Low cortisol and hydrocortisol.

[dee2382]

My endo called me this morn and was little panicked. He urged me to come to his office today to collect a script for hydrocortisone. Im on 20mg in morn and 10mg in arvo (he said night but i plan on 4pm as to not play havoc with sleep). He said when im unwell i need to double it. I currently have sinus infection which is ongoing and iv doubled todays arvo dose (my first dose) and wi do til tuesday. The back to the normal dose he said. He has also left me a request form for more bloods.

My cortisol was 45

ACTH- NOT DETECTABLE

Can someone tell me what relation they have to thyroid or adrenals? Photo is the listed tests requested.

WHY IS ACTH NON DETECTABLE? CAUSE?

Hope this helps cos i have felt beyond crap. Its been a rollercoaster for months if not years really. Finally someone is keen to help.

[Ali-Bucks]

Hi Dee2382,

This post and your previous one regarding the short synacthen test suggest you have 'secondary adrenal insufficiency'. This can also be referred to as 'secondary hypoadrenalism' or 'ACTH deficiency hypoadrenalism'. Note that I am not a medical professional but someone who may also have this condition, so I am only sharing some of what I have found out about it myself!

In secondary adrenal insufficiency the problem is with the pituitary gland not producing sufficient ACTH hormone to stimulate your adrenals to produce the cortisol your body needs. (This is in contrast to primary adrenal insufficiency, which is also known as Addison's disease, where there is plenty of ACTH produced by the pituitary, but the problem is with the adrenals themselves).

Some of the further tests your endo has requested are to check other hormones which should be produced by the pituitary to see if there are issues with any of those too. Presumably this is their first step towards working out the cause, by checking if it is a general problem with the pituitary itself.

In case you think it may apply to you, one cause can also be the use of steroids (this can include inhaled steroids for asthma for example), as this can suppress the ACTH production from the pituitary. Note that if you or anyone else reading this thinks that applies to them you should not stop taking/using the steroid as that can make it even worse!

Whilst it is a worrying thing to be wondering what the cause is, I hope it is at least some relief that some progress is being made, as I can fully sympathise with you saying it has been a roller coaster for months. Now that they have given you some hydrocortisone, I hope that you will soon be feeling better day to day whilst they get to the bottom of what is causing the problem.

Ali

[dee2382 in reply to Ali-Bucks]

Thanks Ali. Yes a relief im getting somewhere as been saying iv gelt crappy for months- years actually. I dont take any steroids for asthma or anythibg else. I did have a stint for 14 days in july for a massive sinus infection that had airways occluded. Post surgery as had 2x massive haemorages that literally almost cost my life in June. Arterial ruptures after sinus FESS surgery.

Ive had 2nd dose this morn..i felt amazing when i woke but quickly faded. I hope i feel better asap. I ate feeling so crap. Esp with a 4yr old. Hoping tomorrow is better. I cant wait for bloods to be done and then i can get to bottom of it all. Been a long road.

Appreciate the response.

[sulamaye in reply to dee2382]

Glad that after your previous post your doctor is sensible and has diagnosed you as needing hc, which was what we were all saying I seem to remember. Hope you start to feel better soon. Cortisone and thyroid have an interelated relationship where one can have a knock on effect on the other.

[dee2382 in reply to sulamaye]

Def. Need more bloods then i can see what else is going on.