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Addison's Disease Message Board


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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?
[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.
...[/QUOTE]
[QUOTE=TheAntiEndo;3541879]
...
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)
...[/QUOTE]
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.)
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.
[/quote]

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?
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





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