SST SYNACHTEN TEST

[Viv123]

Hi all,

I feel bad for many years, got a bit improvement with my thyroid after hearing for years “it’s all in my head”. Now I know my adrenals respond unwel to t3 treatment which I know I need. I was rejected by all endocrinologists in the Netherlands, and went to Ukraine to try here. They have checked cortisol in urine, ACTH, morning cortisol, aldosterone and couple more less viable things. In their opinion all the tests are “in range”, I should stop digging and live further as it is. I begged to make Synachten Test but was rejected. I feel desperate.

Then they told me it’s easy I can do it myself. Take dexamethasone pills in the evening and test morning cortisol…

I always thought this test is made in the morning one measure, injection, second measure. Can I trust an option with the pills? If it’s not worth it I would not bother making it and search for an injection version.

[Hidden]

The Dexamethasone Suppression test is used to see if you have high cortisol levels & is used as one of the tests to diagnose Cushing's syndrome & not adrenal insufficiency & is not the same as the short synacthen test (SST). You are right that with the SST they should take a base level cortisol test, plus an ACTH blood test to see if the issue is with the pituitary gland rather than the adrenal glands. You are then injected with artificial ACTH to stimulate the adrenal glands to produce cortisol. The SST is only useful if you have had a low morning cortisol result.

[Viv123 in reply to Hidden]

So the test where you take dexamethasone at night and test in the morning is called Dexamethasone Supression test?

[Hidden in reply to Viv123]

Yes & its used to see if you have too much cortisol in your body, it's no use for testing low cortisol. This may help you understand it. youtube.com/watch?v=ZINZOob...(Not working as expected?)

[Hidden]

If it's not working then search on YouTube for the Dexamethasone Suppression test.

[Viv123 in reply to Hidden]

Thank you so much Pauline. First endo I’ve visited here had suggested I am talking about this Suppression one and he referred me further to other doctors with the wrong name of the test. But smth tells me doctors here are not going to make SST either because they would come up with the right test name themselves.It's like their goal was to keep me confused.

My tests are mostly low in range, just aldosterone is a bit higher then norm and 17-oh-progesterone is higher. Progrstrinr and estrogen is low but Gino doesn't think we should treat it. My symptoms are just ignored. How annoying it is.

Thank you for giving me a bit more clarity about where I went wrong. I will continue to look for SST test options.

[headinjuryhypo]

For diagnosing secondary adrenal insufficiency, the short synacthen test is not that reliable (See Dorin acpjournals.org/doi/abs/10.... as it misses about 40% of cases. For diagnosing primary adrenal insufficiency (i.e. in the adrenal glands themselves) it is OK. For secondary AI the best test is the glucagon stimulation test or the more rarely performed insulin stress test are much more reliable. I would push for the glucagon stimulation test if I were you.

[Viv123 in reply to headinjuryhypo]

Thx, I will see how it will turn out. I will update when there will be some result