Short Synacthen Test results (no ranges though)

[Wispymisty]

Having had my SST on 13th Sept, I've finally had a letter from the endocrinologist with my results.

My baseline was 333 nmol/L at 30 mins it rose to 770 nmol/L and at 60 mins it was 807 nmol/L

I am due a review meeting with her in a month or so (no appt yet) and she has said my results are reassuring and I will merely be monitored.

I also had a pituitary profile done at the same time which the letter merely says is within normal range.

I can't find anything particularly clear about results and wondered if anyone here had any thoughts or any links to result interpretation?

Thanks :o)

[SilverAvocado]

Hi Wispymisty, sorry you've had no replies. Its probably because you've asked a very specific question and maybe no one who knows has seen your post.

I'm pretty sure with the SST test it's intended to stimulate your adrenals to produce cortisol, in the same way TSH stimulates the Thyroid. The test is to see if your adrenals are capable of responding to that stimulation. Your number has risen, so it's going in the right direction, the only question is whether it's risen enough to show your adrenals are healthy. You may be able to find the results of other people's tests if you use the search bar.

[Wispymisty in reply to SilverAvocado]

Thanks for your reply - I guess it is quite specific! I'm wondering really if there is an upper limit as a lot of my health issues seem to show an over reaction to stimulation - so I'm puzzling whether my results may be in range but at the upper end - I think it's something to do with the ratio between readings but not completely sure.

Thanks again

[SilverAvocado in reply to Wispymisty]

Wispymisty, The NHS testing will mainly be interested in whether you have overactive or underactive adrenal glands, collectively, I think, called adrenal insufficiency. These are the two diseases Addisons (underactive) and Cushings (overactive).

I don't know enough to really get into the nitty gritty of the different tests. I think but may be wrong that the SST is one of the first tests you'll be given when one of those is suspected (probably after a morning cortisol blood test?). As it is able to show whether the adrenals react to their usual chemical instruction to make more cortisol or not. I think this test is specifically to rule out one of the causes of underactive adrenals, and I suspect it isn't designed to identify overactive adrenals - it's a very large dose of stimulating chemical, so the expectation is that you'll create loads of cortisol. Most people find it extremely unpleasant as a result - it's like your body reacting to a huge amount of stress.

Both Cushing and Addisons are diseases in their own right, separate from thyoid illness and from being sick for a long time. I think both can have a few different causes, but I also think most commonly they are auto immune, similar to Hashimoto's. If you're being investigated for the pituitary as well then this suggests that it may be your pituitary acting up rather than the adrenals, so they suspect a secondary adrenal insufficiency - this is like secondary hypothyroid, where rather than the adrenal glands/thyroid themself under performing, they are receiving the wrong instructions from the pituitary and not being told to work properly. This is good because you're being tested from both ends, suggesting someone took things seriously.

The only think important to mention is that many people who have been hypo a long time and have adrenal problems won't actually have adrenal insufficiency, which the NHS looks into. They may actually have a situation that goes by many names but simply put adrenal fatigue. This adrenals work hard to take up the slack when we're ill and the body can't run properly. They aren't designed to work so hard 24/7 as they do when we're sick, which leads to them getting burnt out and under performing - they basically just need a long rest to recover.

Unfortunately the NHS don't recognise or treat this, they are very black and white, either you have adrenal illness, OR the adrenals are completely fine. If your doctor decides your adrenals are fine, you have the option to go it alone and look into adrenal fatigue. The first step is getting a 24hr adrenal saliva test. That test and adrenal fatigue in general are quite often discussed on the forum.

[Wispymisty in reply to SilverAvocado]

Thanks again - that makes a lot of sense. I have thought about adrenal fatigue for a while so it may indeed be time to look into that a bit further. I've been ill long enough! I will put some more research in.

:o)

[SilverAvocado in reply to Wispymisty]

You've got loads on you plate because you've had so many out of range results to look into! I self treat my thyroid after cancer, and have been very disabled with it, so I know how hard it can be trying to research, choose what tests to have, and make decisions about illness when also wiped out and struggling w normal life!

I suggest choosing one thing to look at at a time, working on that alone for a few weeks or months and then once you've got a handle on it or useful results move onto the next thing.

[SilverAvocado in reply to Wispymisty]

Hi Wispymisty, I've just had a look over your history of posts on the forum, and saw your long list of blood tests. Sounds like you have had a really hard time and there is loads going on

Your thyroid results definitely look low to me, you've got a very low freeT4 and a mix of low-ish and very low freeT3. Your TSH should be responding to this by raising and asking the body for more hormone, but it isn't. This strongly suggests your TSH isn't working properly, which again comes back to the pituitary, which makes TSH.

You've also got lots of low vitamin results, too. The semi-good news with low vitsmins is that you can start working on them yourself straight away, and you've had good advice on your old post about how to do that. If I were you I would dig into that and work on them now if you haven't already.

Other than that it looks like your health is going to be a bit of a puzzle to work out, and you will almost certainly struggle with doctors. They tend not to be very helpful once things get a tiny bit complex, and you will have to do a lot of the figuring out yourself, and then fight with doctors to get the referrals and treatment.

Pituitary problems could explain your thyroid results, and could cause adrenal problems, and sex hormone problems. The pituitary produces hormones that go out as instructions to a lot of different parts of the body. There are about 7 different areas it impacts, so it's worth looking into all of them to see if you can dig up clues. You've got a prolactin result in your old post and its a shame that's not elevated, as that can be a marker of a pituitary tumour, although not everyone gets it.

If you haven't done so already, I suggest going back and studying your older posts on a regular basis as you try to figure out your illness, you've had replied from knowledgeable people.

One other note about central hypothyroid. Its such a struggle to get that diagnosed. If you're making no headway with getting your pituitary investigated in the coming months, it's something to consider self medicating with. There's a lot of work and reading required, but the treatment for the thyroid end of central hypo is just to take thyroid hormone, you can't get the pituitary working again. I expect you're having symptoms and that makes it a hard slog to do research and fight for treatment, but getting that thyroid treated should give you a big improvement in symptoms. Same with vitamin D and the other vitamins, too.

[Wispymisty in reply to SilverAvocado]

Gosh, thanks so much for going back to my earlier posts. It has definitely been a very exhausting journey so far. L

I've started to work on my vitamins again, including magnesium in the mix, and oddly enough was talking to my other half about self medication for my thyroid this afternoon, and he agrees it would make sense to try for 6 months at least. We've decided to chase up a date for my next endo appointment, and see whether I can get a NHS prescription for it (although I doubt it) and failing that arrange it privately.

:o)

[SilverAvocado in reply to Wispymisty]

Good luck!

[Wispymisty in reply to SilverAvocado]

Thank you :o)