Blood serum cortisol

[Emidjemal]

Hi I don't know if any one can advise me my serum cortisol level is 278 blood taken around noon I was not told to take it at any particular time. Is this level normal they refused to give me the range even though I asked twice. I'm seeing the idiot endo again on the 12th thanks

[Gsp177]

Ideally you want it taken before 9am when it should be at it's highest. Can't understand why they refused to give you the range, but sadly I'm not surprised. What is it they don't like about patients taking responsibility for their own health, they should be actively encouraging it.

[Emidjemal in reply to Gsp177]

So true they want all the power I wouldn't trust them with my shoe. It was my gp that reffered me because my tsh was suppressed and my antibobles were I've a 100O. She was useless I'll see what she has to say on Tuesday

[ukangell in reply to Gsp177]

1. Cortisol should have been taken before 9 or 9am by the latest and you should keep as calm as possible.

2. To give you an idea of ranges, I know each lab has their own, my ref range was 185nmol to 800nmol.

3. I can tell you now that your endo will be 'very happy' with this result. Mine was with a level of 195nmol at an 8.45am test.

4. Endos do not recognise secondary adrenal insufficiency. They tell you about all 3 but they're only interested in addisons also known as primary! In the words of an endo I saw "your body can function perfectly well on 10% of your adrenals working. It's like people can function well on only 30% left of their heart and diabetic on only a small part of their pancreas..." Useless creatures!

[Clutter]

Emidjemal, contact the endo's secretary or the hospital's lab and ask for the ranges.

[Emidjemal in reply to Clutter]

I did Clutter but she said she could only give me the ones that the endo said was allowed

[Clutter in reply to Emidjemal]

Emidjemal, it is so frustrating and stupid! You can ask the lab what their ranges are or you can contact PALS and get them to find out or instruct the endo's secretary to tell you. What a PITA!

[Emidjemal in reply to Clutter]

I'm Seeing her on Tuesday I'll ask her then and if she refuses then I'll take it further but I want a second opinion but my gps has no knowledge on how to go about it. Some recommended a NHS endo who doesall the appropriate tests apparently

[Clutter in reply to Emidjemal]

Emidjemal, you could point out to her that patients are entitled to their results which include the ref ranges under the Data Protection Act and there's no point in having the results without the ranges.

[silverfox7]

I had the same problem with an Endo, was refused ranges-I didn't need to know apparently! I kept insisting and I got the upper range but not the lower so again meaningless. I tried the secretary-I cannot give anything out without permission etc so I asked to speak to my practice manager. He appreciated my concern and told me normally he should charge me £25 for the letter but would waive it under the circumstances! I know I should have contacted the lab but I wanted to make as many waves as possible! What a relief when I saw my new Endo to be told, when we got around to having tests, that he said, your body, your results so all will be sent to me as well as my GP!

[Hidden]

My endoc told me between 350 - 450 but it does depend on the time of day...mornings are higher....I've been In for cortisol testing morning, afternoon and evening. If you're worried about having to take steroids I wouldn't think that they would start you until it was lower than that x

[Emidjemal in reply to Hidden]

I wouldn't take serious I would try some thing natural first before resorting to that

[blackqueen65]

Hi, re cortisol levels, don't know if this helps but this is from the nice guidelines regarding levels and when to do further dynamic testing.

How should I investigate suspected adrenal insufficiency in primary care?

In adults, if adrenal insufficiency is suspected on the basis of clinical features, request a serum cortisol level and urea and electrolytes. The serum cortisol level should ideally be obtained at 8–9 am. Random serum cortisol levels have a low sensitivity for Addison's disease because there is a diurnal variation in cortisol levels (highest in the early morning and lowest late in the evening).

Sodium levels may be low and potassium levels high in Addison's disease, but normal serum sodium and potassium levels do not exclude the diagnosis. Seek specialist advice if there is electrolyte disturbance.

If the serum cortisol level is less than 100 nanomol/L, admit the person to hospital or refer urgently to an endocrinologist (use clinical judgement depending on the severity of symptoms). Adrenal insufficiency is highly likely.

If the serum cortisol level is 100–500 nanomol/L, refer the person to an endocrinologist for further investigations, including an adrenocorticotrophic hormone stimulation (Synacthen®) test. Urgency of referral will depend on the severity of symptoms and the serum cortisol level. Postural hypotension and electrolyte disturbance are indications for urgent referral or admission.

If the serum cortisol level is more than 400 nanomol/L, the diagnosis of Addison's disease is unlikely. However, some experts recommend a cut-off of 500 nanomol/L to exclude Addison's disease.

Here's the link in case you want to print it out - cks.nice.org.uk/addisons-di...

[Emidjemal in reply to blackqueen65]

Thank you at least I have some thing to go by I'll print that out and take it with me. Its because I'm not dying and look ok buts that because I've been supplementing not for adrenal but vitamins. Unless your on your death bed they won't do any thing

[Emidjemal in reply to blackqueen65]

my pottasium and sodium levels were fine but again that's because i did some research and have been supplementing

[whiphaven]

I have no idea which lab did mine, but mine was 384nmol/L taken at 850am and the reference range was 9-10am 150-700, and midnight 30-330. Mine was considered normal by my GP, but I did a saliva test via Genova, and that showed low morning cortisol. There was 6 weeks in between my saliva test (which the GP dismissed) and the NHS blood test. So either the blood wasn't taken early enough (I wake at 6am), or the lifestyle changes I have made in those 6 weeks are working. Who knows? I am currently working on adrenal support, via getting to bed earlier, and on advice from a very knowledgeable lady, I have just purchased blue light filter glasses to wear in the evenings to allow the production of melatonin. I do wish we could get proper help on the NHS, and someone who seems remotely interested would be nice :o(

[Emidjemal in reply to whiphaven]

I know my gps is sort of coming round and has done son blood test that some people have beg for. But I can see the fear I'm her eyes when I ask her about about certain things its a long journey

[blackqueen65]

My baseline cortisol at 10am was 195 on the short synacthen test but it went up to 683 at 30 mins so I guess going by the guidelines my adrenals must be working normally.

[Emidjemal in reply to blackqueen65]

The only way to really tell is a saliva cortisol test but NHS won't do it instead they waste money on complicated rubbish useless test unless you have got so bad you've got Addison's or Chussings. No such thing as perventitive medicine here

[amac]

My advice is this. Pay your 90-0dd quid to Genova and get a 24 hr salivary test done. If your cortisol is low, get yourself HC online and adjust your dose until you fell right. Visiting GPs and Endos will just drive you mad when it comes to adrenals.

If you go the Genova route, you can use Thyroid UK as your referral.

[Emidjemal in reply to amac]

I don't have £90

[kimbo]

I have just wrote to my gp, I had a saliva test done about two years ago, and have been battling ever since I wrote a letter to her quoting a letter off website about saliva tests on the nhs, she wrote back, not a very nice letter passing the problem onto my endo which I see privately for her comments in the matter , well I know what her comments are so I'm stuck at the moment, why we cannot be treated when we are clearly not well is beyond words.

[Emidjemal in reply to kimbo]

I feel for you it's almost like they want us to be ill. My son said they would rather save a thousand £'s rather then save a thousand lives! The endo I see is the most ignorant person I have ever meet