Low Cortisol-Thoughts please.

[Katherine0121]

Hello,

It has been a while since i posted on the forum. To summarise I have no improvement in my symptoms. Unfortunately my health has drastically deteriorated. I am dealing with debilitating fatigue/exhaustion on a daily basis.

I have recently changed GP practices and now have a wonderful GP who actually listens and takes things on board.

I would like some advice/thoughts with regards to Cortisol please.

20/04/2022 223nmol/L

07/03/2024 168nmol/L

My GP referred me for a Short Synacthen Test. I since received a letter from the Endocrinologist stating “Your cortisol at baseline was 199nmol/L rising to 412 after Synacthen. This excludes adrenal insufficiency as a cause of your symptoms and we discharge you back to primary care”.

I did a little research and reading up before the test. And based on that I thought the above results would at least warrant further tests and/or investigate?

I would really appreciate any input please.

As always thank you 😊

[greygoose]

I agree with you, they should. But doctors don't really seem to understand why they're doing this test.

This excludes adrenal insufficiency as a cause of your symptoms and we discharge you back to primary care”.

Yes, it does. But that's not the point. The cause of your symptoms is probably low cortisol. And the test was to find out why your cortisol is low. And, it turns out there's nothing wrong with your adrenals because they responded to stimulation.

Therefore we have to conclude that the cause of your low cortisol is lack of stimulationg - i.e. a pituitary problem. The pituitary makes ATCH, which stimulates the adrenals to make cortisol. Rather like it makes TSH to stimulate the thyroid to make thyroid hormones.

However, whatever the cause - and there's not a lot you can do about a sluggish pituitary - your cortisol is still low and causing symptoms, and therefore should be 'treated' in the same way as the thyroid is 'treated' when thyroid hormones are low - i.e. hormone replacement. But, apparently, that is too complicated for the poor dears to understand.

[pennyannie]

Hello Katherine :

As I understand things the Short Synacthan Test is not ' sensitive enough ' and basically used to rule in or out Addison's Disease.

My SST came back as ' no action ' and decided to self medicate with an adrenal glandular and still do 8+ years on - I also now self medicate Natutal Desiccated Thyroid and am much improved.

Looking back - I can't believe you have been struggling with what looks like iron deficiency anaemia for so long - was a full iron panel run - were you offered an iron infusion - where are your levels 2024 ?

Everywhere I researched when I found my ferritin down at 22 suggested that ferritin needed to be over 70 for any thyroid hormone replacement to work well -

I now know I need my ferritin up at around 100 - folate around 20 - active B12 125 ( serum B12 500++) and vitamin D up at around 125.

[SlowDragon Administrator]

What are your most recent thyroid and vitamin results

From your Profile

Jan 2023

20/01/2023

Serum Folate Level 11.6ug/L

Serum Ferritin Level 18ug/L

B12 638 pmol/L (115-1000)

T3 3.7 pmol/L (3.8-6)

T4 8.1 pmol/L (7.8-21)

TSH 9.8 (0.35-4.7)

Currently taking Levo 175 daily - always the same brand.

Fultium-D3 800unit daily.

Ferrous fumarate 210mg 3 times/day from 20/01/2023.

Retest full iron panel 3-4 times a year

It’s possible to have low ferritin but high iron

Test early morning, only water to drink between waking and test. Avoid high iron rich dinner night before test

Stop iron supplements 5-7 days before testing

Medichecks iron panel test

medichecks.com/products/iro...

no vitamin D result

800iu vitamin D is low dose

Folate looks low

Are you now taking daily vitamin B complex