Synacthen Test Results

[Lalalala5]

Hi everyone, just looking for some clarification on a Synacthen test I've had.

Bit of background, 36M, pretty healthy in terms of diet, exercise, sleep etc. No medications. I've been suffering for a few months with fatigue, heart palpitations. Seems to get a lot worse after exercise.

Checked cortisol with Medichecks which produced a 150 at 9am. Doctor referred my to an endocrinologist who ordered a few tests and this Synacthen test. Results attached were taken at 9:40am for baseline.

Cortisol

Baseline: 144 nmol/l

30 mins: 574 nmol/l

60 mins: 720 nmol/l

Strange thing is after the test I actually felt better/normal for the whole day. So I thought "right this must be the answer I don't have enough cortisol usually".

On my follow up the endocrinologist said I passed the test and that anyone would feel better after the test as it's steroids and he wouldn't recommend going down that route for medication.

Thing is I'm wondering where to go, does this result conclusively rule out secondary arenal insufficiency? Could I not be producing enough ACTH?

If it's not that then any advice how to raise cortisol naturally would be great.

[radd]

Lalalala5

Welcome to our forum,

This is always the issue. You pass the test that is evaluating whether adrenals are capable of producing enough cortisol when the right stimuli is given BUT then further tests to evaluate why stimuli was insufficient in the first place aren't usually concluded.

This stimuli comes from the pituitary and it might be worth pushing for further pituitary hormone tests to exclude a pituitary problem. Otherwise it usually means a secondary form of adrenal insufficiency (adrenal fatigue) which isn't recognised in convention medicine and needs careful nurturing to get all hormones optimised and back working well again.

Adapatogens help normalise the HPA axis and glandulars help fill hormone/enzyme deficiencies but you shouldn’t take anything if you are going to push for further testing.

Adrenal fatigue (HPA dysfunction) often goes hand in hand with long term thyroid issues. Do you have a known thyroid issues or have you had a recent comprehensive thyroid hormone test (TSHJ, FT4 & FT3)?

[greygoose]

Hi Lalalala5 welcome to the forum.

I have never understood why endos do this test as they don't seem to understand what the results imply. It's not a pass or fail test. It's to find out why you have low cortisol. Is it the adrenals at fault? Or is it the pituitary. As the cortisol rose with stimulation - ATCH - it shows that the adrenals are perfectly capable of functioning but they're not getting the stimulation they need on a daily basis. As you say, low ATCH. ATCH is made by the pituitary, therefore, seems clear to me that the pituitary is at fault. And there's not a lot to be done about that, except replace the missing cortisol.

On my follow up the endocrinologist said I passed the test and that anyone would feel better after the test as it's steroids and he wouldn't recommend going down that route for medication.

Did he cross himself when he said that? Or hold up a bunch of garlic? Seems like 'steroids' is a dirty word like 'hormones', which is a strange reaction coming from someone who is supposed to be a hormone expert. So, what route would he recommend? You can't live a full like with low cortisol. And you can only replace a hormone with a hormone. So, I don't really see any other solution that 'going down that route'.

What you need now, is an endo that actually knows something about his job. Because if your pituitary is mal-functioning, you could have a thyroid problem as well. Have you had that tested? And some of the other pituitary hormones could be low, too, causing problems. So, they need to be tested. But, you can't do that privately, I don't think.

To sum up: you didn't feel better because you were given 'a steroid', you felt better because you were given the hormone you need and are short of. There's a lot missing in his logic, there.

[Lalalala5]

Hi Radd and Greygoose,

Thanks for the quick replies I really appreciate it. I've just sent an email asking if the result can definitely rule out secondary adrenal insufficiency, see what they come back with. I did find it a bit strange but I didn't know if there was another reason why this could be ruled out.

I had quite a lot of tests, some of which were thyroid but I'm not sure if they cover the ones you mentioned Radd? They did say it 'looks all ok', I've attached a screenshot of the results to this post.

With the adaptogens and glandulars, is there any you know of that might help with raising cortisol? Just did a quick google and could only find reference to lowering cortisol.

