Short Synacthen test

[Gcart]

Could anyone please help to explain this test.

First cortisol. 564

At 30 minutes 852

At 60 minutes. 977

No ranges , don’t know if that would be needed.

Just would like to understand if anyone could help with explaining

Thank you

My consultant told me Im a bit anemic. But that my iron stores are ok so therefore it can’t be treated. It’s the red blood cell which are low. I looked it up and it was being called AI anemia as it’s caused by the underlying illness. So the only thing is the treat the illness. I’d not known of that before and wondered if anyone else had.

It says that palpatations , breathlessness and fatigue can be a symptoms , so very tricky to know what’s what .

[humanbean]

If your consultant said that you are anaemic then you should be treated I would have thought. As long as you test yourself fairly frequently and don't go over or under the optimal levels for iron-related tests then I can't see that you will do any harm by supplementing and may end up feeling much better.

I dose myself with iron based on the results from an iron panel and a Full Blood Count, and I try to keep my levels as close to optimal as I can.

medichecks.com/iron-tests/i...

medichecks.com/haematology-...

For optimal levels of iron :

rt3-adrenals.org/Iron_test_...

It is important to make sure you don't over-treat yourself with iron, since it is poisonous in overdose, so regular testing is essential, and you should err on the side of caution.

[humanbean]

Regarding your SST test you can get info on the test from pages 68 - 70 on this link :

imperialendo.co.uk/Bible201...

Obviously where your test was done will have their own reference ranges, but at least you can get a rough idea about how good or bad your results are from that link.

My first impression is that

a) You have plenty of cortisol.

b) You may even have too much cortisol.

[MULLIONAIRE]

I agree your iron seems to be a problem but you may find the following information useful:

The protocol for the synacthen test can be seen with ranges etc. here

pathology.leedsth.nhs.uk/dn... Please note the timings given for the tests are essential to follow.

The latest information from the Pituitary Foundation: “Please note: for patients with symptoms that may suggest cortisol deficiency that a ‘pass’ on a SST, may not always mean that cortisol deficiency is excluded, and that with persisting symptoms, referral to an endocrinologist is recommended, where testing may be carried out with alternatives such as the glucagon test or insulin stress test.” (pituitary.org.uk/informatio... <pituitary.org.uk/informatio...

Within their Pituitary Gland booklet they state:

Adrenocorticotrophic Hormone (ACTH)

“ACTH controls the adrenal glands which are situated just above the kidneys, and steroid hormone production. The symptoms of lack of ACTH are due to the lack of the steroid hormones from the adrenal, in particular cortisol, and include fatigue, feeling dizzy and a loss of physical wellbeing and energy. Some patients also suffer from nausea and diarrhoea. If you have severe ACTH deficiency a single blood test may show this, but usually you would need to attend an endocrine specialist unit for tests which are more dynamic to help diagnose you accurately.”

Trouble is there are common symptoms for many conditions. Like finding a needle in a hay stack, good luck.

[Angel_of_the_North in reply to MULLIONAIRE]

Warning: insulin stress test is really, really nasty. Make sure that someone is there to help you get home afterwards if you have to have this test.

[Gcart in reply to Angel_of_the_North]

Im type 2 diabetic diet controlled . Had glucose tolerance test to diagnose it . Guess thats not the same as you are saying , but boy that left me feeling dreadful for rest of day. Had to go to bed and sleep it off 😭🙃

[Angel_of_the_North in reply to Gcart]

Not the same at al - probably the opposite. They inject you with a lot of insulin (weight dependent) and then take your blood every 30 mins for most of the day. The they give you some flat lucozade and a digestive biscuit and send you home. I collapsed in the car park after it and had to take 2 days off work.

[MULLIONAIRE in reply to Angel_of_the_North]

I cannot comment on the Insulin Stress Test because of my known health problems, I had the glucagon test twice. The first time although my results meant I should have been treated with hydrocortisone for low cortisol was denied me. I suffered no adverse affects during or after the test. The second time, when my health had deteriorated even further, I could not get out of bed during the test and certainly was not fit to drive home.

The terrible part, the second test was ordered by my endocrinologist when he was leaving the NHS. He made an appointment for after the testing for me to have the results. By then he had left and my appointment was cancelled. My medical records had previously been 'lost' and falsified so I contacted the medical records department direct for the result and discovered that my levels of cortisol were dangerously low. I had been given a new appointment four months away, when I could have been dead. My GP tried to get it brought forward but I had to pay to see an endocrinologist to be prescribed hydrocortisone. The difference this has made to my life is unbelievable. Sadly, the endocrinologist who eventually prescribed hydrocortisone and my GP have now left the NHS.

[Gcart in reply to MULLIONAIRE]

This should never have happened to you. Hugs

[Gcart]

Just to add that at that time my one off serum cortisol was 155. Range 171-536.

So thanks for your replies,but I just can’t seem to understand it. Information just doesn’t go in these days🤔 at first glance it would seem low on serum test but very slightly high on SST.

Just trying to help myself

[humanbean in reply to Gcart]

Please be aware that saliva testing and blood testing for cortisol are not measuring the same thing. You could come to different conclusions depending on which one was tested. See this link for an explanation of the issue :

blog.zrtlab.com/cortisol-te...

[Pop_pop20]

Was the test done at 0800. Ur initial cortisol level is very good. They look for your cortisol to climb >550 (assays differ but they normally range from 500-600). Yours well surpassed that. Due to a good response and very good initial cortisol level no evidence of Primary or secondary adrenal insufficiceny.

Sorry I don’t have much knowledge on the AI anemia, but those symptoms mentioned a very typical of anemia. If ur symptomatic I believe u should be treated. Take care

[Gcart]

Test was timed at 11.30.

Thanks for posting. I am understanding now .

[humanbean in reply to Gcart]

If you did an SST test at 11.30 it was done far too late. If you had done the test at 9am (which is when they are usually done in the UK if the conditions are right) your results would have been even higher.

[Gcart]

Would that have been good ?

[humanbean in reply to Gcart]

Well, if it leads doctors to the diagnosis that is right for you then, yes it would.

Let's imagine that you have Cushing's Syndrome or Cushing's Disease which is characterised by very high cortisol.

If your levels are super-high at 9am and a bit less high at 11.30am then your diagnosis could be missed because the test was done at the wrong time. I don't know how high cortisol goes in Cushing's.

But, you haven't given any reference ranges so this answer is based on "what-ifs" and "maybes" rather than actual proper data.

[Gcart]

Thanks for all your help