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Addison's Disease Message Board

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You are definitely adrenal insufficient. I do not know if you can clearly state primary or secondary from this.. but it does require medication.

Have they tested you for your ACA antibodies these are the main adrenal gland attack antibodies? This can determine if AI attack of the adrenals is at fault.

As to what is needed hydrocortisone in the morning.. before 3 pm I would guess. Morning and noon.

As to why things are up at night.. have you looked at your supplements. Any DHA, EPA, DHEA in them? If you are taking them in the evening.. that is your spike source. I am close to you without the high DHEA or midnight spike. My spike one in range cortisol reading was at 8 am at a whopping 17%. The hydrocortisone will make a big difference. Just watch for the swelling and water retention.

MG -

What tests should I suggest to my Endo to check for Adrenal autoimmune problems?

I'm not taking any supplements or medications at all, so what you see in the numbers is all me. I did accidently eat a little chocolate about 3 hours before my midnight reading, but I called a Doc associated with the Lab that did my saliva testing, and he said that it might have only affected it by 1%.

I just chalked it up to being a "flattened" rhythm, and found a few forums elsewhere (STTM) that say it also points to Adrenal Exhaustion. Even though the Midnight read takes a spike up, I'm still only moving 4 between the lowest and highest points during the day. What I'd really like to see is how ACTH vs Cortisol looks at 11:00p-Midnight, but that will probably not happen since my Endo already dismissed the Saliva Cortisol test by saying they were unreliable.

I'm somewhat hoping that root cause has to do with some other Hormonal issues I'm looking into, and with HC support and restoring other imbalances that the Adrenals will be able to start working again.

The Doc still hasn't called me back to make an appointment. I actually tried to make an appoitment when I went to pick up the lab results because the office has a particularly booked schedule, but they just told me the Dr would call when he wanted to see me.

As they say, "Waiting is the hardest part", (especially when it takes the willpower and faith of Job from the Bible just to roll out of bed each morning when I feel twice as bad as I did when I went to bed...).
Well you can add a DHEA supplement first thing in the morning. Issue there is do not exceed 20 mg and if you suddenly get really bad acne.. it is normally from more DHEA than you can handle.

The autoimmune flavor of adrenal insufficiency can be detected with the ACA antibody test. Your Endo may or may not know of it. It is a newer test in endocrine studies from 2006 forward.

As to the fact your ACTH is high and your cortisol low normal. Would point toward your adrenals being the culprite in your insufficiency. I wish I could help you more. My internal medicine MD is treating me. My Endo thinks I am normal.. My TSH is too low for me to have an issue. ;) Glad I have the brains to self-diagnose and keep looking for a good MD.

[QUOTE=mkgbrook;3542203]Well you can add a DHEA supplement first thing in the morning. Issue there is do not exceed 20 mg and if you suddenly get really bad acne.. it is normally from more DHEA than you can handle.
Test #1 - ACTH Stim Test (Done @ 2:00pm):
Baseline DHEA(S) - 461 (110-370) - (135% of range)

Test #2 - Saliva Cortisol Panel:
DHEA - 9 (3-10)
My DHEA and DHEA(S) look pretty high as it is. Will the supplement take some of the stress off my Adrenals by not having to make so much on its own, or would that give me too much? (And Acne has always been a problem, so nothing to lose there...)

I'm really trying to stay off as many supplements as I can until we figure this whole thing out so I don't "Muddy up the waters". (Except for Iron, which I have to start taking because Red Cross donations and all this blood work have made me mildly Anemic.)
Thanks Hormoneman!

I have been compiling a list of additional tests to get run for next week. You were very thorough. I need my whole system evaluated too. So far i am adrenal insufficient, hashimoto's, secondary hypoT, possible Hashimoto's encephalopathy and no telling what else. My joints and such have been killing me so I am going to do the RA tests. I am getting the other antibodies run and the aldosterone, progesterone, estrogen, and a few pituitary and thyroid tests as well. We shall see what comes up. It is SO hard having to got it on your own. You think the MDs would do this work for us. *snort*

You're welcome. By the way, I've never seen secondary hypo without secondary AI. Not saying secondary hypo can't happen with secondary AI though, but have yet to see an exception.

