Despite asking for a print-out, my husband has been sent just an endo's letter giving results but no reference ranges, which of course makes interpretation difficult. His blood was taken at 8.30am and the cortisol result has come back as 302. Can anybody comment on this please?
Help with interpreting Cortisol blood test resu... - Thyroid UK
Do you know what measurement unit was used is it Mg or nmol or something else
Unfortunately no. It's unbelievable isn't it that a doctor would send out a result without specifying the measurement units, or the reference range? I'm assuming it's nmols as it seems too high to be mgs.
When I did a recent 9am cortisol blood test -I set myself the lower limit of 400nmol/L and came out above that.[171-536 refs]. So, I sat with that for now. I thought the range rather low, though.
The adrenals are as bad business with GPs as the thyroid from what I see and hear -but GPs/Endos do vary, of course.
I would say follow it up further- and maybe find an online test to take to see how challenged adrenals actually are.
It may be historical, as it is with me.
Recovery will take time!
According to Arlt and Allolio addisonssupport.com/Documen...
For primary AI:
Less than 165 + a high reading on ACTH suggests definitive primary AI
Less than 300 does not exclude primary AI
Greater than 500 usually excludes primary AI.
For secondary AI:
Less than 100 and ACTH between 1.1-11 suggests definitive AI
Greater than 100 but less than 500 does not exclude secondary AI
Greater than 500 excludes secondary AI
This means your husband's test is on the borderline for not excluding primary adrenal insufficiency and it does not exclude secondary adrenal insufficiency.
At 302, I would think you could ask for a synacthen test to exclude adrenal insufficiency and an ITT to exclude secondary adrenal insufficiency.
You might have to argue a bit though!
What did the endo say?
Thanks for this helpful reply Juliet. Endo has in fact ordered a synacthen test though he described 302 as "normal"...of course! What is an ITT please?
The ITT stands for insulin tolerance test. Basically it is used to assess whether or not someone has secondary adrenal insufficiency which arises when there is a problem with the pituitary gland not sending a signal to the adrenals to produce cortisol. In this case, the adrenal glands are normal but the pituitary is not working.
For the ITT they give you insulin to send you into hypoglycaemia (low blood sugar). Once you go hypoglycaemic, they check your levels of ACTH and cortisol to see if your pituitary gland is working properly or not.
It can be that a person passes the synacthen test and is declared "normal" but in fact has secondary adrenal insufficiency. So if your husband passes the synacthen test don't forget that it doesn't rule out secondary adrenal insufficiency.
It's good that the endo is doing the synacthen test though. Try and get the full results from the endo once it is done, don't just let them tell you "normal" (as they're so inclined to do!!!)
Many thanks - yes, I'm training my husband!
My morning cortisol was 217. After the sHort synacthen test it only went up to 317. I am on steroids for this 3 x per day.
Thank you - that's helpful to know. Do you feel better on the steroids?
I also meant to ask which endo at which hospital put you on steroids? My husband's endo seems to think that 302 is a satisfactory level, and it would be good to be able to mention yours, who clearly thinks that sort of level needs treatment.
Hi sue, sorry for late reply. Initially, the steroids helped take the edge off my symptoms. However, these days I find that I'm really struggling to feel 'well'. I generally feel poorly most days. But, I can't live without the steriods. I take 3 dosages each day and I know that its getting near my steroid time, as I start getting bit ill. Then, when I have the steroid, it kicks starts me a bit.
I'm sorry that I can't give a better picture, but that's my experience. I find that I need to pace myself, otherwise, I'm wacked out for ages.
Anyway, from what little I know, 302 for a morning reading is satisfactory, but it DOESN'T exclude adrenal insufficiency. So, your husband could have adrenal insufficiency. The only way to check if his adrenal glands are ok is by having the short synacthen test. This test basically stimulates the adrenal glands and, if they are impaired, they won't respond well, and the reading will still be relatively low. If they are working okay, then the reading will rise quite high.
Basically, you have two blood tests taken. One at 9am to get the baseline figure. Then you get a hormone injected to stimulate the pituatry gland, which in turn switches on the adrenals. If the adrenal glands are working okay, your second blood reading should go up to at least 500-550 or above. In my case, my reading went up by only 100 from 217 to 317, which showed that my adrenals were not responding enough. They should have gone up to at least 500-550.
You should insist that your husband has a short syancthen test. This is the only way to know for sure whether your husband has an adrenal problem or not. I would push for it. xx
Thanks so much for all this information. In fact he has an appointment for a synacthen test in a couple of weeks, so he'll now be well prepared and will know to ask for a printout of the results and to keep an eye on exactly what is happening.
Sorry, I'm at Peterborough and my endo is mr oybio