a large family and dont have the energy i need,our youngest is 1 and has had ill health and we have a little girl whos 5 who has downs syndrome,and another 9 children beside .(not all living at home,they range from 1-27yrs)so you can see i need to get myself well.sorry to moan on ,but i would value your opinions.

many thanks..

michelles 13
What are your thyroid levels? FT3 and Ft4? You may not be optimized there.. many do not get optimized. Have you been tested for Hashimoto's? It is worth always gettign a copy of your labs. What dose of LevoT are you on?

MG
[QUOTE=mkgbrook;3473943]What are your thyroid levels? FT3 and Ft4? You may not be optimized there.. many do not get optimized. Have you been tested for Hashimoto's? It is worth always gettign a copy of your labs. What dose of LevoT are you on?

MG[/QUOTE]

hi mg. my tsh is 2.36 and free t4 is 16.i am on 100mg of levothyroxine now i went up to 125 mg when i was pregnant.then they dropped it about 6 mnths since. thing is as well i recently had a large lump removed out my arm and when they removed the stitches it all fell open,i have to twice a week for dressings changed also i dont feel better on monthly b12 jabs ,my head is foggy all the time
and carnt think what i want to say most of the time.hope someone can help.thanks.
michelles13
So they are not checking your T3 levels? It sounds like you are unbalanced. 2 out of 3 thyroid patients need T3 supplementation to optimize.

Optimized thyroid levels are FT3 and Ft4 levels in the 50-80% range, where the FT3 and fT4 levels are with in 5-10% of each other and your symptoms are negligible. Is an endo working with you. Do they believe in testing and using T3 if necessary? Ask them if they believe in getting you to your optimal level or if they just want you in normal range? I suspect they are just getting you into normal range and settling. Fight for better management. Also get your antibodies tested. If you have Hashi's it needs to be watched.. and your children may need to be watched as well.

Come to the thyroid board and many will offer experience and advice.

MG
i have my first appt with endo on 28Th March but he said my thyroid levels were normal and its only because of other things that he gave the appointment no i havent been tested for T-3 or Hashimotos. What is the difference? Thanks will go onto thyroid thread.

Regard
Michelles13
T3 hormones are the active, short lived thyroid hormones. They are used for driving every system in your body. T4 is not used in as much.. it is the thyroid stores that the liver takes and converts to T3.

Hashimoto's is an autoimmune thyroiditis. Your body develops antibodies to the enzyme TPO and a few others that are used to make T4. After the antibodies form.. everytime T4 production is triggered the antibodies attack killing off thyroid tissue. This continues until the thyroid is dead.

MG
Dear Bugsmom,
Is your doctor an endocrinologist? 80 mg of hydrocortisone is a LOT. A normal dosage of hydrocortisone (Cortef) is 20 mg. Please go to [url]www.nadf.us[/url] and look for the normal cortisol levels daily. the numbers you quoted look too low. A morning cortisol should be somewhere around 15-25 (don't quote me on this - I haven't checked in a while) I have had addison's disease (secondary) for 3 years. When I had a .04 cortisol in the afternoon I was put in the hospital for addisonian crisis. The NADF has a lot of information and a lot of smart people you can email to get help. Doctor's do not know about addisons. There are two types: Primary and Secondary. With Secondary it has been caused by giving too much steroid (that is one way). The pituitary can't make enough ACTH to tell the adrenals to make cortisol. That is what I have. I take 5 mg of prednisone ( I didn't do well on cortef it caused me to hold fluid). Good luck.
Pam50,
Thank you so much for replying. No he is just a General Practioner, I have an appt. with an endo on the 31st. The 80mg were making me sick, my legs were cramping really bad and I was swelling up a lot. The 60 did the same. I finally on my own started with just the 20mg and have stopped per my dr. now. I went to see him yesterday and he took more blood to check my vitamens and nutrients and stuff like that. I asked him about Addisons and he said he didn't think it was that.
My cortisol in the AM is at 1.0, I know it is exceptionally low and he said that is why he put me on such a high amount of steroids..The afternoon is good but my night is also low. I am SOOOO tired all the time, I could sleep for so long and I work 50 hours a week and have a 14 year old that is on a dance competition team, so I am always running with her, I can not be this tired it's causing problems so I really need to find out what is going on.
With the Addison's were you very tired?
I go on the 31st to the Endo.,so hopefully I will find out more.
thank you again.
80mg will give you Cushing's disease and make you fatigued as well. The GP may think that more is better, but it will in the end, just damage your body. You need around 20mg. But you cannot just quit, now you have to taper down to that dose so you don't have an adrenal crisis.
Rumpled,
Thank you so much for your reply.
However my Doctor took me off of the steroids last week. So I am no longer taking anything. I do not go back to him for 6 weeks, however, I do have an appt. with an endo. ont he 31st so hopefully they will be able to help me.
I am at a lost, because I just don't know what to do at this point.





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