About twice a year I see Hashi's/secondary hypothyroid combo. This may be antibodies attacking the pituitary and or possible past head injury as the cause. I see this combo in the ratio of 10 women for every 1 man, so maybe seen two other men with this combo over the years. About once every 2 months I see Hashi's with secondary AI. Again tell them possible antibodies attacking their pit (no test for that as far as I know) or they may have damaged their pituitary in a head bump in the past (could be decades earlier).

Make sure you get the renin run with the aldosterone. The renin can be helpful in determining primary or secondary. I've see secondary AI with high renin about once a year for exception (low renin = secondary AI 99% of the time), so very good predictor of secondary. You should have sodium and potassium tests (in CBC) if you want to get an indication of whether your renin could be low or high.
I just posted this on the other thread.

My cortisol was at 5 % in the blood serum and only in normal region at 8 am. After i take my DHEA supplementation. ACTH Stim high.. 70 when normal <35

I am vit D deficient. Now aggressively treating this. Doesn't help the hypoT constipation issues.
I was vit B12, ferritin, and magnesium deficient.. But I have gotten those into the 40% range of normal and holding six months now.

My Hashimoto's antibodies are about 2000.
My CSF is at an elevated pressure and I have oligomeric banding and noted milan destruction.. MRI is clean.. as well as a bunch of other tests.. no MS or lupus.. so Hashimoto's encephalopathy is suspected. Go back in May for another round of testing on that one.

I am having issues with regulating thyroid meds because my T3 levels are/were 2 fold my T4 levels and I keep pushing my self hyperT in T3 while remaining hypoT in T4.

My endo claims I am normal because my TSH was 2 before meds.. all else was irrelevent. Bless her. So I am working with my IM and we are both in new territory. Know any good Endos with in 4 hours of Chattanooga, TN with this mess.

Right now my list is:
Thyroid: TPOAb, TGAb, TBG, TSH 3rd Gen, Ft3, Ft4, T2

Adrenals: ACTH, Cortisol 8 am, Aldosterone, and ACA, renin

Pituitary/hypothalamus: PTH, TRH

General AI: ANA

So anything I am missing? I am giving my blood chemistry a good 3 months to level out and equilibrate. So the Vit D and other mess will wait. Also any advice in getting rid of the water retention in the feet? Just the feet and my right ankle. Ocassionally my knees swell but that normally corresponds to a Hashi's flare and hypoT state. AHHHH! Okay better now. Crud.. I think I am working up to a hyperT swing again. This really sucks.

As too my Ca, Mg, K levels. The used to be high normal.. now they are dropping. Head injuries are a nil. Here is a familial kicker for you. My mom and one of her 4 sister's are Hashi's and Graves. Two more aunts are Hashi's and one is Graves. All five have AI's. None have exceeded a TSH of 2.5 even after a thyroidectomy or RAI was performed. ;) Secondary hypoT runs rampant with us. My mom's top TSH was 2.33 with only half a thyroid and an RAI uptake showing the remaining lobe dead. Aunt B1 2 RAIs and finally a TT max TSH 2.54. My Aunt B2.. due her TT max TSH 2.67. My max before meds 2.077. It is true I have yet to find a AI marker for secondary hypoT. However.. TPOAbs have been known to interfere with TSH binding receptors.. so maybe they work in two ways.

Alright, Hormoneman, you asked for it! (and MG, watch it with the Thread Hijacking! ;))

It all started with Thyroid checks:

Thyroid #1 (Late Jan):
TSH - 1.26 (18.8% of range)
FT4 - 1.15 (25% of range, +6% from TSH)
FT3 - 367 (72% of range, +47% from FT4)

Thyroid #2 (Early Feb):
TSH - 0.825 (8.6% of range)
FT4 - 1.07 (19.2% of range, +10% from TSH)
FT3 - 362 (69.4% of range, +50% from FT3)
Reverse T3 - 24 (Ref: 11-32)
Anti-TPO (for Hashi's) - <10 (Ref: <35)
TSI (for Grave's) - 106 (Ref: <=125)

Saliva Sex Hormones (as part of "Test #2" mentioned in first post):
Free Testosterone - 39 (50-80 pg/mL) - (-35% of range)
Progesterone - 39 (5-95 pg/mL) - (38% of range)
Estradiol - 10 (1-3 pg/mL) - (450% of range)

