Serum cortisol result is mine normal?

[Innersmile12]

For a year I've been suffering a number of symptoms & I am sure it's something to do with my hormones although all my bloods are coming back normal. My blood was tested for cortisol at around 10am and came back at 181nmol. Is this within normal range? Online ranges are not clear and confusing. The NHS will not test my urine or saliva so I am considering buying a home test kit. Has anyone had anything show up in saliva tests that didn't show up in blood tests?

[weezles]

I saw an endo yesterday for results. My 9am cortisol was 253 nmol and he said it was too low. I asked what is should be and he said best to be around 500 nmol in morning.

[jezebel69 in reply to weezles]

Probably the best way of raising morning cortisol is by mastering relaxation techniques. Mindfulness apps for your phone are pretty effective!

[weezles in reply to jezebel69]

Thank you for your reply. I've to have synacthen test, which I had a couple of years ago and was fine, and checking pituitary function. I asked endo what would happen if synacthen normal and he said if I'm still symptomatic (and thyroid levels normal) would trial hydrocortisone. Think I'm in the minority having an endo willing to try but would definitely prefer managing it without meds. In fact also in the minority that endo didn't even look at Tsh but commented on low T3 ☺️

[JGBH]

From my endo I understand early morning serum cortisol tests should be done before 9 am fasting and if you take thyroid medicine leave off for 24 hours and take straight after test. A repeat test should be done the following day. Not sure what levels should be but am to have that test on Monday and Tuesday next week.

[AngleX]

I’ve just had mine done also last week however wasn’t advised to fast or take thyroid meds’ after and they came back “normal levels” however I know there’s something not right Too by how I’m feeling 🙁

[Innersmile12 in reply to AngleX]

It's awful knowing something is not right and things coming back normal. Makes you feel a little crazy doesn't it when the doctors start looking at you like a hypochondriac. Do you know what levels are classed as normal?

[SilverAvocado]

I'm surprised no one has commented so far on your question. I don't know as much about this as many, but these NHS tests are not very sensitive. They are really only testing you for Addisons disease, which is a collapse of the adrenal gland at least as serious as a thyroid problem, where you may go into a coma.

The NHS doesn't currently support adrenal fatigue. Which is anything in-between having completely healthy adrenals and having them in this state of collapse - thyroid patients only very rarely have Addisons, but very commonly gave adrenal fatigue.

So if you want to investigate and treat adrenal fatigue it has to be private /self medicating. The first step is to get the 24hr saliva test. I believe Geneva and Medichecks are the main ones that do it. You will likely find it very different from your snapshot single blood test. I had a high blood test, but it turned out only my morning reading was high, and it was on the floor the rest of the day. The blood tests are just not very revealing.

[Donought]

Hi, I was in a similar position with the GP testing morning cortisol only because I causally mentioned about licorice tea making me jittery. Turns out that my morning, 8:30am, cortisol was 350 ish which they said was too low. Been waiting ages for an endo appointment so decided to do 24hr saliva test with Genova.

Came back that I'm super high in the morning and normal/highish around lunch then normalish for the rest of the day. Definitely worth doing to see what comes back as the NHS most definitely won't do 24hr testing. Not cheap but gives you more data than you'll get from the NHS and quicker too.

So annoying that we've got to do this as GP's are either ignorant or restricted by budgets.

[Hidden]

Cortisol is best done between 8-9am however, you result is on the low side, a normal cortisol test at that time of day should be between 350-600 depending on the range from the testing laboratory as they do vary. A lot of doctors don't like the private tests but they can be helpful.

Saliva tests are only really good for testing for Cushing's which is high cortisol rather than for low cortisol.

[Hidden in reply to Hidden]

PaulineS "Saliva tests are only really good for testing for Cushing's" - Given their popularity and wide use in identifying both highs and lows, could you possibly expand on that please?

[JaninaWalker]

I had my 4 saliva tests done in 2016 and they were slightly off kilter in that my time of day is affected by my best friend being a night owl and I told my doctor that who is also his doctor too and yet that did not register with the doctor. He had just said my cortisol was low all around and gave me a prescription for cortisol tablets which I took in very small doses like about a quarter what he said and not all the time. Also for many months none at all because I was going for the in hospital intravenous test which tests how you respond to an injection of a hormone and mine came back as being very strong according to my endocrinologist who ordered it as he said the 4 saliva tests were not as accurate that my GP was basing his assessment on.

Anyway I am a very quiet laid back person normally and I hated the effect of the occasional small dose of cortisol as it made me very angry with the news and I vowed never would I take it again as frankly I do not need it and if my GP doctor is seeing other people with higher cortisol levels fine for them, but I do not need to be that enervated and angry and I had used a one month's supply over several months at a very tiny dose I can't even remember now, but know that I do not need that kind of upset in my life.

When I was getting it the pharmacist said it would make me gain weight and the endocrinologist said it would not at the very tiny dose I was taking.

So that is my experience with extra cortisol and I will never repeat it as it appears I can output enough if needed and prefer not to be feeling the enraged feeling that taking it gave me.

In the UK you refer to it as the synacthen test and here in Canada my endo referred to it as the ACTH challenge test, but it is the exact same test. So what that means is I do not need to take the cortisol and I am glad. I also saw a very good explanation by Dr John Bergman who is an amusing and excellent doctor-instructor on youtube where he said when the body is concentrating on the thyroid hormones the adrenal hormones are less. So I guess when you are upset and outputting a lot of cortisol maybe the thyroid hormones are taking a backseat and vice versa. He is a chiropractor, but has an excellent grasp of how to teach things so please check out his videos.