Cortisol results

[heathermr]

I am a T3 only person, having taken about 90 mcg for well over 8 years, split into doses during the day. Recently I have been feeling unwell with nausea, chronic fatigue, dizzy, weakness. I do not have a TSH, it vanished long before I started taking T3 so I have always felt that a head injury some 30 years ago has damaged my pituitary. The nausea etc has reared its head over a long period, but it is getting worse and I have had a couple of chronic attacks when I find it difficult to get out of bed. I have been given a short course of very low steroids by the Gp to help with an unrelated breathing problem which certainly helps but a visit to the Endo has put a stop to that.

I had an SST done in June, the Endo says they are perfectly normal but I have my doubts. The results for the cortisol are as follows.

!st blood taken at 10.00 am 235

2nd blood draw at 10.30 am 437

The Endo insists that the first blood draw is fine as its above 170, and the second result has to be more than 420, both of which I pass by the skin of my teeth according to him. He can't see any problem with these results and has discharged me despite me being down on my knees. He says that he can't find anything wrong with me and suggests I return to my Gp to find out whats making me ill and weak. I did say that I had tried a steroid to help me get on my feet and he was horrified. Apparently I dont need it. Any one any ideas?

Heather

[Hidden]

You're right, your base line cortisol is low the reference range is 170-550nmol/Ls however cortisol varies throughout the day, it should be at it's highest point first thing in the morning so your cortisol level should be around 500. ideally your cortisol should double which yours hasn't, the prefer it to be nearer 470nmol/Ls. Did they do an ACTH blood test when they took the first draw? This goes on ice straightaway, this shows what your pituitary gland is doing. Sadly not many Endo's have experience of pituitary/adrenal issues, so it's important to go to one who is. Where about are you in the country?

[heathermr in reply to Hidden]

I did ask about an ACTH test but apparently Derby don't do this test. I did repeatedly query this decision but he would not budge an inch. The guy I saw is supposed to deal with pituitary issues but he clearly does not know what he is talking about because he kept on about the increase rather than looking at the base level. He also said the head trauma has nothing to do with it!

Heather

[helvella in reply to heathermr]

Very odd. I suggest you go to the website of University Hospitals of Derby and Burton NHS Foundation Trust and search for ACTH.

I've already done that!

uhdb.nhs.uk/pathology-test-...

And click on the link to the PDF for the ACTH test:

uhdb.nhs.uk/download.cfm?do...

Now, just why would that be there if Derby "don't do" the ACTH test? - It even mentions Synacthen in the document!

[heathermr in reply to helvella]

The Endo definitely will not do an ACTH test, he thinks there is nothing wrong. He is not interested that I am really struggling and wants me to go back to the Gp cos he has no idea what's wrong despite doing a range of blood tests which show nothing wrong. The Gp is completely at a loss too. I told the Endo that I would see him again when I collapse and get brought in to A&E. Yes it's that bad!

Heather

[Hidden in reply to heathermr]

Unfortunately Derby isn't listed on the Pituitary Foundation's list of centres of excellence for pituitary/adrenal issues. Head trauma can cause pituitary issues, so I don't know why he won't test your ACTH! Time for a second opinion, i's your right under the 2012 health & Social care act.