Short Synacthen Test

[Yppah]

Hi, I’ve to have a Short Synacthen Test. I’ve to do it in the morning before eating or drinking, except water. Is there an optimal time for doing the test? And should I take my levothyroxine before it or hang off until afterwards? Also are there any supplements I shouldn’t take in the run up to it? Thanks

[humanbean]

For info on the SST test read pages 68 - 70 in this document :

imperialendo.co.uk/Bible201...

I'd suggest waiting to take prescribed medication and any supplements on the morning of the test until after all the blood draws have been done.

Best time for the test is often quoted as being 9am. Some sources suggest 8am - 9am. Either will do, I think. The idea is to find the result of your cortisol at the time it is at its highest. Cortisol has a circadian rhythm i.e. it changes according to time of day.

Supplements and meds affecting cortisol :

1) stopthethyroidmadness.com/s...

2) rt3-adrenals.org/does_it_af...

Read the extra info and links supplied in link 1 above. Note that neither list above tells you which supplements and meds raise cortisol and which lower it. You would have to do your own research into each supplement or prescribed med that applies to you

[Yppah in reply to humanbean]

Thank you, that’s really helpful.

[Hidden]

If this is your first time having it done then it's best to do it as near to 9am. They should also do an ACTH blood test which needs to go on ice straightaway to see if it is the pituitary gland causing problems. you dont' usually need to fast for the test as food & drink doesn't affect the effectiveness of the test.

[Yppah in reply to Hidden]

Thank you, yes 1st time, no ACTH Test scheduled. Reason for test is low morning cortisol of 190 at 10.30am test, range for 6-10am 133-537. What might a pituitary issue be here? (My family have form on pituitary issues with Cushing’s disease and Acromegaly.)

[Hidden in reply to Yppah]

The pituitary gland stimulates the adrenal glands with ACTH to produce cortisol, so if your cortisol is low it could be due to either the adrenal glands not producing cortisol which is primary adrenal insufficiency/Addison's. Or if the pituitary gland is producing enough ACTH to stimulate the adrenal glands it's secondary adrenal insufficiency, this is why it's important for them to do an ACTH blood test as well as the base line blood test before they inject the artificial ACTH. The base line should be around 450-550 nmol/Ls if done around 9am, cortisol then drops throughout the day. Your result should double after 30 mins to at least 450nmol/Ls. I have adrenal insufficiency due to having Cushing's disease from a pituitary tumour, my pituitary gland has not woken up so I am steroid dependent. As there are pituitary conditions in your family it is even more important to have the ACTH test taken at the SST. ps I now am admin for a Cushing's UK group on Facebook because it's a rare condition & wanted to support people.

[Yppah in reply to Hidden]

Thanks for this info. I will ask about the ACTH test also in that case. I did provide family history so I find it a bit irritating to then have to suggest this. But I guess that’s just how it works from now on. My sis is probably in your group as she had to drive her own diagnosis and care. She had a pituitary tumour removed, but it came back and so then she had an adrenalectomy.

[Hidden in reply to Yppah]

Oh really? Do pm me her name

[Yppah in reply to Hidden]

Will do 😃

[YuliK]

I’m going for the test on the 29/10/19. 9.am

Not to take any medications 24 hours before.

Good luck

[Yppah in reply to YuliK]

And to you - let me know how it goes!

[Hidden]

That's a long time to go without!!