Adrenal function results question

[LBM1953]

Hi All

I am currently on 2.5 mg of Pred (and about to DSNS to 2 mg). I had a Serum Cortisol test in July 2022 which was 218 nmol/L. However, I had taken my pred as normal on the day of the test (3mg at 3 a.m., blood test at 9 a.m.) not knowing that you were supposed to abstain for 24 hours before. I had another test last week and had not had any pred for 30 hours beforehand and my result was 316 nmol/L.

Question. Should I read anything into these results?

Thanks for all the wisdonm in advance..

LBM1953

[Cyclo5]

From what my endocrinologist has told me, us, pred will make a difference to the result, so probably needs a retest.

[LBM1953 in reply to Cyclo5]

My test last week was a retest...

[Purpleazalia]

Hi LBM, what time was your second test? Has your medical professional spoken with you about the results? If so, what did they tell you?

Here is a link to a previous question where PMRpro gave some guidance about results. You will see other 'related posts' if you scroll down (if on mobile) or on the right hand side (on a computer)

healthunlocked.com/pmrgcauk...

[PMRpro Ambassador]

I would have said nothing other than your adrenal glands are working reasonably well though not at full blast yet and another test in 6 months will show if they are continuing to improve. I would be quite satisfied with that result at this stage - fully normal is 450 or so.

[Hirondelle in reply to PMRpro]

good morning PMRPro. I’d love a wise thought from you. I have been on 3 mgs pred for some months. My rheumatologist asked GP for cortisol test. Result 98; deemed ok by GP. I queried this and was told that as the result was better than a previous one of 62 done in August 2021, I was fine. My gp had hurried me in the first months of PMR to reduce quickly - I had to go backwards in 2022. I have been feeling v tired which is why rheumatologist asked for test. She is puzzled by GP response so I think she is contacting an endocrinologist. In the meantime, I have been wiped out by gastroenteritis but a bit better since yesterday. What do you advise/ think please?

[PMRpro Ambassador in reply to Hirondelle]

No it isn't OK! Any result under 100 is indicative of adrenal insufficiency. Normal is over 450. Anything in between needs further investigation but at your level, there is no point in a synacthen test, it is a waste of money. You need to be managed as adrenally insufficient.

That the basal cortisol level has risen is PROMISING but no more than that, It means your adrenal function is still there but to call it OK is like saying that totally flat battery that has been on charge for a couple of hours is now raring to go and you can set off on a long journey without a care in the world.

Did you indulge in Sick Day Rules for the gastroenteritis? You should have. No wonder you are wiped out.

[Hirondelle in reply to PMRpro]

thank you for reinforcing my take on the cortisol level. The nurse couldn’t cope with all the numbers and thought I had been using ‘Dr Google’ when I said the vomiting and diarrhoea might be an indication that there was an adrenal malfunction- that’s written on the emergency card. She then called a GP who said all was ok and I should stop worrying…very upsetting seeing the nhs sliding down into the gutter, I used to work in it .

[PMRpro Ambassador in reply to Hirondelle]

Just goes to show the new card hasn't been communicated well to the HCPs it was supposed to help!!!! I and OH used to work in the NHS, both daughters and one grandson still do and the other grandson is heading that way.

They can't have it all ways - either we use online advice to know what to do or we don't - and frankly, given some of the advice I've heard from nurses and GPs recently, DrG comes out pretty well!!!

[Dydee in reply to PMRpro]

A couple of months ago I had my thyroid blood work done and while that was OK, they also tested my cortisol. They must measure it different here. Mine was 1.9 ug/dL whatever that means, taken at 2:45 PM. My functional doc said that is too low. I was not taking the Astragalus at the time and have quit taking it as you suggested. Doc suggested I stay at 6 mg Pred. and increase my Liothyronine.

[PMRpro Ambassador in reply to Dydee]

At 6mg pred, your cortisol is likely to be suppressed anyway. Most endocrinologists would recommend waiting until well below 5mg, 3mg is a usual point. However - 2.45pm is too late for basal cortisol. that needs to be measured between 9am and 1pm before it starts to fall again.

journals.plos.org/plosone/a....

"Our study established the optimal cut-off for the 0800 h morning cortisol levels as 380 nmol/L (13.8 μg/dL) for the lower and upper values, respectively. Moreover, the proper cut-off levels for basal cortisol were 350 nmol/L (12.7 μg/dL), respectively."

They quote both sorts of units used. Your level must be under 60 - pretty low.

[Dydee in reply to PMRpro]

Thank you so much. But you think at 6 mg Pred. I am probably where it's normal to be taking all into consideration? I will do my next testing in the morning to make sure I get a better read. I am due in April for a repeat.

[PMRpro Ambassador in reply to Dydee]

I don't think the results are unsurprising - but the only way you will encourage the adrenal production of cortisol to improve is to reduce your pred dose further. What sort of doc said to stay at 6mg?

[Dydee in reply to PMRpro]

Doctor of Functional Medicine who is also a GP. She wanted me to stay at 6 until we got everything else figured out. I did try going to 5.5 3 days apart but legs got real heavy and I was afraid to continue, even every 3 days.

[LBM1953]

Many Thanks....