Low cortisol

[Anniefun]

Hi rumpled thanks for your reply. My sodium levels were okay as well  I think the other hormones you mentioned were tested and normal also but I will check with doctor. I was back for check up today and he wants me to lower my hydrocortisone to 10 mg in morning and 5 in the afternoon and once my appointment comes through I will not take it the day before. The doctor thinks a lot of my problems are stress/anxiety related I'm not sure if this would effect my cortisol. Do you know if your cortisol drops in the week before your period I definitely feel my symptoms are worse at this time. The doctor started me on the hydrocortisone to help with the dizzy ness and it has helped. He said today he doesn't think I have addisons but wants to check anyway to be safe he says maybe adrenal fatigue and will hopefully rectify itself with diet and rest. I don't crave salt he didn't mention taking salt does this help . Thank u x

[rumpled]

You can post in the same thread to keep things together - it helps so I can follow the entire story.

It helps if you get a copy of labs and all. That way you can see exact numbers.

I tend to be a bit suspicious of the *stress/anxiety" lump as a cause. Tapering down on the dose can be painful - do be aware of this. Skipping a dose - was that the doctor's advice? That is unusual. Your adrenals are fully suppressed. Usually for testing I only skipped the afternoon doses - that way I was off for 24 hours, but still had my morning dose. I then took my dose right after testing.

AI is a salt wasting disease. Is your BP low?

[Anniefun]

Hi rumpled, I will ask doctor tomorrow if I can have print out of my blood tests so I can be more specific. I did ask about my potassium and sodium levels and he said they were perfect. I'm sure the acth level was normal also. My cortisol was slightly low and this seems to be the only clue as to why im feeling miserable. The doctor had put me on the low dose hydrocortisone after speaking to endocrinologist at the hospital as I had said I couldn't cope feeling the way I was feeling for another 12 weeks before seeing the endocrinologist. Ive been on the hydrocortisone for abt 3 weeks now, 2weeks I was on15 mg (10mg am and 5mg about 2pm) then my symptoms got worse again around the time of my period so my doctor changed my dose to 25mg per day (15mg am 5mg at12 and 5 mg at 4) but I felt this was too much I only took this dose for four days. I am now down to 20 mg for a week then next week I will go back to 15 mg per day. I had questioned the doctor about being worried about my adrenal glands being suppressed and the doctor said I was only take a physiological dose so the wouldn't be fully suppressed is this wrong. I also asked about taking them before stimulation test as I was worried it would affect the results and he said it only lasts 8 hours in the bloodstream so just not to take the morning dose before I go and take it after the test is this okay. Sorry i've rabbled on again I will try and get blood work results. Thanks for all your help.

[rumpled]

Um... the physiological dose is a replacement dose which is from what my docs say, suppressive. That is my understanding.

Here is an excerpt from a paper talking about a form of HC that they are developing (not available yet in the US, but is in Europe) that follows the natural ciradian rhythm:
"We have now analyzed circadian cortisol levels from a group
of healthy subjects to define the parameters of physiological cor-
tisol secretion. These can then be used to judge any new therapy
that aims for physiological circadian replacement of cortisol. We
have then performed a detailed phase 1 study on new modified-
release formulations of hydrocortisone and compared them with
the kinetics of 10 mg immediate-release hydrocortisone (IR-
HC), the conventional hydrocortisone preparation currently
used in the routine clinical care for adrenal insufficiency and
congenital adrenal hyperplasia. These data were then used to
define optimal treatment regimens with MR-HC for mimicking
physiological cortisol levels, a novel concept in the delivery of
glucocorticoid replacement."

HC does have a short biologic half-life. But the stim test should be done in the morning to be accurate so the proper way is to skip the afternoon dose (or if you take it early, it should be fine), do the test in the morning and then dose after the test.

I can understand this is confusing - I had to get a lot of help too - and read up and take time to understand it all at first too.

[Anniefun]

Hi it is so confusing I don't have much understanding of all this stuff and unfortunately I feel its not something doctors are all very clued up on its very frustrating. Im reading through a book just now called the safe uses of cortisol by Dr William Jefferies its very interesting and informative but a little hard to follow. I picked up my lab report from doctor today so here goes I will give you urea and electrolytes first:
serum sodium ;139mmol/l normal range 133-146
serum potassium;  4.3mmol/l normal range 3.5-5.3
serum chloride ; 105mmol/l normal range 95-108
serum bicarbonate; 24mmol/l normal range 22-29
serum urea level; 4.3mmol/l normal range 2.5-7.8
serum creatinine; 50 umol/l normal range 60-100

So the only low one in above is serum creatinine and the doctor didn't seem at all concerned by this he said that means I have good functioning kidneys be more of a concern if it was a high level.

my thyroid tests were;  free t4 level 18.0pmol/l normal range 9.0-21.0
serum tsh level 2.00mu/l normal range 0.20-5.00

and my cortisol was 235nmol/l normal range 280-720
my vitamin b12 195.8pg/ml normal range 190.0-900
serum folate 7.13ng/ml normal range 4.60-18.70
so only low reading was my cortisol.

my full blood count was all normal also. I don't see anything about my acth level being tested so I will phone and ask about this on Monday im not sure if its just not on the print out they have gave me can they test for this while im on the hydrocortisone. Is there any other blood tests you think I should ask for. Thanks for your help.

[rumpled]

I am personally not a proponent of Jeffries.

Your cortisol is low but sodium/potassium is normal - that is weird. What time were the tests done?

The range is only valid at certain times...

[Anniefun]

It was taken at ten am . I spoke to my doctor about my vitamin b12 levels as I feel they are a bit low but he said they are in the normal range but not from what I'm reading I'm not sure my problems are adrenal now I'm on the 15 mg hydrocortisone now 10mg am abt 8 then 5 mg abt 1 .

[rumpled]

10am is at the very end of the range - what time did you get up that day?

Typically you peak about the time you get up or shortly after, and they set the range at 8am, so my doc wants the test at 8am fasting. After that, you naturally start to fall. You get lower all through the day. That is normal.

It is not the norm to put someone on replacements based on 1 test - usually it is several, and a stim test.

[Anniefun]

That's what I asked doctor rumpled I thought by ten am my levels would be abt normal I had been up since around 7. I think the problem is my doctor doesn't have much knowledge of all this I had two low cortisol tests . I am waiting for the stimulation test but probably have another ten weeks to wait for that. The doctor says if it's okay they will just withdraw steroids slowly . I was wondering rumpled if you have any knowledge on vitamin b12 mine is 195 normal range is 190-900 it's seems low but when I asked doctor he was very dismissive and I feel awkward abt going back as he makes me feel like a hypocondriac. But I think some of the symptoms of b12 deficiency could be relevant to me. I'm starting to get very down and depressed now can stop crying with worry.

[rumpled]

I know only basics on B12. My mom had an issue and I have some too - mom's was pernicious anemia (which means she had to have the shots as she lacked the ability to absorb B12 from food).

Tapering is... well... painful. So I would expect that if you really need the cortisol and your adrenals are suppressed, your body is going to be upset that you are taking away something it wants.

Have you lost or gained weight?

I had low cortisol tests in the morning - but I was high at night - I had Cushing's. Point in time tests (just doing a blood test) can be a bit misleading so it takes time and effort to really know.

Depression can be part of the hormones too.