Short synacthen test for hypothyroidism? Adrenal insufficiency

[Trinav]

Hello I'm just wondering if anyone can shed some light on the test above with regards to HRT ?? The paperwork arrived today to go for this test early July but only tells me to stop any steroid based meds on the day, but when I had a look before at other hospital preparation s they recommend stopping oestrogen meds 6 weeks before as it can raise cortisol results. I've tried to speak to department involved but no body can advise me . Does anyone have any advice? Thank you in advance

[Hidden]

Definitely stop glucocorticoids such as hydrocortisone and the birth control pill or oestrogen. Surprised your hospital hasn't advised correctly.

[Hidden in reply to Hidden]

Just to add that HC needs to be stopped for 24 hours and pill/oestrogen for 6 weeks. As you mentioned in your post.

[Trinav in reply to Hidden]

Thank you for your swift response ! I think I will stop it to be on the safe side but not looking forward to getting the menopause symptoms back on top of everything else!!!

[Hidden in reply to Trinav]

I can imagine you're not looking forward to it. It's a long time to be off HRT. I have the same test soon too (appointment letter pending) but being male don't have to stop anything other than hydrocortisone. Just to add, I don't think there's any dietary requirements such as fasting. Good luck.

[Trinav in reply to Hidden]

Thank you I'm just trying to read up on it as I think they need to be looking at pituitary angle primarily but I'm not sure this will necessarily show this .good luck to you too !!

[Hidden in reply to Trinav]

Thank you! I believe the test can be used to diagnose primary and secondary adrenal insufficiency, although if pituitary related other tests are needed i.e. an insulin stress test. I'm reading up on it too!

[Hidden in reply to Trinav]

I found this link (among many I've looked at!) pretty good.

endocrinology.org/media/176...

[Trinav in reply to Hidden]

Will look more knowledge is always useful !!

[Hidden]

It's best to stop any oestrogen based products for 6 weeks prior to the SST, as you are right, it can give a false elevation to the results. The SST takes a base level cortisol at 0 minutes & then give you artificial ACTH to see if your adrenals respond to the stimulation. The idea is to see if the artificial ACTH will cause the cortisol levels to double . It is important that they also do an ACTH blood test at the start of the SST. This will show if the pituitary gland is producing ACTH to stimulate the adrenal glands to produce cortisol. This blood test needs to go on ice straightaway. Often you will be told that you have passed the SST because the cortisol levels have doubled but if your base level cortisol is low & they haven't tested ACTH then they won't know if your pituitary is secreting ACTH. Hope that helps?

[Trinav in reply to Hidden]

Thank you very much will take this and show the nurse specialist who's doing the test as I'm concerned its pituitary as I dont fit the Addison's description and I've got hashimoto's but my tsh is always severely suppressed..

[Hidden in reply to Trinav]

Both the Pituitary Foundation & the Addisons disease websites are great for info. If you are on Facebook then go onto the UK Addisons Info & support group, there's some very knowledgeable people on there.

[Trinav in reply to Hidden]

Thank you I'll have a look !

[Trinav in reply to Hidden]

Had the test on wed and no they wont do ACTH test and consultant said yesterday the results were fine ??baseline cortiso was 171 and think it jumped to 546 . Endo said all good even tho 9am cortisol was lower than 10.30 one a few weeks ago she said it usually fluctuates. Next stop pituitary mri she says shes sure it will come back ok but putting up t4 to 275mcg and asking gp to supplement vit d. Hope I get plenty of energy and shift so weight soon!!!