Does anyone have knowledge of short synatchen tests, low cortisol levels?
I have had 3 x 9am cortisol tests over 3 months
1st = 280nmol
2nd =250nmol
3rd = 242nmol
I've recently had a short synatchen test. Results of this are
Baseline 242nmol
30mins 481nmol
60mins 569nmol
These have come back normal no further action/investigation.
My Mum is also going through the same testing but her results are far worse, baseline cortisol has been 70nmol and is now 30nmol with treatment.
I've been feeling unwell for about 2 years with quite vague symptoms that I appreciate could be a number of things. But my baseline cortisol levels do seem a bit low and wondered if this should be investigated further or retested in a few months.
Does anyone know if the SST tests both adrenal and pituitary function or if this just tests the adrenal glands and further testing is needed for the pituitary gland?
Any information is appreciated 😊
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LDG1
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Obviously adrenal issues can be due to inadequate treatment for hypothyroidism
The fact your levels increase after short synacthen test shows Your adrenals can respond, so it’s not Addison’s
More likely adrenal exhaustion
Regenerus saliva cortisol test can give clearer evaluation of daily cortisol levels
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Are you currently prescribed levothyroxine?
what vitamin supplements are you currently taking?
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12
Low vitamin levels are extremely common, especially if you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies
Ask GP to test vitamin levels
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .
Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)
If/when also on T3, make sure to take last third or half of daily dose 8-12 hours prior to test, even if this means adjusting time or splitting of dose day before test
Is this how you do your tests?
Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins
List of private testing options
thyroiduk.org/getting-a-dia...
Medichecks Thyroid plus ultra vitamin
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Medichecks often have special offers, if order on Thursdays
Thriva Thyroid plus vitamins
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Blue Horizon Thyroid Premium Gold includes vitamins
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Small selection of posts mentioning Regenerus results
Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption
This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.
What time of day were your cortisol tests done? Also what time of day was the SST done? Ideally they should all be done between 8 & 9 am. Did you have an ACTH test done at the same time as the SST? This is essential to differentiate between primary adrenal insufficiency (PAI) and secondary (SAI) in the first instance. If all tests were done first thing in the morning then whilst your cortisol levels aren’t too bad, they certainly would warrant further investigation as below 300. With the SST, your adrenals did stim but the baseline was below 300 so an ACTH would show if your pituitary is not producing ACTH which the adrenals need to tell them to produce cortisol.
The ACTH blood is taken at the same time as the blood for the baseline but would have been put onto ice and immediately taken to the lab for testing. You also need to ask for Adrenal antibodies to be tested as if these are not positive, then adrenal insufficiency would be secondary rather than primary.
Regarding your mum’s results, is the medication that she has been given hydrocortisone or prednisolone, as this is what is given to treat Adrenal Insufficiency? What dose does she take and how is it split during the day. Most knowledgeable endocrinologists will recommend hydrocortisone being split over 3 doses as it only stays in the system for 6-8 hours, whilst prednisolone is usually taken over 2 doses. I take hydrocortisone but take mine every 3 hours as I am a fast metaboliser. This dosing suits me much more and I’m feeling a lot better since I started taking it every 3 hours. She could request a day curve to determine dosing rates.
Thanks, I don't recall blood being put on ice, I can check what was tested with my GP.
My mum is on hydrocortisone 3 x daily. She was on a higher dose and starts to feel a bit better, then it's reduced every 3 days and by the time it nears the lower dose she's back to being quite poorly. Her 70nmol result was with no treatment which has now lowered to 30nmol with the hydrocortisone.
Why are they trying to lower her daily dose? I suspect they are trying to get her adrenal glands to start producing cortisol again but depending on how long she has been taking hydrocortisone, it may well be pretty unlikely to happen. What dose is she taking? The usual dose is 20mg, spread through the day but some,of us need more. That is why a Day Curve is helpful as it tests what the levels of cortisol are throughout the day.
My Mum is also going through the same testing but her results are far worse, baseline cortisol has been 70nmol and is now 30nmol with treatment.
Your mother's results are absolutely diabolical and suggest she could have Addison's Disease. This is a life-threatening condition and she needs referral to a good endocrinologist as soon as possible, although how you find such a person, I don't know.
Have a poke around in these sites for more information :
The PDF version can be downloaded and is the one I prefer.
To see how the SST test should be done, how to prepare and how to interpret the results take a look at pages 68 - 70 in the PDF file. Individual pages can be printed out and used for reference in appointments with doctors/endocrinologists. (Don't try and print out the whole document - it's nearly 200 pages.)
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For good advice on all things adrenal, Hidden is very knowledgeable.
Thank you for responding and the links, I will certainly have a read.
She really is struggling and has other health conditions on top. The tablets prescribed aren't helping and things get considerably worse when the dose is lowered. She's been advised if the treatment doesn't work it's not her adrenal glands and will require a full body CT.
The fact that your mother's results have got worse after treatment was started suggests to me that the people testing and treating her have absolutely no clue what they are doing. Perhaps your mother can ask for a second opinion at a different hospital because doing nothing won't help.
What treatment has she been given? Addison's Disease should be treated with steroids :
It's all very new, this was tested mid March and now due to COVID19 and her shielding they don't want her going in for tests.
She hasn't been seen by an endocrinologist just a phone call to start treatment of hydrocortisone 3 x daily.
Okay, your SST shows a good response to the artificial ACTH which suggests that the issues is not with your adrenal glands, however it doesn't tell you if there is an issue with your pituitary gland, which as Barrister says should be done at the start of the test & put on ice.
As regards your Mum she most definitely has adrenal insufficiency, whether it is Addisons (primary) or secondary doen't seem to have been determined. I'm guessing that the second test she had done where it was even lower was with her off the Hydrocortisone, all that shows is that she is adrenal insufficient. However if they tested her while she was still on the HC then she needs immediate hospital treatment. It will take some time for her to start to feel better, it's not a quick fix. She needs to take the first dose, which should be the largest dose at least 30 mins to an hour before she gets out of bed, then the other two doses spread out. I'm like Barrister & metabolise HC quickly so I take mine 5 or 6 times a day. How much is she on? What dose & what times is she taking it? It is important to see an Endo who is experienced with pituitary/adrenal issues as not all of them are. I can recommend one if you message me where you live, I have the ones recommended by the Pituitary Foundation. The PF is also a good place to get more information as is the Addisons Disease organisation as well. If you are on Facebook then join the UK Addisons info & support group for a lot fo help & support. Hope that help a bit?
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