Adrenal function test results

[FoggyThinker]

Following on from my post on Monday - I've now received my adrenal function saliva cortisol/DHEA test results, taken on the same day, no caffeine, no supplements for 2+ weeks before testing. Please could anyone help me figure out what (if anything) this adds to the picture? (General consensus is that the Thyroid results are showing Hashimotos with one high Thyroid antibody reading; plus FT4 low in range, TSH high in range, plus some other indicators that I need to read through again and summarise!). It does match somewhat with how I'm feeling, energy is poor first thing, OK mid morning, and drops out completely after lunch, except that I'm surprised by the really high reading half an hour after waking (especially as it took me about 20 - 25 mins to fill the first vial...).

[Regenallotment Ambassador]

I haven’t seen Cortisol results before and will be interested to hear what experts here suggest. Are you planning to follow these up with your GP? The swing from above range early doors to low in range after midday does tally with your exhaustion pattern doesn’t it. 🦋💚🦋

[FoggyThinker in reply to Regenallotment]

Yes, I definitely need to follow up with the GP but, as everything is "in the normal range" I think I need to do some careful research on the forums to see how to approach this. From what I've seen there is a bit of a chicken-and-egg relationship between the hypothalamus-pituitary axis(?) and thyroid function, if one goes wrong the other is often wrong especially if you are a bit stressy (which I am and always have been) but it doesn't seem clear which one starts things off. It seems to be important as some people seem to say it can affect the response to thyroid medications if they are prescribed... but this is early reading so I could be quite wrong on this. I'll add links when I have something more concrete!

[FoggyThinker in reply to FoggyThinker]

ETA I should say everything is normal except those first two cortisol readings, and the Thyroid antibody reading!

[SeasideSusie Remembering]

FoggyThinker

The test you have done also includes the "Cortisol Awakening Response" (CAR).

I don't know which lab you did your test with but Genova Diagnostics explains the CAR as follows:

Cortisol Awakening Response (CAR)

Two awakening samples to evaluate CAR

CAR is a transient, immediate rise in cortisol upon awakening and is distinct from the diurnal rhythm. CAR reflects a person's ability to cope with anticipated challenges and their perception of control around chronic stress, providing insight into HPA axis resiliency.

There should be a sharp rise in cortisol level about 30 minutes or so after awakening.

Your Cortisol 2 level is your CAR and this is showing a rise but it is over the range and looks like it's far higher than one would expect.

With regards to the other results, optimal levels according to rt3-adrenals.org/cortisol_t... are:

• Morning at the top of the range

• Noon approximately 75% of the range

• Evening close to 50% of the range

• Nighttime at the bottom of the range

Unfortunately the times of your samples do not correspond with the tests we usually see here - Regenerus and Genova Diagnostics and it's a shame you didn't go with either of these two labs as suggested - so it's difficult to interpret them based on what we usually see but we do know that cortisol should be highest early morning, falling throughout the day until it's at it's lowest at bedtime.

Cortisol 1 (awakening) result is very low, it is below range and ideally would be very close to the top of it's range (near to 16)

Cortisol 2 (CAR) mentioned above.

Cortisol 3 is going in the right direction but looks to be lower than it should be.

Cortisol 4 is the nearest sample to the Noon one mentioned above where it should be 75% through range but is in fact 6.67% through range so is very low.

Cortisol 5 is the bedtime one where it should be low and is 11.43% through it's range, which if the others were where they should be this would be OK but it's higher than your lunchtime level.

Your Cortisol Daily Total looks "reasonable" but that is only because of the very high CAR.

I can't comment on your DHEA results as I've not seen two samples tested before.

Did your results come with any comments?

[FoggyThinker in reply to SeasideSusie]

Thanks SeasideSusie - aaah, sorry, I never thought about it being easier to get help with interpretation using the suggested tests and I should have. I went with the test recommended on Thyroid UK which is the Cambridge Labs one, I think this was just because they have the three sample points for CAR which matched what little I'd so far seen of Cortisol results; and I felt that from my symptoms that would be important. If I'd thought of the easier interpretation/comparison though I would have gone with the recommendation. Foggy by name, foggy by nature at the moment...

There is quite a lot of generic discussion in the results document. It is basically saying:

Stress evaluation. Adrenal response:normal They get this from total cortisol (sum of readings - I see what you are saying, this would be skewed by that 2nd reading being very high)

Cortisol awakening response. They note that the first reading is below range, second reading above, but nothing about what this indicates except for a stress response and general reasons which seem to relate to why your cortisol levels could be high (but I think these relate to high all day? e.g. diabetes, pregnancy, heavy exercise - I wish!, smoking, obesity, depression, alcoholism...)

Afternoon response, Prior to sleep level. Normal

DHEA Normal (there's nothing about how the two levels should compare to each other and I think maybe they're looking at the average?)

Cortisol:DHEA ratio. DHEA to Cortisol is 52%:48% close to 50%:50% which is normal (high cortisol:low DHEA would be most undesirable). Ratio also given as 66.7, Normal range is 46.6 - 77.6.

So I think I need to find out more about what that high second reading and the other readings all being low is telling me.