Greygoose, I thought the same, and no other route was given lol, so I have also asked about this on email to see what they suggest. I'm not sure if the tests I've had rule out a pituitary issue and maybe that is why they said not to pursue, either way it does look like it's low in the morning and I felt better after the ATCH stimulation so logically it seems like I would benefit from fixing that somehow.

Appreciate any help and advice. Thanks

results

[greygoose in reply to Lalalala5]

So, your tests are not exactly 'all ok'. All in-range, yes, but that doesn't mean very much. Your folate is too low and your B12 could/should be higher - at least over 550. But that could be due to diet.

Unfortunately, they tested the Total T3, not the Free T3. TT3 doesn't help all that much. It's low, but that doesn't autmatically mean that your FT3 is low. And as the level of the FT3 will affect the TSH, it's difficult to pass comment. Your FT4 is actually on the high-side, so that could mean that your FT3 is low. But, that's only a guess. On the other hand, your SBGH is over-range, which is usually associated with hyperthyroidism. So, it's all a bit inconclusive.

With the adaptogens and glandulars, is there any you know of that might help with raising cortisol?

Adaptogens are unpredictable. In some people they might raise cortisol, in others they might lower it. But, if your problem is secondary adrenal insufficiency, I'm not sure that adaptogens can help at all. I have no experience with glandulars.

I think what you're going to have to do is wait a while - say three months - then do a private test with all the essentail tests to see how things have evolved. I don't see there's much else you can do at the moment.

[Lalalala5 in reply to greygoose]

Thanks for the reply greygoose. Looking into T3, I might get a test for the free T3 as I can get one posted through Medichecks, might be worth just knowing that level. Interesting about shbg, it's been high for a while but the doc said not to worry again and it might be 'because I'm fit' lol 🤷‍♂️. I did give blood a few months ago to get rid of excess ferritin (apparently it can also raise shbg) and felt better for a while. But ferritin has now come down and shbg seems to be raising again. Will look into it more.

[greygoose in reply to Lalalala5]

Not a good idea to get just one isolated test done. The TSH, FT4 and FT3 should all be done together at the same time, because they all three affect each other, and should be considered together. That will give you a clearer picture of what's happening than just testing them individually.

I don't think you need to worry about the shbg as such, it's more about it's reason for being high that is important, rather than the excess hormone. But that's not the sort of thing doctors tend to understand. They take all these individual results as separate entities and can't see the connection between them.

[Lalalala5 in reply to greygoose]

Hi greygoose, thanks for that, I've had a look and Medichecks do the TSH, Free T3 and T4 in one test so will go ahead and get that one.Also did a quick search for an ACTH test, it does exist in London. Do you think it would be worth getting that done too to check my levels or would it be useless in isolation?

[greygoose in reply to Lalalala5]

I'm afraid I can't answer that question. It should really have been tested at the time of your Synacthen test. Did they not do it?

[Lalalala5 in reply to greygoose]

I thought so too but nothing on the results. 🤷‍♂️

[greygoose in reply to Lalalala5]

OK, well, maybe try testing it. That would give you another clue at least.

[McPammy]

Your T3 is very low.

I had very low cortisol a few years ago and had x2 synacthen tests. Both tests I past but only just. I was in a bad way and eventually after being on mono therapy levothyroxine T4 for over a decade for Hashimoto’s I eventually found out by going private that I’m a very poor converter of T4 to the most important hormone T3. My bloods reflected the poor conversion and I also did the DIO2 gene test privately which came back positive. I was privately put on a 3 month trial of combined treatment T4 levothyroxine plus T3 liothyronine. Within a few weeks by cortisol had shot up from 150 to 450 (155-650). Not only was my cortisol much better but basically everything single thing was and still is. I feel that you need to consider trialing combination treatment levo plus lio if you haven’t already. Your T3 result is very low.!! I recently had another synacthen test and past with perfect response. I also felt much better each time I had my synacthen tests. The most recent synacthen test I felt like an athlete for a day and half. Then I felt ‘normal’ again. The test is to check if the adrenals respond well. We need cortisol in times of stress or if you catch a virus. Cortisol is our own steroids.

[Lalalala5 in reply to McPammy]

Thanks so much for the reply mcpammy, I will look into this T3 I had no idea about it. Appreciate the information.

[McPammy in reply to Lalalala5]

I also had no idea what T3 is until I joined this brilliant community