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Addison's Disease Message Board


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Hi Everybody,

I have some test results that I don't know how to read and I'm hoping somebody out there can help me?

TSH 1.6
cortisol serum baseline 7.4
cortisol after cortisol stimulation 29.3
calcium 9.5
sodium 140
potassium 3.8

I've been so tired and weak for the past several months and I'm desperate to find answers. When I stand up, I'm extremely dizzy and have to sit down. Last Thursday, at a doctor's appointment, my doctor did an orthostatic test -when I stand up, my blood pressure goes straight up.

Can anybody shed some light on this?

Thanks! :)
Your stimulation test shows you have secondary adrenal insufficiency. Secondaries will double or more from a low base cortisol which your is very low.

Your potassium being so low also supports this. Secondaries have low potassium, primaries high. Your TSH is high matching with primary hypothyroid. Most of us see 1.0 as being a good number for women, but what matters really is what your free T3 and free T4 are at. When you get those post them on the thyroid forum.

That you have secondary AI with primary hypo, that always happens with Hashimoto's. This is one name for when antibodies are attacking the thyroid. You need to ask for TPO and Tga thyroid antibody tests. Most with Hashi's/secondary AI combo also have antibodies attacking their pituitary, but there is no test to determine if this is the case and can't rule out a past head injury or combo of past head injuries with Hashi's causing the secondary AI. That you have secondary AI automatically makes you hypopituitary. You need to test all your pit hormones.

Some Hashi's fluctuate TSH from below to above 1.0 in the earlier stages of the diseases as their thyroid overproduces in response to the antibodies which will push TSH down.

That are you dizzy when standing, you could have low aldosterone which happens with secondary and primary AI, but aldosterone usually causes bp to fall when standing. Aldosterone regulates sodium and potassium (also Chloride). Your sodium is low enough that I'd suspect you have salt wasting (excessive sweating and urination, salt craving, hard to handle heat). I look for sodium being good at 144-146.

Renin helps regulate aldosterone (primary AI= high renin high potassium secondary AI=low renin low potassium) When aldosterone is low, sodium is lost, so water is lost which causes blood volume and blood pressure to fall. This causes the heart to pump harder and faster trying to get blood pressure back up. Usually the heart over compensates causing high blood pressure. In some cases, aldosterone and blood volume can be so low that the heart beats fast, but can't get blood pressure up so bp is low.

Ask for Aldosterone and renin tests. You must fast salt and foods with significant sodium content for 24 hours. This is to try to get renin and aldosterone as high as they can get. If your aldosterone doesn't reach at least 20, then that would show a problem. Renin range is usually given as normal salt intake (around 1-5), but the salt restricted range which labs don't include much anymore is around 3-24. If your renin comes back in the low half the range that would also support that you have secondary AI.

The treatment is salt and water intake which you can do now but have to fast for the tests as I mentioned. I say if you need more than 2 teaspoons of salt (real sea salt in water) florinef should be considered.

Keep in mind that endos are terrible with this stuff, diabetes is what they are good at. I recommend osteopaths. As a group they are best with hormone issues. Hang in there.





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