Addendum to "Test #3" mentioned in first post:
T, Total - 248 (241-827) - (1% of range)
T, Free - 73 (34-194) - (24% of range)
T, Free & Weakly Bound - 166 (84-402) - (25% of range)
Albumin - 5.0 (3.6-5.1) - (93% of range)
SHBG - 14 (8-48) - (15% of range)
LH - 1.8 (1.5-9.3) - (3.8% of range)
FSH - <0.7 "Undetectable" (1.6-8.0)
Prolactin - 6.1 (2.0-18.0) - (25.6% of range)
IGF-1 - 266 (106-255) - (107% of range)
ACTH - 69 (7-50) - (144% of range)
Cortisol @ 11:00a - 8.8 (4-22 @ 9:00am) - (26% of range)

CBC (last week):
WBC - 4.8 (4.0-11.0)
RBC - 4.77 (4.60-6.10)
HGB - 13.4 (13.5-18.0)
HCT - 39.3 (41.0-53.0)
MCV - 82.3 (80.0-98.0)
MCHC - 34.1 (32.0-36.0)
RDW - 14.4 (11.5-14.5)
PLT - 220 (130-400)

CMP (last week):
Glucose, Fasting - 82 (70-100)
Sodium - 142 (135-145)
Potassium - 4.2 (3.5-5.5)
Chloride - 103 (98-107)
CO2 - 27 (23.0-31.0)
Anion Gap - 12 (7-16)
BUN - 11 (5-25)
Creatinine - 0.9 (0.5-1.4)
Calcium - 9.6 (8.7-10.2)
Bilirubin, Total - 0.5 (0-1.0)
Bilirubin, Direct - 0.0 (0.0-0.4)
Total Protein - 7.4 (6.3-8.2)
Albumin - 4.9 (3.5-5.0)
AST (SGOT) - 32 (14-50)
ALT (SGPT) - 35 (21-72)
Alk Phosphate - 97 (50-136)
GGTP - 23 (8-78)
eGFR - >60 (Ref: >60)

Iron / Anemia Profile (Last Week):
Iron - 66 (60-180)
Iron Binding - 400 (200-400)
Percent Saturation - 16.5% (14-55%)
Ferritin, Serum - 8 (25-335)

Lipid Panel (Last week):
Cholesterol, Total - 150 (Ref: <200)
Triglycerides - 211 (Ref: <150)
HDL - 29 (40-59)
LDL - 79 (Ref: <100)
VLDL - 42 (No Ref given)
LDL/HDL Ratio - 2.7 (Ref: <3.55)
TC/HDL Ratio - 5.2 (Ref: <4.97)

Various Other Labs (Last Week):
Vit B12 - 355 (Ref: >240)
RBC Folate - 1150.1 (Ref: >160)
Phosphorous - 3.5 (2.5-4.5)
Uric Acid - 6.0 (3.5-8.0)
Relative Retic - 1.85% (0.1-2.0%)
Absolute Retic - 88 (5-94)

I've read the ACTH "Inperpretation Guide" on other forums (STTM) before, and I too was leaning towards Secondary, but my ACTH vs Cortisol looks like my Pit knows it's too low and is "raising it's voice" (we don't yell/shout in our household :D) to try to get more Cortisol.

Do you have references (that are legal to post here) that state that low Pregnenolone is a marker for Hypopituitarism? I thought since Preg. was a precursor for DHEA, and since my ACTH is probably high all the time, that it is all used up making DHEA and the other Adrenal products, (but not Cortisol for some reason - maybe an enzyme deficiency that is blocking Cortisol synthesis?). Doesn't the high ACTH in response to chronic lower Cortisol make Hypopituitarism less likely? (FSH/LH are low, but we'll get to that later). Also, since Aldosterone isn't ACTH depentent, wouldn't Pregnenolone need to be indepentend of ACTH as well, (or am I out in left field)?

Hopefully in "Round 2" with my Endo, he'll do the Aldosterone/Renin tests, (along with the Estradiol since it was high on the Saliva stuff). I have the "Hard to handle outside heat" thing, but I live in the Southern States, so that doesn't say much. ;) I haven't noticed any "excessive sweating" or "excessive urination", but if it were congenital, (which I suspect it is), then I wouldn't have a good point of reference to compare "excessive" to. Potassium and Sodium look ok. I did have a slightly low Potassium of 2.9 once back in 1994, but that was a while ago.

