Cortisol levels normal?

[Clara9]

My cortisol at 9.00am was 273 is that normal?

[Hidden]

It's on the low side & probably needs further investigation if you are experiencing symptoms. This is from the Addisons website.

9am cortisol

The diagnosis is highly likely if 9am cortisol is less than

100nmol/L. If the patient is already on oral or inhaled steroids,

this may indicated steroid suppression.

The diagnosis is unlikely if cortisol is greater than 400 nmol/L -

but not excluded if the patient is acutely unwell at the time.

For values between 100 and 400 nmol/L the diagnosis can

only be excluded by a short Synacthen test (ACTH stimulation

test)

Patients in the early stages of disease may have 9am cortisol values towards the top of this range.

[Hidden]

Did you do the test four times throughout the day. Where are the ranges too.

[Clara9 in reply to Hidden]

No it was a blood test at 9am. No ranges I'm afraid.

[Hidden in reply to Clara9]

I had one done last year by Blue Horizon this is taken 4 times throughout the day to give a much better idea of your levels. Saliva test

[Bramble83]

That is too low. It should be closer to 500 at 9am.

9am blood test is the gold standard for cortisol testing and will be the test any endocrinologist wants to see. Saliva tests are irrelevant for testing for Addisons.

Are you having a follow up shirt synacthen test?

What are you symptoms?

[Clara9 in reply to Bramble83]

This was when I had a short synacthen test and the first test was 271 and 30 min after the injection it was

672. Is this OK? I was told that it was but then nobody told me my cortisol was on the low side...

[Bramble83]

The response to the synacthen test is very good (it needs to rise to over 500 at 30 minutes after the injection); this tells you that your adrenal glands *can* work okay.

What it doesn’t tell you is whether or not they are getting the correct message (called ACTH) from your pituitary gland to work okay in your day to day life.

There are two types of adrenal insufficiency (low cortisol); one is when the adrenal glands themselves don’t work. This is clearly not the case with you, as the synacthen test shows that they can respond very well. This is called primary adrenal insufficiency.

The second type of adrenal insufficiency is when the message (a hormone called ACTH) that is sent to your adrenal glands from your pituitary gland doesn’t work. In this instance your adrenal glands aren’t working because they’re not getting the message to do anything. This is called secondary adrenal insufficiency.

With secondary adrenal insufficiency you can get low baseline cortisol (like yours) but when an artificial ACTH message is given (this is what the synacthen test is), because your adrenal glands *can* work, they do. The result is a good stimulation to over the 500 cutoff. The problem with this is that in your day to day life the message from your pituitary to your adrenals isn’t working, so you are consistently low on cortisol.

Have you ever taken any form of steroids for any other medical conditions eg asthma etc?

I’m only able to explain this as I have Addison’s disease (AKA primary adrenal insufficiency) sonhave spent a lot of time over the last few years researching and understanding it all with my endocrinologist.

[Clara9 in reply to Bramble83]

Yes, I have taken asthma inhalers but not often. Only when having a cold.

I do have hypothyroidism and am taking both t4 and t3. Could the ct3m method work for me do you think?

[Bramble83]

I’m really sorry, I don’t know what the ct3m method is, but I do know that adrenal issues need to be sorted prior to thyroid medication