Help with short synacthen test results

[JonnyA]

I originally posted this on the thyroid section of this site, but there appears to be some good experience of the short synacthen test here too, so I hope this is ok.

Quick background, I’m 38 years old, male, and been experiencing pretty debilitating symptoms for about 6 years - fatigue, brain fog, feelings of weakness, and so on. It was identified that I had a thyroid issue a while back, and I’ve been taking T3 for about 2 years which has helped some, but not all symptoms. This has led me down the path of seeing more endocrinologists and ultimately, to taking a short synacthen test to rule out Addison’s disease / adrenal insufficiency.

On the report I received from pathology, they describe the following with regard to interpretation:

“30 minute results should show an increment over the basal value of >200 nmol/L to a level of >500 nmol/L. A nil or suppressed response may be seen in adrenal insufficiency, hypopituitarism, or prolonged steroid therapy“

Here are my results, full report below (with personal details redacted) for reference.

0 minutes cortisol - 422.9 nmol/L

30 minute cortisol - 511.2 nmol/L

Now, evidently my 30 minute result is just above the minimum threshold, however it does not rise by an incremental 200 nmol/L - just 88.3 (44% of the minimum incremental rise).

I’m unsure on a couple of fronts. Firstly, does a result of >500 nmol/L after 30 minutes completely rule out adrenal insufficiency? I ask not because it’s borderline, but because I’ve seen some NHS documentation reference 420 nmol/L as the minimum, and yet my baseline result is already slightly higher than that.

Second question is how significant is that seemingly inadequate response of 88.3 nmol/L to the synacthen? The note on the report states that “a suppressed response may be seen in adrenal insufficiency”. Could my result indicate as such?

Naturally, I intend to follow-up with my endocrinologist, however since I’m paying for this by my own steam at this point, I wanted to better understand how worthwhile this was likely to be in the first instance.

Thanks!

[PMRpro Ambassador]

I don't think anyone here has the competencies to answer your question. Most people on here having a synacthen test are still taking corticosteroids - we have adrenal insufficiency secondary to long term corticosteroid medication and only really want to see if their adrenal function is recovering - it can take up to a year after stopping steroids altogether for good function to return.

I suspect your diagnosis may be adequate but not optimal function. You have a reasonable baseline level of cortisol - but under stress, you probably don't have much reserve.

But the only person who can answer your question is the endocrinologist who is the expert.

[JonnyA in reply to PMRpro]

Thanks. Appreciate the context and your thoughts.

[PMRpro Ambassador in reply to JonnyA]

Do let me know what the verdict is in the end!

[Lizzo30]

Hi

have you had your testosterone tested - testosterone is the reason why men don't get autoimmune disorders at the same rate as women

DHEA promotes testosterone and helps exhausted adrenals

you don't need much I buy my DHEA on ebay I take approx 5mg a week atm I am female a man could have a bit more

Pregnenalone as a suppliment may also be of interest - pregnenalone is the grandmother of all hormones so when you take it it will turn into the hormone your body is most lacking , it is often reccomended that you take pregnenalone at night bc it will probably make you sleepy but when I took it in the evening I had insomnia bc the pregnenalone created cortisol in me bc that was the hormone I was low on

Reading your earlier posts I think extreme rapid weight loss is the cause of your health problems so imo it's going to take time to restore homostasiss years even and it's best to do it naturally rather than relying on medication whenever you can