Sex hormones are another puzzler. As you can see, my T's, SHBG, and my FSH/LH are low, but my IGF-1 and Albumin are high. He didn't check Estradiol (E2), but since it was pretty high on the Saliva testing, I suspect it's pretty high. I read in some Endo training materials that the Hypothalamus can't tell T from E2, so if E2 is high it will lower GnHR and thus drop LH/FSH, and lower T/DHT production. Since low T/DHT means E2 synthesis isn't as repressed, more E2 is produced, the Hypothalamus sees too much sex hormones, and the cycle continues. I don't have Gynecomastia, (male boobies), but I don't think that rules out "Male Estrogen Dominance". It may be something as simple as too much T is being Aromatased into E2, and could I just use something to slow down the conversion, but there isn't a lot of info on this topic that I've found. I've called my Endo and left several messages asking to come in and check E2 and Aromatase rate, but I haven't heard anything back yet.

Thyroid function looks normal, (as far as TSH vs FT4), since it looks like my Thyroid is "following orders" and making as much T4 as the Pit wants. I know the TSH is lowered, but I think that has to do with low Cortisol downregulating Thyroid function instead of Hypopituitarism. The real puzzler is what is causing my FT3 to be +50 percentile higher then my FT4. I thought it was low Cortisol which prevents binding of the T3 at the cell and thus causing an increase in circulating T3, (what I term "Effective Hypothyroidism" since it's there but I can't seem to use it). I also read on a few other boards that E2 and T3 both compete for the same receptors, so high E2 might also explain the extra floating T3, (but I don't have any references other then a few posts on a Body Building forum). I'm still a little unsure as to if the Hypothalamus looks at FT4 or FT3 to regulate the Thyroid, so the relative elevated FT3 could also be a factor in causing the lowered TSH.

Prolactin, WBC, and RBC look good, so I don't suspect a tumor.

Iron, Ferritin, HGB, and HCT are a bit low, but that has to do with giving myself temporary low-iron Anemia, as I stated previously.

(Is it just me, or is this starting to feel like an episode of "House"...) :(
Hey Anti, ;)

Your antibody series is incomplete. Hashimoto's can be identified by both or either TGAb and TPOAb. It is rarer for just TGAb to be present but it does happen. Also there is teh chance of false negatives on the tests as well. Only 100% for Hashimoto's is a biopsy of the tissue. Have you had an uptake scan or ultrasound of your thyroid to detect blood flow/iodine uptake?

As to Graves test same deal.. you need TSI and TRAb. While TSI has the highest accuracy and is most common TRAb is an idicator as well. Also these only have a 60-75% positive ID rate of Graves. Best Graves ID method is iodine uptake scan. With Graves your thyroid lights up like a funny shaped white bulb. Hot nodules are spots of white. Cold are blue.. normal funciton is yellow orange imagery.

Have you had your immune panel run? IgG, IgA, IgE, and IgM.. i think there is another one.. but those are the biggies. Once again I think you need adrenal cortisol supplementation. Can not tell about aldosterone issues and you mostlikely need thyroid supplementation too boot. I promise not to add any more of my blood work.. I have more.. but will spare you all and refrain from any more interloping. ;)

When I went in for the 2nd Thyoid panel, I specifically asked the Nurse for both the Anti-TPO and the TgAB, but they only ran one. I was going to go back to push the issue, but I was too distracted becaused they agreed to do an ACTH Stim test without any resistance.

From my understanding, you have two variants of Thyroid AB problems. Hashi's attacks the Thyroid itself causing spilliage, and Grave's fakes the Thyroid into thinking the Pit has told it increase production.

