Sorry, my bad. It should obviously say ACTH stimulation test, I’ve edited that.
I’m from Sweden and the test was done at a hospital. Anyway, do you have any comments on the results? I’m getting inconclusive info on what the response should be in a healthy individual. Some sources state that a value of 18-20 mcg/dL or greater is healthy, whereas other, more layman-like sources, state the value should at least double.
15-20 is the ideal level for an 8am initial blood draw.
all of my other info on the ACTH test is from wikipedia.
No sorry, I don’t know a whole lot about it, but I do know that double response is expected…it doesn’t seem like yours is getting there.
Do you have other symptoms of hypoadrenia/hypocortisolism?
Well, most of my symptoms are that of hypothyroidism, but it seems like adrenal insufficiency symptoms are similar. I’ve noticed that since starting with iodine, my body temp occassionally reaches 98.6, usually in the evening, but it always drops and stays low during the day. My low T level and poor semen quality is obviously the biggest problem but I can’t really deal with that directly. Besides, I’m convinced the root cause is somewhere else.
I can’t really shake this idea I have in my head that the topical treatment of eczema for several years (starting when I was 12) could have affected my adrenals. The only reasonable explanations I’ve been able to come up with so far as to why I’m even having these problems are either adrenal insufficiency from previous cortisone treatment, or permanent hormone damage from being anorexic when I was 19-20.
Edit: I just added the P-ACTH levels during the ACTH stim test. The elevated P-ACTH levels seem to definitively point towards primary adrenal insufficiency, but the doctors seemed to have missed it. Mind you, this was 7 years ago, so I’m obviously going to get a re-test.
You should talk to your doc about a 4x Saliva Cortisol test kit. This allows you to measure your cortisol at 4 different points during a standard, moderate stress day, and will tell you whether you are producing cortisol at the right times.
I used the one from Genova Diagnostics, and I think they require your doc to request it. There are other brands out there that don’t require the doc, but I can’t remember the name. You should be able to do a google search to find them though.
Your cortisol could indeed have been affected by the hydrocortisone treatment for exczema…that is some harsh stuff…especially if you didn’t wean off and just stopped suddenly…though I would have thought if that were the case, you would have receovered by now.
4x Saliva Cortisol test kits are somewhat controversial in Sweden. The only company that offers them is Scandlab and there’s currently a debate going on between Scandlab and the medical community regarding the validity of those tests. So even if I get the test, no doctor is going to analyze the results.
By the way, do you have a medical source stating the cortisol level should double in healthy individuals during the ACTH stim test? I’ve only read it on Wikipedia and in an article written by someone at STTM, but no medical source. I need one if I’m going to convince my doc that adrenals aren’t working…
Was the wiki source cited?
I’m sure you can google search it and find something that will back it up…
Maybe something on PubMed…
I would still get the 4x test done for your own benefit…cross the bridge with the doctor when you know yo uwill have to cross it…don’t avoid the path just because it might end up difficult…you have to take charge of your healthcare and do what is right by you…only one life to live man…
Yes, the wiki source was cited but I couldn’t find any mention of cortisol having to double in order for the adrenal glands to be healthy.
I see your point re 4x saliva cortisol, but what am I going to do with the information? Since doctors discard the whole test, I’d have to self-medicate with hydrocortisone and that’s something I want to avoid. I’m already taking supplements for adrenal support but I’m not sure it will be enough to kick-start the adrenals to begin producing more cortisone.
By the way, does anyone know where KSMan is? I haven’t seen him around for a while. It’d be interesting to hear what he has to say about all this.
Here’s another update after doing some research. I have Gilbert’s syndrome which causes elevated levels of bilirubin och the consensus in the medical community is that it is a benign condition. However, from reading www.gilbertssyndrome.com, it seems a lot of people which Gilbert’s also have thyroid problems due to the liver’s inability to effectively convert T4 to T3. Gilbert’s is caused by a genetic defect in the liver so perhaps it could be the root cause of all this. I’ll have a hard time convincing my doctor though…
I am not grounded well enough on this current traffic to comment. Wilson’s “Adrenal Fatigue” is the basis of what I do know.
I was heads down with some server/software issues.
Below is an update with the latest test results. I’m seeing different doctors who use different labs so the ranges and tests might vary. Also, from now on, I’m going to start converting to US units as this is an American forum after all 
May 16, 8 AM:
S-Sodium: 139 mEq/L (137-145)
S-Potassium: 4.4 mEq/L (3.6-5.0)
S-Calcium: 9.84 mg/dL (8.6-10)
S-Calcium, albumin corrected: 9.72 mg/dL (8.6-10)
S-Albumin: 4.4 g/dL (3.6-4.8)
S-Cortisol: 13.55 mcg/dl (3.62-19.39)
S-TSH: 3.12 mIU/L (0.20-4.00)
S-fT4: 1.01 ng/dL (0.70-1.71)
S-fT3: 207.79 ng/dL (162.34-363.64)
S-Prolactin: 11.48 mcg/L (3-19)
S-PTH: 2.7 pmol/L (1.3-6.8) ← couldn’t find conversion factor
S-Methylmalonate: 0.08 Ã?µmol/L (<0.28) ← couldn’t find conversion factor
Some thoughts:
Calcium is no longer elevated which it was last time so that’s good. Hyperparathyroidism is something I could really do without at this stage.
