Thyroid UK

Dazed and confused and Adrenal Test

Many thanks to everyone who has replied to my previous post. Sorry I haven't had chance to reply to everyone yet to thank you individually yet but have had some family issues to deal with.

I have a chance to have an adrenal test via my Endo. It is a blood test with your cortisol levels checked 3 tines starting at 8.30am then 2 more times that mornibg after being given sone medication.

I had read that the blood tests are not as good as the saliva tests. Does anyone hace an exoerience if these tests?

Taking all my vitamins and its helping a lot. Wonderful organic health food shop near me in Bristol Wild Oats with a very large range of vitamins and supplements and qualified staff who give excellent advice and help. They see so many ladies and some gents self diagnosibg and unable to get help with treatment for high antibodies. They have also put me in touch with a private Doctor who can help.

Thanks again everyone..

15 Replies

I haven't heard of or experienced the test you describe and wonder what medication it is that he is giving you.

Most doctors take a single blood test which is useless as our cortisol levels vary dramatically, starting high when we wake and tapering off until they reach their lowest point late at night. A sharp spike in the morning and an 80% drop by night time is normal.

Although your endo is conducting three blood tests you say they are all in the morning so making it hard to assess your spikes and lows in a 24 hour period.

Blood tests measure both protein bound and free cortisol at a given time. Only free cortisol is biologically active (so available for use) and can be measured in a saliva test. These may be carried out in four regular intervals over the course of a day giving a much clearer picture of adrenal activity.

How lovely to have such a friendly, helpful and local health shop. I wish mine wasn't so far away.


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yes, I have had this done. they do it to check that your adrenal glands are responding to the acth hormone. in a healthy person, the Cortisol should continue rising for a couple of hours or more once they have injected you. if this does not happen, then it means that your adrenal glands are not responding normally.


Hi the problem is with the blood test is that there is so much going on in the bloodstream. It's like the M25. With saliva it's different and much more accurate. Readings are taken 4 times a day.

Genova do the saliva test. If you have been referred to a private doctor then he can order it for you.

My husband is secondary Addisons, diagnosed by many private doctors, however, our local hospital did a synacthen test and it came back fine. The blood was drawn too late in the morning, it must be done as soon as possible in the day and also the bloods drawn following the first test should be to the minute. Well it was about 20 minutes too late on both following blood tests so it could never have been accurate.

I had this test done by recommendation in the USA of my private doctor out there and they were really on the ball so when my husband had it done here I knew it was a waste of time and a waste of NHS money.

Take care

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Hi My Endo prefers 24 hour urine test with cortisone tablet at midnight and blood test at 9 am.



This is the Short Synacthen test and has to be done accurately. They should take a sample before 9am then inject you with ACTH which stimulates the adrenal gland to produce cortisol. They then take another blood test half an hour later and take another half an hour after that if they are doing a third. Ideally they would take a test for ACTH at the same time as the initial blood draw but when I had it done they didn't bother with that. It would show up Addison's disease but isn't conclusive for secondary adrenal insufficiency.


Hi Shaz49,

Am I right in saying an Insulin Tolerance Test is the Gold Standard for Secondary AI?


Yes that's apparently the gold standard test. The short synacthen test sometimes shows secondary AI but not always



Thanks for the quick response.

How can the SST sometimes spot Secondary?

Thanks again.



If ACTH is measured at the same time as the baseline blood it can point to secondary AI if cortisol doesn't double or reach 500/550. It could still double or raise high even if you have secondary AI so it isn't really conclusive. To be absolutely certain the only way is to do the insulin tolerance test as far as I can tell.


Cheers, I was concerned that I may have an in range Cortisol response which may have meant an ITT would be omitted.


Exactly, I have had it done too and my starting blood was too high to ever be considered addisons, one of the problems is how they interpret the test, it should really be testing ur body's ability to make cortisol under stress, mine only went up by 200 which is not much, but most endo's administer the test incorrectly and say if last sample is over 500 then you are fine. My saliva stress test showed my bio available cortisol was below range on all samples, yet my blood cortisol is high, this indicates that my cortisol is being prevented from being unbound and therefore available for some unknown reason. The NHS are not interested in any of this. Have the test for addisons done just in case, but don't expect it to give you an accurate picture of your adrenals unless they have given up the ghost.

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I've had this test also. My starting point of cortisol was low to begin with, but was ignored. The test started 2 hours late! And I was next to an elderly woman who staff couldn't get the cannula in. I'm the same, I elected to have it put in my arm the other side of my elbow where I know injections/ blood tests can be done. It was very stressful as I have a phobia of hospitals. The ACTH that is injected is 10 times more than would be naturally produced. Unless you have primary Addison's the test is a waste of time. My adrenal stress profile was much more accurate, you do it at home so you're not stressed out!

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As others said, it's probably an acth test.

Here is a great page explaining what they can mean:

ACTH STIM: The ACTH Stimulation test, also called the Cosyntropin test, measures the ability of your adrenals to be stimulated by the ACTH, a pituitary hormone, and is used to diagnose Addison’s or Cushings disease, as well as hypopituitary. Usually done in an out-patient setting and takes only a few hours. A synthetic ACTH is injected into your arm and the response of your plasma cortisol levels are measured. You’ll need to fast, and the test is usually done in the morning. You cannot be on any cortisol medications or supplements. An ACTH plasma test is often done at the same time ot measure the amount of ACTH being secreted by the pituitary gland. Your cortisol levels will double if your adrenals are not diseased. The ACTH has not been found to be a good test for the kind of adrenal fatigue manifested by thyroid patients, which is sluggishness, not disease.

From Stop the Thyroid Madness optimal lab values.


The non-saliva 24-hour urine cortisol test provides you valuable information because it tells you if your daily total is out of whack or not. High cortisol over a long period of time is bad for you.

The saliva tests are also valuable, but it is my experience that most docs run these tests, but don't really know what to do with the results. Still, it is useful for you to know if you have an arrhythmia situation going on.


Thanks for the advice. I was not aware of the urine test The Endo has only offered an Adrenal blood test, which I have decided not to take.


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