[quote=(A site I am not able to link to on these Forums)]

Hashimoto’s Thyroiditis is a common autoimmune condition in which one develops an allergy to one’s own thyroid gland. In the early phase when there is destruction of thyroid gland and spillage of thyroid hormone (T4), there is a hyperthyroid effect. In an effort to lower the T4 level in the blood, the pituitary gland decreases the amount of TSH it secretes producing a low TSH. The hyper-metabolic state that occurs usually stresses the adrenal glands and causes adrenal fatigue. When enough destruction has occurred and the thyroid gland can make only a small amount of T4, one goes into a hypothyroid phase. Now one has hypothyroidism and adrenal fatigue. Autoimmune antibodies, Anti Thyroglobulin Antibodies (ATA) and Thyroid PerOxidase Antibodies (TPO), are almost always present on blood testing. The body can eventually counter the hyper-metabolic state by reducing the conversion of T4 to T3 (and increasing T4 to RT3 conversion). Thus metabolically, this is like stepping on the brakes in a car that’s going too fast.

If you look at my FT4 vs TSH, it is only about +8 percentile higher. I assume that if it were Hashi's, the FT4 would be higher and the liver would try to slow things down by pumping up RT3. However, my FT3 is higher then my FT4 and my RT3 looks ok, so there doesn't seem to be a lot of throttling down.

[QUOTE=(Same site as above)]

Grave’s Disease is an autoimmune disease in which an antibody is produced that mimics TSH. It signals the thyroid gland to make T4. As the T4 level rises, the pituitary tries to reduce the T4 level by reducing TSH levels and we get a low TSH. Typically we find elevation of Thyroid Stimulating Immuneglobulin or TSI. Most labs consider a level of 130 or higher as evidence of Grave’s Disease. In reality, we often see the signs of hyperthyroidism begin to appear in a subtle way at a level of 90. At 110 the symptoms are easier to see. By the time we get to 130 the symptoms are usually severe. Unlike Hashimoto’s Thyroiditis, in Grave’s disease the T4 goes into high conversion to T3. This is like driving a car too fast and stepping on the accelerator. This is extremely stressful to the adrenals. [/QUOTE]

My FT4 is pretty good in the 20-25% of range, and my TSI was at 106, so if there is Grave's it is very slight. However, after I figure out the Adrenal / Sex Horemones thing, I will keep an eye on my TSI/TRAb levels.

So, MG, based on your Thyroid knowledge, am I doing ok, or am I totally missing the point?
I think that you have low cortisol and need treatment for that.. then you need to boost your thyroid hormones. As to Graves.. I think you would be worse off with it. But Hashi's is a definite possibility. If you want a thorough baseline you should get the missing antibodies run.

Also in my opinion visiting an ENT and getting a physical profile of the thyroid could be a good thing if you have any thyroiditis symptoms. As to should you hurry out and DO IT RIGHT NOW! I do not think it is urgent. At your next opportunity I would get the blood work run.. just for a better chronological profile of your antibody state.

I read somewhere that:
[QUOTE]Excess DHEA can cause excess levels of estrogen and testosterone, as well as creating a dependence. [/QUOTE]
Any truth to this?

My DHEA-S is up, but it's only about at 135% of range, and since my ACTH is about at 144% of range it might just be an appropriate response to the high ACTH.

If the statements is true, I could see things happening like this...
- Adrenals have a problem producing Cortisol (still need to figure this one out)
- Hypothalamus/Pit sees low Cortisol so ups CRH/ACTH to get more
- Adrenals try to respond but the best they can do is to raise DHEA, (and in doing so reducing the amout of Pregnenolone available)
- Excess DHEA is converted to estrogen (and a little to testosterone)
- Extra Estradiol is sensed by the Hypothalamus, so lowers GnRH
- Low GnRH means low FSH/LH
- Low FSH/LH means low testosterone
- Low testosterone/DHT means Estradiol synthesis isn't challenged, resulting in higher Estradiol production
- High Estradiol to testosterone ratio causes stress on the body
- Hypothalamus/Pit ups CRH/ACTH to get more Cortisol in response to stress
- Rinse & repeat

Would a low FSH/LH still convert extra DHEA to Estradiol, or would that throw my whole theory out the window?

I'm really looking forward to seeing what being on HC for a few months will do to this whole cycle, (if and when I ever get to the Endo to start HC...)
My DHEA is low normal.. my ACTH is about 200+% of range. So they do not have to be parallel in range.

My cortisol is lower.. and with regards to the ACTH it means as you say.. your pituitary is telling it to make more.. but the adrenals just can not put out. I need to now test the aldosterone and other home made steriods to see if it is an isolated phenomena. You should do the same.

