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What is likelihood of Adrenal Insufficiency in combination with pituitary tumor?

I have been fatigued for a few years. 42 yr old female.

Finally  started investigating and started at naturopath June 2015.  Diagnosed hypothyroidism and the following:
DHEA 85 (reference 106-300)
Cortisol AM saliva 19 (reference 18-35)
Epinephrine 0.4 (reference 3.4-5)
CRP, high sensitive, 5.9 (reference  < 0.9)

I left that naturopath due to thinking I needed more, so went to an End of.  Confirmed hypothyroidism, but noted the following in Jan 2016:
Cortisol 2.2 (reference 5-25)
ACTH 77.6 (reference 0-56)
CRP 6.5 (reference 0.02-1.10)

She didn't freak out and made no adjustments to thyroid meds.  Sent me for arthritis testing due to continued high CRP and multiple joints with arthritis and previous surgeries.  Made follow up for June.  Arthritis testing: nothing came out to explain CRP levels, no lupus, etc...

June blood test at endo:
Cortisol 6 (reference 5-25)
ACTH 93 (Reference 0-56)
CRP 2.73 (Reference 0.02-1.10)

Now she sort of started going hmm.  Order MRI of pituitary, which I had done.  Came back as 4x3 mm microadenoma.  OK I get that the microadenoma explains the high ACTH, but what's  up with the cortisol?  What happens when tumor removed, will my cortisol go down or back up?  Could this be primary adrenal insufficiencyou?

My endo is on vacation until next week and I want to be armed with what I should ask.  I also have no appointment at MAYO for a second opinion.

Thank you for any help or insight.
1 Responses
Avatar universal
COMMUNITY LEADER
The pituitary tumor until properly diagnosed (and it seems you need a pituitary center really as your endo is doing a really basic job testing and it is not enough). You have to do extensive testing with blood urine and stimulation testing depending on the results. Tests have to be 8 am fasting.  Tests can be really botched by the labs (that held up my diagnosis for years).

Mayo is good if you have an established diagnosis otherwise it may be expensive and not helpful. Your doc has not established much.

I don't know why you are on thyroid meds, I did not see a test, what is tsh? Does it show central hypo?
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