Stress and a Short Synathcen Test

[Thenightowl]

Hi, I saw my new pituitary specialist on Friday who surprisingly offered me a Short Synathcen Test for suspected low cortisol.

I had a cortisol test recently and it was normal.

I have just realised that fasting for the test was not recommended, and I had had no coffee or food overnight.

Before my morning coffee I can barely function or even string a sentence together, dreadful headache- I have to drink it in bed. Before food I am woozy and clumsy. I felt really unwell.

I was also incredibly stressed with a high heart rate as I have a needle phobia, and became overwhelmed and tearful straight after the test (as usual).

So I am now wondering whether my normal result was skewed by the stress.

I am also seeing that stress affects the Short Synathcen Test too.

It seems like there may be other alternatives which include the Glucagon test, ACTH and the insulin stress test, or am I barking up wrong trees?

Do the NHS readily offer alternatives?

Any ideas?

[Hidden]

The short synacthen test will show how well your adrenal glands respond to the artificial ACTH that is injected at the start of the test. Ideally they should do an ACTH blood test at the start of the test to see if the issue is with your pituitary gland. Have you had the results for the SST? If it is low then they will contact you as soon after the test to put you on steroids. You say that you had a normal cortisol test, do you have the results for that? What time was it done? The Glucagon test & the insulin tolerance test are even more stressful tests as they cause a far greater reaction than to the SST.

[Thenightowl in reply to Hidden]

Hi, sorry I wasn't very clear- I haven't had the SST test yet, my concern is that the stress I get from my needle phobia will cause my adrenaline to be sky high throughout the test, and skew the results. So I am wondering whether other hormones etc could be tested too, which wouldn't be affected by me being very stressed. I'll check my cortisol test and get back to you.

[Hidden in reply to Thenightowl]

Unless specifically asked they will only be checking cortisol in the SST, although a good unit iwll test ACTH at the start of the test.

[Thenightowl in reply to Hidden]

Cortisol was 357 (133-537)

[Hidden in reply to Thenightowl]

What time of day was that done? If it was first thing in the morning it's within normal limits, cortisol at 8-9am should be between 350-550nmol/Ls, so surprised they have offered a SST.

[Thenightowl in reply to Hidden]

8am. I was surprised too! Also offered pituitary and brain MRI, I have a lot of symptoms that point to adrenal insufficiency/Addison's.

[Thenightowl in reply to Thenightowl]

And TSH/ft4 indicate central hypothyroidism which my brother has.

[Hidden in reply to Thenightowl]

Your certainly not showing adrenal insufficiency with those results, cortisol usually has to be much lower than that to trigger having a SST. Mu cortisol levels off Hydrocortisone are 11nmol/Ls

[Thenightowl in reply to Hidden]

I've been offered an SST for some reason. Very good to know adrenal insufficiency is not likely. 11, gosh.

[Thenightowl in reply to Hidden]

Just seen this, so I think it looks possible to have an issue at my levels:Misinterpretation of serum cortisol ...by JC Smith · 2004 · — A morning (8-9 am) cortisol concentration of > 500 nmol/l effectively rules out the possibility of adrenal insufficiency in most cases.

Or > 15 mcg/dL.

[Angel_of_the_North]

Insulin stress test is really, really awful and often given if SST is abnormal. Should have ACTH test just before SST