The human adrenal cortex produces aldosterone, cortisol and the so-called adrenal androgens, dehydroepiandrosterone (DHEA) and DHEA sulfate (DHEAS). We know you are low in cortisol and high in DHEA.

I do not know about the others for you or me. My IM was humoring me when she ran the others and I was right again. Which got a snort and grin and a you know as much if not more than me out of her. I told her not true.. i do not know more about medicine, I am just ground zero to my symptoms and a a.retentive chemist. I am going to have to do some digging into the mechanistic theory you have proposed here. May take me a few days. But it sounds good. ;)

Pregnenolone is a natural hormone made from cholesterol in the body. Pregnenolone is an intermediate in the synthesis of all steroid hormones. It is synthesized inside the mitochondria, the tiny "power plants" found in each cell. Pregnenolone is synthesized from cholesterol and is a precursor for the biosynthesis of steroid hormones. Pregnenolone is the basic precursor for the production of all the human steroid hormones, including DHEA, progesterone, estrogen, testosterone, cortisone, cortisol and aldosterone. Its levels are highest in the brain and studies have shown that it enhances many of our mental functions.

Conclusions: Low pregnenolone can mean a deficiency in any of the hormones it is a precurser for. What minerals and limiting reagents does our body need to convert it to cortisone, cortisol.. etc. Maybe it is a blood chemistry thing aggravating issues. Once again the endocrine system is far from A + B = C.

The thyroid hormone T2 is suspected to be a driving force in this. Since your hormones are off yhou may need to look into your T2 levels. T0-T2 were once thought of as inactive.. however.. T2 has been found integral on a cellular level. SO a good look at the thyroid which is just as tied into the adrenals and pituitary/hypothalumus cogs as well may be helpful. The endocrine sysdtem is a delicate balance of everything.. somethings a fix of the thyroid makes everything else behave.. others require more attention. Who KNOWS.. we have to make hypotheses and run them all out to conclusion.

Here is a tangent for you.;) I am good at those.. it is a blonde moment. I will dig more into the mechanisms.. but you are looking sound given the data you have. Me? I am just screwed up. :D

Dug up this fact from and NIH reference.. "Similar to the adrenal gland, there is an intradermal neuro-immune network involving the local expression of cytokines and neuropeptides. Dysregulation of androgens in the adrenals and/or the skin is associated with acne, hirsutism and androgenic alopecia." I have had an increase in acne of late.. not a normal occurance. Maybe the DHEA supplementation and HC is causing a temporary inbalance.

MG -

I found a few similar pages showing the pathways of steroid "cascade", as well as a lot of research about how to find enzyme problems by looking at the "precursor-to-product ratios".

I'm sure this is an over simplification, (and I'm not sure if it really even works this way), but I look at each step in the cascade like the old "flow rate" problems they used to make us do in school. Each steroid chemical is a seperate bucket, and it has inputs (enzymes that produce the chemical) and outputs (enzymes that turn the chemical into a different steroid), each with their own flow rate (level of enzyme conversion). Theoretically speaking, if a bucket is low it doesn't necessarily mean that it isn't filling up fast enough, it could also mean that it's emptying out too fast. I think some enzyme activity is constant, and some is mediated by Pituitary hormones, (ACTH / FSH / LH / etc).

Since Pregnenolone is the "mother hormone" for all the other steroids, and since my Total Cholesterol or LDL's aren't too high, I assume normal generation of Pregnenolone. My Pregnenolone is low, but later things such as DHEA(S) and Estradiol (at least on the saliva tests) are high; I take that also to mean that I'm making enough Preg. since I'm not running low on all the steroids.

The DHEA(S) was high (probably in response to high ACTH), my Testosterone was low, and my saliva Estradiol was high. Since DHEA is a precursor to the Androgens, the increase will probably show up in them somewhere as well, (that extra DHEA has to go somewhere...). Because the Testosterone was low, this once again leads me to believe that when we check my Estradiol via blood, it will also be elevated, (or, it could be low as well, which means one of the DHEA enzymes aren't working).

Progesterone was normal on saliva, and I think we've pretty much established that I've got low Cortisol production. My current hunch is that if we also check Aldosterone (a product of Prog.), we'll see a decrease there as well, and might even be able to trace back to what enzyme is having problems. I'm currently leaning towards "11B-hydroxylase", because if it was "21-hydroxylase" I would think we'd see elevated Progesterone.

