Adrenal function

[WillOllier]

I've had PMR for 2 years and 2 months and am currently on 5mg Pred having reduced from 20mg with occasional fluctuations due to a few flares. I thought I should check cortisol level as a way of checking whether my adrenal function is kicking in around this 5mg stage. The cortisol reading was "158 nmol/L Normal" with the normal range quoted as 133 to 537. The ESR rate was "5mm/1stHr Normal" with the normal range quoted as less than 7. I haven't had these numbers interpreted for me by the doctor (as they are both normal so he hasn't got back to me) but wondered if anyone out there knows what they mean?! and do they give a clue to my current adrenal function. Many thanks

[jinasc]

PMRpro will be along soon - figures are beyond me........

Did you have the 9am Cortisol Test?

[WillOllier in reply to jinasc]

Yes it was the 9am cortisol test

[PMRpro Ambassador]

Are you sure the 7 figure was ESR? I have never come across a normal range for ESR that stopped at 7 - it is generally up to 20. However, if they say it is in normal range it is showing there isn't any excessive unidentified inflammation in your body in general - it is only ever a general indicator, not specific for anything particular.

If your adrenal function was still poor, the cortisol level would be lower. With time it will probably get higher. But the basal cortisol level only shows you are OK for normal purposes, it may not rise in response to an emergency. There probably isn't a lot of point asking for a synacthen test just yet, most endocrinologists say under 5mg pred but prefer 3mg. In the synacthen test they give you an injection that stimulates the production of cortisol which gives a bit more information - that your adrenals are able to produce cortisol but not that they necessarily are, it depends on a load of other factors too.

[pugrescue in reply to PMRpro]

just before GCA dx, it was thought I had Sjgorens, ESR was 44 normal <20. Rheumy threw down the papers and said I did not have Sjogrens so he could not treat me, as he said 44 would be considered normal for a 67 yr old female. Tried to tell him I had never had even a hint of arthritis or other inflammatory disease. My GP sent me for a lip biopsy anyway, the ENT re-tested for ESR, now at 78 and CRP 110. She dx the GCA. Sent me back to same rheumy and his first comment was "this is the most excellent diagnosis". Perhps from his point of view......2 yrs later now off pred for 3 months my ESR is 5....CRP 2

[PMRpro Ambassador in reply to pugrescue]

I'd have made a complaint - because 44 has NEVER been accepted as normal for a 67 year old woman:

"Use of a formula to determine the upper limit of the reference range for ESR can help physicians obtain an age-adjusted ESR (BMJ 1983;286:266): Men: Upper limit of normal ESR = age/2. Women: Upper limit of normal ESR = (age +10)/2. "

And that gives a result of 37.

It has been widely disputed over the years since Millar worked out his formula - because it has been alleged that the only reason it appears to rise with age is because there is undiagnosed inflammation somewhere. Like you, my normal ESR is low single figures - it ran at 16-18 for weeks when I could hardly move but that wasn't "out of normal range". They are very keen to say it rises with age - so how do they account for us?

[WillOllier in reply to PMRpro]

Yes it definitely said the normal ESR range is less than 7 but as you say its showing no excessive inflammation although so that's OK but I note your caution that's only a general indicator. When all this began 2 years ago it was 51! Thanks for the reassurance re the cortisol although again I note your caution on that one. I hope to get to 3mg over the next few months (I tried to go from 5 to 4.5 on the slow route but pain reoccurred so sticking on 5mg for now and will try the dead slow route next.) When I get to 3mg I will enquire about the synacthen test. Many thanks for the information onwards and upwards!

[piglette]

I think the ESR level should be the CRP level with maximum normal level of 7mg. Looks like things are normal!

[WillOllier in reply to piglette]

Yep normal for now!

[SheffieldJane]

If I remember correctly, that Cortisol reading is low. Mine was deemed satisfactory at 488. It may rise as you reduce Prednisalone. You need advice from an Endocrinologist. I was on 5 mgs when I got the “normal” reading

[PMRpro Ambassador in reply to SheffieldJane]

It depends on whether it is a basal cortisol level or a post-synactheninjection one - which should shoot up way above your basal level, irrespective of what it is.

[SheffieldJane in reply to PMRpro]

That was the post Synacthen reading. The basal one was much lower. Mine will probably be all messed up now having spent time on GCA doses and now stuck at 10 mgs. Snakes and Ladders.

[PMRpro Ambassador in reply to SheffieldJane]

I was meaning your comment about WillOllier's result - we don't know if it is post-synacthen

[WillOllier in reply to SheffieldJane]

Yes I'm expecting it to rise as I try to decrease from 5mg pred

[WillOllier]

Many thanks for all this very useful insight. No I didn't have a synacthen test. I'm going to digest all this and then ask my GP to interpret these results in context of my full history.