Is a Short Synacthen Test enough?

[thyroidorwhat]

Saw an endo after bloods showed low cortisol. I've been exhausted for about 10 years.

He only did the same routine tests my GP did (FBC, TSH, FT4) , repeated the cortisol (low again) and is doing an SST to "complete the investigation".

No pituitary/hormone panel, no MRI, nothing. My libido is GONE. I'm a 24 year old male.

What next? I can't really afford to get more private tests, I already paid for a thyroid panel after the endo refused to test FT3 and antibodies. It was normal, just slightly low folate...

[Bfarliegh]

what were your results from the blood tests the endo did?

Why did the endo not do any hormone tests?

[thyroidorwhat in reply to Bfarliegh]

I have no idea, I did ask for more tests :(. I don't have the written results yet, but the secretary read them over the phone ("kidney, liver, iron, thyroid all normal...")

Cortisol was 238

[humanbean]

Just for info, to find out about the preparation, timing, and how the SST test is performed, see pages 68 - 70 on this link :

imperialendo.co.uk/Bible201...

Make sure when you have the test done that ACTH is tested for as well as cortisol. Without ACTH the SST test is of little use, but apparently lots of endocrinology departments don't do ACTH unless pushed into it. (Take the printed info with you as ammunition - just pages 68 - 70 and the title page to show where your information came from.)

Please note that you should have the SST test having fasted overnight (apart from water). Make sure your test is booked for 9am or as close to it as possible. Make sure you leave home in plenty of time - don't let yourself be stressed or rushed because this will interfere with the results. Talk as little as possible. Don't get into an argument with your family before the test. Don't gossip to the person you sit next to in the hospital. Don't even read anything. Just sit with your eyes closed while you relax as much as possible.

The above link contains information on every test that an endocrinology department is ever likely to do. It is updated regularly. To find the latest version, search for "endocrine bible". Personally, I always prefer the PDF version, which can be downloaded if necessary, and is easily searched on or off line.

If your endo hasn't tested testosterone perhaps you could ask for it to be tested too. Or perhaps your GP would do it if you asked.

[thyroidorwhat in reply to humanbean]

Thanks so much. I got my testosterone tested in December, it was middle of the range so fine. I'll definitely arm myself with info this time! Fingers crossed.

[thyroidorwhat in reply to thyroidorwhat]

I'm having my SST this week, I will ask for ACTH. However, from experience I'm sure they will refuse no matter what.

[Hidden]

What time was the cortisol blood test done as cortisol varies throughout the day? The SST test is a gold standard test for adrenal insufficiency/Addison's but it does need an Endo who understands the to read it correctly!!

[thyroidorwhat in reply to Hidden]

They were both around 10am

[Hidden]

Your cortisol levels are quite low at that time of day, so a Synacthen test should show if you have either primary adrenal insufficiency(Addisons) or Secondary adrenal insufficiency. The treatment is the same for both of them.

[thyroidorwhat in reply to Hidden]

Thank you. I hope that's the cause of my fatigue. I AM SO TIRED. I don't want to keep having more tests but I also can't let it go and live with it.

[thyroidorwhat]

I had the test today, it was so straightforward but probably not as comprehensive as could have been? The nurse took a blood sample, injected artificial cortisol and then tested 30 minutes later. Results tomorrow.