Once again, this is all stuff I just made up and I'm sure it has no scientific basis, but at least it gives me something to think about while I'm waiting for the Endo to call me back so I don't go crazy. :dizzy:
Speaking of "waiting for my Endo", I just called this morning to see if he had scheduled an appointment yet. He hadn't, but they let me make one in advance.

Two months.

Eight weeks.

[i][u]56 days[/u][/i].

How in the world am I going to last two months, when every morning I wake up feeling like someone has "flavor injected" my cranial cavity with Grey Poupon? I actually have to build up my courage to go to bed each night because I know how bad I'm going to feel in the morning and how much courage it's going to take to actually get out of bed to get my daughter to school and myself to work. How am I going to last 56 mornings of being held in the P.O.W. camp that is my body? (And, if I did make it that long, he'll probably just run some more tests and make me wait another 2 months).

I am in full on "Zombie" mode, and have been for weeks, (months?). I basically do nothing all day but stumble around in a daze. And, looking back at my journal, it's the same thing every year about this time, (only this time I don't have antidepressants giving me nasty thoughts about "running away").

And, to add insult to injury, I'm the healthiest person in our house. The wife has Lyme Diseasee & Thyroid issues, and as much as she insists that her Lyme treatment has been helping immensely, she still has to take several naps during the day to (mildly) function. The kids act a lot like I did when I was there age, (impulse control, obsessing about toys they must have / being their favorite super hero / parties or plays they want to put together, lots of "potential" but never able to stay focused, convinced everyone at school hates them). They also have Lyme through the womb, and now I'm freaked out that they have whatever genetic flaw that will cause them to tank like I am when they get older. I have no outlets, no social life, and either I'm at work wishing I could go home to rest, or at home dreading going back to work the next day and have to act "normal" or else they'll fire my unproductive butt.

The only reason that I somehow find the mental capacity to search the Net for answers is that for some reason I still have a strong sense of Self Preservation, (and doing so is the only thing I have found that still gives me hope).

I was able to get an appointment with my GP for this afternoon, so if nothing else I'll have someone to listen to me ramble on about my nonsense theories about my illness, (and with any luck he'll find something I need to be hospitalized for that will last for a few days...).

He're hoping that it all doesn't end by "exploding in a fiery ball that was visible from space".


(Sorry for the "Dumping" - it's been a particularly bad week)
Your thought process is good. In any reaction chain you have to take into account reactants.. their nature (limiting reagent and what not).. the mechanism/catalyst employed.. and the prooducts.

You do have a similar bucket flow scenario.. but have to take into account that the kidneys will dump excess hormone out in the urine if we make too much.

As to normal cholesterol.. normal pregnenolone production. This is a base assumption assuming that the mechanism creating the pregnenolone is behaving properly. :) My cholesterol is low.. always has been. My MD is fond of telling me to go eat lard. *shivers* Such a nasty thought. He also asks me if I lick salt blocks.. I don't I just have really high triglycerides.. my whole family does. *shrug* We also have to take into account what is normal for the average normal male used in the N A C B limit studies.. may not be normal for us.

It is distracting and kinda fun to see iif we can out think our MDs and come up with the right answer. So far.. I have been right. Now I need more puzzle pieces to play with. I must say the cortisol was needed and my hubby is happy. I am getting my libido back. ;) Now if I could just reset my internal clock so the urges are at a better hour.

My SIL lacks the enzyme responsible for cartilage repair and maintanence. She is 29 and working on arthritis. It is possible to have a genetic flaw in enzyme production. it is possible to also determine if those enzymes are present or not. it is not a common test and may require visiting a research hospital.. but you can do it. I will be interested what you find out. I will share what I find out as well. It is interesting to figure out how you are put together and working on a fundamental level.

