It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Addison's Disease Message Board


Addison's Disease Board Index


I got a copy of the latest ACTH / Cortisol results (Test #3) myself and haven't been in for a follow-up with my Endo, but does this look like Primary Adrenal Insufficiency or am I just jumping to conclusions?

Test #1 - ACTH Stim Test (Done @ 2:00pm):
Baseline Cortisol - 3.2
Baseline DHEA(S) - 461 (110-370) - (135% of range)
Baseline Pregnenolone - 11 (13-208) - (-1% of range)
30 Min Cortisol - 12.7 (Ref >20) - More than doubled, but Low
60 Min Cortisol - 15.2 (Ref >20) - More then doubled, but Low

Test #2 - Saliva Cortisol Panel:
Morning - 7 (13-24) - "Depressed"
Noon - 6 (5-10)
Evening - 4 (3-8)
Midnight - 8 (1-4) - "Elevated"
Cortisol Burden - 25 (23-42)
DHEA - 9 (3-10)

Test #3 - Various Blood Tests:
ACTH - 69 (7-50) - (144% of range)
Cortisol @ 11:00a - 8.8 (4-22 @ 9:00am) - (26% of range)

It also bugs me that my DHEA(S) is High, but my Pregnenolone is Low. I thought Pregnenolone was a precursor to DHEA - does this mean I'm not making enough Pregnenolone from Cholesterol, or am I using it up too quickly to make DHEA/Progesterone/Aldosterone and all their products?

Any insight from anyone?
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"...) :(
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
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:





All times are GMT -7. The time now is 11:21 AM.





2019 MH Sub I, LLC dba Internet Brands. All rights reserved.
Do not copy or redistribute in any form!