Adrenal Insufficiency?

[Ciara02]

Can someone please help, I had a short synacthen test (SST) done at the start of the year but although my results showed an appropriate adrenal response I drank caffeine and ate something sugary before and during the test. Would this have influenced the results at all and would it be a good idea to repeat the short synacthen test or get morning cortisol checked?

Basal cortisol - 622 mmol/L
30 minute cortisol - 915 mmol/L
60 minute cortisol - 985 mmol/L

I have the results of a saliva test too but I know my doctor will not accept these:

Cortisol Levels

Sample 1 (post awakening) - 14.8 (12-22)
Sample 2 (+ 4-5 hours) - 3.9 (5.0-9.0)
Sample 3 (+ 4-5 hours) - 8.9 (3.0-7.0)
Sample 4 (prior to sleep) - 2.0 (1.0-3.0)

Total daily cortisol - 29.6 (21-41)

DHEA Levels

Sample 2 (am) - 0.16 (Low)
Sample 3 (pm) - 0.18 (Low)

DHEA Mean - 0.17 (0.40-1.47)
DHEA: Cortisol ratio - 0.57 (2.0-6.0)

Adrenal Stress Stage - "Resistance Stage 3 - Maladaptation: This generally reflects the "pre-exhaustion or pre-adrenal fatigue" states. Usually DHEA levels fall before cortisol levels are reduced. This is often as a result of an inability to balance chronic stressors or poor adaptation to intensive acute stressors. This pattern would indicate a state of long-term stressors depleting adrenal reserves. Stress analysis and adrenal support and restorative measures are exceedingly important. A recheck in 1 month is also strongly recommended."

Deviations from the normal cortisol rhythm - "The noon cortisol is below the normal range. Noon cortisol levels may be a good indication of adaptive adrenal gland function since they represent the adrenal glands' response to the demands of the first few hours of the day. Low noon cortisol levels suggest a degree of adrenal hypofunction with decreased adaptive response.

The afternoon cortisol level is above the normal range. This may be indicative of the blood glucose counter regulation process or stress. Action: Keep blood sugar levels stable."

Deviations in DHEA production - "Decreased DHEA levels may be seen in thyroid disorders, cardiovascular disease, obesity, reduced immunity, rheumatological diseases, and excess cortisol production or with administration of pharmacological doses of glucocorticosteroids. Low levels are indicative of a lowered capacity to endure physiological or psychological stress/trauma/injury and may present with abnormal immune response with increased incidence of autoimmune disease."

Any ideas please?

Other test results:

Free T3 - 4.6 (3.9-6.7)
Free T4 - 13.4 (12-22)
TSH - 7.4 (0.2-4.2)
TPOab - 199 (<34)
(Levothyroxine 75mcg)

[rumpled]

I would say that would rather discount a cortisol issue. But it does take more than one set of testing to rule an issue in or out.

Cortisol normally drops at noon. Cortisol peaks at 8am, and drops thru the day to reach a low around midnight.

[Ciara02]

Thanks for reply.

I have had sodium and potassium tested but they are normal.

Sodium - 143 (135-145)
Potassium - 4.5 (3.5-5.0)

These were done in July 2014 - still awaiting complete blood count from Thursday as well as thyroid medication review and ferritin.

[rumpled]

So, there are no other tests by the doc but the stim test? No sodium, potassium or ACTH etc.?

I am not a follower of the fatigue school... and the test schedule on the saliva makes it strange, usually one tests at 8am, 2pm and midnight - all your tests were pretty early so it is not at a time when you really know, or I can tell, that cortisol levels are known to peak and wane.

It looks like you have Hashimoto's?