I liked the bucket visualization.. well done.
Going up in a blaze of glory huh? :D I like it. Just my style. If I have to go out.. why not with a big bang. Wallowing on the couch is such a sad end. Humm.. have you thought about going to a neurologist? I have one.. he is fun and good. He has had me do MRI's and a spinal tap. That was new. It showed that my antibodies were attacking my milan protien protecting the nerves in my brain. The increased fluid pressure and antibodies also caused migraines and visual anomolies and preliminary atrophe of my optic nerves. I have a neuro-opthamologist I see as well.;)

The electrophysiology cardiologist is fun to work with and keeps close tabs on me. He feels that my endo and other mD let things go to far. He has been a doll. Is your GP an internal medicine specialist? it might be worth getting one as your GP. My latest GP is an integrative IM and she is handling my adrenal and thyroid mess... and what ever else shows up next.

I used to like surprises.. now it is, Humm? Really? Well that is nice. My body just loves to self distruct doesn't it. *snort* I want salt.. gotta get some salt.

You do have a similar bucket flow scenario.. but have to take into account that the kidneys will dump excess hormone out in the urine if we make too much.
Yeah, I forgot to mention the part about how each bucket has a finite holding capacity and anything over that will "spill" out, as well as that the liquid can evaporate (half-life) if left too long.

[QUOTE=mkgbrook;3543881]Going up in a blaze of glory huh? :D I like it. Just my style. If I have to go out.. why not with a big bang. [/quote]

Not so much a "blaze of glory", as more a distant star collapsing under it's own pressure, silently forming a new black hole, (yeah, so I'm having a bad day...)

[QUOTE=mkgbrook;3543881]Is your GP an internal medicine specialist? [/quote]

We moved across country a few years ago from the Pac Northwest. We had a DO there, and he was great. The problem was that we spent most of our effort on my wife b/c we didn't know she had Lyme until we moved here. I had always been a bit off on my health, but she always took priority because at least I could function, (even though my mental/social/emotional "quirks" always made things difficult for me).

When we moved here, we couldn't find a DO close, and since we found a Lyme specialist close by, we didn't really have a big need to find a GP for the family. The one I did find had more to do with location compared to work and home then any specialty or quality of care. He's just a Family Prac doc, but as long as he lets me run labs, he's at least good for something. I've been too drained trying to keep things together (while suffering) to really have time to shop for a good GP.

We'll, looks like I've got to get in the car for my appt. Wish me luck... :(
Got a call from the Endo.

He said my T's "Looked good", and that even though my FSH was "undetectable" they only look at my FSH/LH if my T's are "Low". He said that my Total T didn't matter as much as my Free T's, and those "looked ok".

He said my IGF-1 must have been a fluke, and that it really wasn't that high.

Only thing he said he would do was run another ACTH Stim test to verify the results.

Pretty much everything that was High/Low he dismissed, and is probably just doing the ACTH Stim again so he can dismiss any abnormalities and tell me everything looks ok.

I'll bed if my Estradiol and Aldosterone come back high/low, he'll find some other way to dismiss those as well.

I really need to find a new Doc...
The tingly numb toes could be neurologial problems as a consequence of insufficient b12. It can manifest as peripheral neuropathy and also be more expansive, such as mental deficits etc. Not saying this isn't anything else going on. But, in my own case, I had low ferritin, low b12 (297), vit d, in addition to my hypothyroid ism as well as possible secondary AI as demonstrated by my low cortisol (not below range), impaired dirunal cortisol rythm and low end ACTH. I also have low female and male hormones, again not below range, but right on the cusp of bottom range. My view is to treat what you can to an optimum level and keep working on what is, in my view, a complex, situation - hormonal and vitamin status-related.

See my response to your post [I]How does low iron affect Adrenal function[/I]?
Can you get your GP to sign off on it given the lab results in hand? Maybe they will give you a token dose of hydrocortisone. They should not have an issue giving you a note stating the need for leave for past and future testing. In the mean time I am assuming the Endo has given you no hydrocortisol? You might be able to get a small boost by topical application of hydrocortisome cream.

Call and talk to the Endo's nurse. explain the situation and fax in a formal letter as to what your employer needs. Then the Endo doesn't have to write it.. just sign it. I wish you didn't have to add this stress in your situation. Is there anyway you can work in a different role or do some work from home? I am not sure of your position, but maybe there are ways to work around it and still get the job done.

If the Endo is wanting a retest your GP should be able to redo it so you do not have to wait on him. I would be going to a DO with results in hand and begging for treatment. I went around my Endo for treatment.


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