I have a short synacthen booked via endocrinology NHS.As I use inhaler for COPD, I have been advised not to use it after 4pm the day before. Other than this, everything else, including food, as normal.
Does anyone know if this is the only medication I should stop.
Thanking you
DandyButch
Have you already had an early morning (08:00 - 09:00) cortisol blood test done? If so, what was the result?
What time is your SST booked for? If it's 08:00 or 09:00, they might be using the first blood draw as your early cortisol blood test if you haven't already had one done. It's unusual, but does happen.
I would advise checking that they will be doing an ACTH blood test before starting the SST. The NICE guidelines say that it should be done, but many endos/hospitals fail to do it, then start people on hydrocortisone without having done a test required as part of a diagnosis.
Oral contraceptives and HRT can interfere with cortisol tests. If you are taking anything containing oestrogen, I would advise checking with the endo (or endocrinology specialist nurse) as to whether you need to do anything differently. Similarly, if you are using anything else steroid based, it's worth checking that too. Unfortunately, the answer can depend on the context in which the test is being done.
Hello, thank you for responding.In April 2024 I had a cortisol test. Result 156nmol/L. No range.
I have been told by endocrinologist that I am fully medicated with T3, and that she cannot increase dosage.
But, I still feel dreadful.
She suggested the SST as my cortisol was low in April and she would expect it to be around 300. I am not on any HRT. Did that 30years ago due to premature menopause. On it 11 years and told to stop it due to health risks at that time. Different now though.
My appointment is 9.30am. Next Tuesday.
If the April 2024 cortisol test was done between 8 and 9 am, then that is low enough to warrant investigation, although not scarily low. If it was later in the day then it would normally be discounted as cortisol levels follow a circadian pattern, with the peak between 8 and 9 am.
Hope all goes well on Tuesday. Do check on the ACTH test though - if you are started on hydrocortisone without having had the ACTH test done first, you'll likely question any diagnosis. The ACTH is used to distinguish between primary and non-primary adrenal insufficiency (it's not the only test, but it's a key one). Contrary to what many people say, treatments are not always identical, and only one form has any chance of reversal.
I cannot get a blood test before 9am as GP's blood test appointments start at 9am.
9am is fine for a cortisol test 
SST can be later is they are not using the first blood draw as equivalent to an early morning cortisol test.
See pages 68 - 70 in this document :
imperialendo.co.uk/Bible202...
It is written by the Imperial Centre for Endocrinology in London.
Thankyou humanbean. I have read it. Brain fog not helpful when trying to absorb and recall info. Trying though.
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