Cortisol is still way too low, but it’s a slight improvement compared to last time. Don’t know if I can attribute that to anything or if it’s just normal variation or within the error margins of the lab.
TSH, fT4 and fT3 are still low which corresponds with my hypothyroid symptoms. TSH is elevated as last time but this is apparently common when supplementing with iodine. I’m hitting 98.6 every now and again but I’m almost always freezing in the middle of the day. However, I’m not ready to throw in the towel just yet and start taking thyroid hormone - I’m going to give this a couple of more months with gluten-free eating, iodine, adrenal support, diet improvements etc.
T levels weren’t on this round of tests but I’ll get that done sometime next week. I doubt that will have changed though.
All in all, I’m still looking for the root cause of low T and hypothyroid symptoms, but I’m not really sure if there’s anything more I could investigate. I’m going to try to find a doctor who will check for intestinal parasites, but until I pick up another lead, that’ll have to be it for now.
temperatures dropping through the day indicate cortisol problems. You start off ok (at 13.5), but then drop off too fast in the afternoon. There is a 4 times daily saliva test that some use to measure that.
you may want to look at taking something (no idea what) to help boost your adrenals.
Ok, are you sure 13.5 is a good morning cortisol value? I thought the ideal level was around 20 or more? Anyway, I’m sure the 4 x Cortisol saliva test would indicate what you suggested - i.e. a drop in the afternoon that’s too steep. However, that test isn’t endorsed by the medical community in Sweden, hence it would be ignored regardless of what doctor I’d show it to. As such, I wouldn’t be able to get a prescription for hydrocortisone which is what I might need and I’m a bit apprehensive about self-medicating with that stuff.
Instead, I’m doing what you suggested and taking adrenal support supplements in the form of licorice root which is supposed to help maintain cortisol levels. I’ve been taking 1000 mg a day for almost a week now with no effect, but I probably need to give it more time. I’m also taking the suggested supplements in the stickies: B complex, fish oil, vit D, magnesium, vitamin E, zink, vitamin C, selenium and iodine.
By the way, any other suggestions of tests I should do or leads to follow up on?
15-20 is ideal. 13.5 is not terrible. <10 is a major concern. doesn’t licorice root impact a lot of other systems not just adrenals? (I truly have no idea, just some vague recollection that it wasn’t the best for some reason.)
Reverse T3 could be helpful, given less than ideal cortisol, RT3 may be higher then normal and block your FT3 from working.
ferritin is good to check as that is impacted by Testosterone and needed by your thyroid to function. <50 is a problem as is D25-OH since most people are low (are you taking 6,000iu D3 daily?)
Ok, 15-20 ideal, roger. Re licorice root, it does impact other systems as well - I even read one study suggesting it lowers T levels! However, I’m only trying it out from reading about it on STTM and apart from vit B, C, D and E supplements, it’s pretty much what’s left in terms of adrenal support (aside from hydrocortisone).
Unfortunately, it’s the same story with RT3 as 4xcortisol saliva - not endorsed by the Swedish medical community. Assuming RT3 is high, what can one do about it?
I should have the ferritin result by next week. It was 82 ng/mL about two months ago which is kind of lowish but I’m hoping it’s risen now from adding more iron-rich foods to my diet.
Yup, I’m taking vit D3, 5000 IU per day. I was taking 15000 IU a couple of months ago as the blood test came back at 19 ng/ml, but the second most recent test showed a nice rise to 70 ng/ml. Vit D levels from the latest test should arrive next week.
Are you familiar with “Adrenal Fatigue” by Dr. Wilson?
You seem to be implementing most of the recommendations, supplement wise from that book…there are other things you can do to set yourself up for success if you do have adrenal fatigue: lifestyle, nutrition, etc.
Also, pregnenolone and progesterone have been shown to increase cortisol production…they are both available OTC here in the US…I think the most often recommended brand is Life-Flo…
RT3 can be fixed by supplementing your adrenals (i.e. - IsoCort OTC hydrocortisone) and by other means, but I don’t know what those other means are.
good points VT
No, I’m afraid I’m not familiar with that book, but I guess I should check it out. I think KSman mentioned it as well. It’s probably not a coincidence that the supplements I’m taking correspond with Dr Wilson’s recommendations - STTM and other sites probably base their recommendations on that book…
Will have to look into the pregenolone and progesterone. Would Dr Wilson’s book be a good reference for supplementation guidelines?
you basically have to treat every single source of information with skepticism. I don’t take anything as gospel - from STTM, any book, any forum, or any individual but if what they are saying makes sense, is corroborated by other sources, fits my personal experience with various treatments, and is confirmed via other people’s personal experiences - then I will give it some weight.
Dr. Wilson’s book probably has a lot of good information, but I also guarantee that it has a lot of misinformation, partial truths, and misleading theories.
You have to tread very carefully.