Short Synacthen versus Adenal Saliva Cortisol Testing for Adrenal function

[Sangrom]

Good morning everyone,

Can any of you lovely people shed some light on this situation I find myself in:

4 years ago my adrenals failed after a miscarriage with an early morning cortisol of 86. Since then my Adrenal function improved spontaneously by supporting my thyroid with NDT and good nutrition, probiotics etc.

Last year I suffered a further miscarriage and developed further endocrine issues. A recent Short Synacthen Test (SST) was 'suboptimal' according to my Endo with a score of 422 reached after 60 mins of ACTH injection. This is the same result I have had over repeated SSTs over several years.

However a recent 24-hour Adrenal Saliva Cortisol test completed around the same time as the SST showed normal Cortisol production over 24 hours and DHEA.

Which of the tests is more accurate and what could account for the different results?

Sincere thanks in advance for taking the time to read this post

[Hidden]

You've said that you reached 422 after 60 mins but what was your base level at the start of the test? This shows what your cortisol levels are doing. Many Endos will say that doubling the cortisol in either 30 or 60 mins is find, however they often ignore the base cortisol level. By doubling your levels it shows that your adrenal glands are responding so you don't have Addisons where the adrenal glands don't work, however if your base level is low it could mean that although your adrenals are fine there is a problem with the pituitary gland not sending ACTH to the adrenal glands to trigger enough cortisol production so you could have secondary adrenal insufficiency which is mostly treated the same way as Addison's/primary adrenal insufficiency.

[Sangrom in reply to Hidden]

Thanks so much PaulineS- here are the SST results..

SYNACTHEN TEST.

Cortisol (Basal sample)229nmol/l

Cortisol (30 minutes)377nmol/l

Cortisol (60 minutes)422nmol/l

I guess the base is pretty low?

[Sangrom in reply to Sangrom]

PS: I have recently had an Insulin Stress Test in the NHS to evaluate pituitary gland function- I guess the Insulin Stress Test will define whether the problem is primary or secondary? Thanks for your help- I do find all this pretty confusing..

[Hidden in reply to Sangrom]

yes it is on the low side but what time was it done? Also you didn't double the numbers so it's not a great response to it. It will be interesting to see what the insulin stress test shows. Often the Endo doing the test doesn't have enough experience of pituitary/adrenal issues so it's important to have one that does.

[Sangrom in reply to Hidden]

Thanks Pauline

Test was done at 8.45am, so I agree not a great result. I shall await Insulin Stress Test result, but if that is normal what would that indicate??

[Hidden in reply to Sangrom]

You might need to find another Endo who is conversant in pituitary/adrenal issues

[Sangrom in reply to Hidden]

Thanks so much- so frustrating! About the 6th one I’ve seen in 4 years.. 😒

[Angel_of_the_North in reply to Sangrom]

That was one horrid test. I don't know why they do it - I think to try to NOT have to give you meds. It brought on all my symptoms and made me collapse in the hospital car park with backache, dizziness and vomiting- but was "normal", so I had to self-treat.

If you want NHS treatment, you need short synacthen test as they don't recognize saliva testing.

[Sangrom in reply to Angel_of_the_North]

I agree 100%