Urgent: in the short Synacthen test now... Anybody had issues?

[Entwicklung]

Ok so I'm a nervous type normally, but I've just had the short Synacthen injected and my heart rate is rising rapidly. It's 120 sitting down.

Is this just me?

My nerves?

Many thanks for any input 🙏

[humanbean]

I assume you've been injected with the artificial ACTH by now. It is stimulating your adrenal glands to produce more cortisol. If your levels of cortisol are rising above the level you are used to then it will increase your heart rate. If you are usually a nervous person this might make you feel more nervous than usual.

Are you in a bed or a chair? Do you have someone with you?

If you are lying on a bed, or can lie across a few chairs, try to relax as much as you can. The extra ACTH and cortisol won't last for ever and your heart rate will return to normal. You could try humming to yourself with a soothing song, and try to keep your breathing under control.

[Entwicklung in reply to humanbean]

Thank you so much for this 🙏

I definitely stressed myself out there and felt a bit panicky. Maybe this indicates the cortisol increase as you say... That would make sense as the pituitary is the suspect here.

I'm alone but it's starting to ease off now. (HR down to 92).

Glad it all done... He just took blood at 30 mins and said that should be sufficient, following the instructions here; gloshospitals.nhs.uk/our-se...

Thanks again for the comforting message ⭐

[humanbean in reply to Entwicklung]

You're welcome.

[Jumbelina]

I had a Synacthen test in hospital. I can't remember whether it made me feel panicky but it certainly gave me a sinking feeling in my stomach- a feeling of dread and apprehension- not pleasant- cortisol I believe.

. What does make me feel very jittery is sometimes when I'm given a numbing injection at the dentist. I have to get up and move about. Apparently sometimes these injections contain adrenaline and that is what makes me so jittery. The adrenaline is apparently used to reduce bleeding in dental procedures.

[JumpJiving in reply to Jumbelina]

Jumbelina If you have a diagnosis of adrenal insufficiency, you need to notify your dentist and ensure that they use local anaesthetic that does not contain adrenaline (there is an alternative available)

[Jumbelina in reply to JumpJiving]

Thank you for that JumpJiving. I've never been diagnosed with adrenal inuslliciency so I guess I'm OK

[Zephyrbear in reply to JumpJiving]

I cannot have the adrenaline local anaesthetic for dental procedures anymore because it used to make my heart race and thump uncomfortably. I now only have the non-adrenaline one which, quite frankly, works just as well with an added advantage of wearing off much quicker.

[Entwicklung in reply to Jumbelina]

Thanks for your message Jumbelina.

Oh it's been unpleasant. I've had a sitting heart rate of between 115 and 120 for a few hrs now. Just got home after a fairly long drive so I'm going to relax and see if I can bring it down. I know what you mean about the sort of 'dread feeling'

Interestingly though the stim test seems to have kicked off my symptoms inc kidney area pain and rapid hr.

Not enjoyed it but hopefully it's worth it.

[JumpJiving in reply to Entwicklung]

Entwicklung Normally people have already been prescribed glucocorticoids by the time they do the SST, or are in an environment where they get a prescription as soon as the SST is done. Unfortunately, that’s not the case for you, so (assuming you had a cortisol response to the SST) your cortisol went up, and it has been dropping since. That may mean sudden low cortisol symptoms. Again, if you feel you are heading for adrenal crisis, it’s a 999 job

[Entwicklung in reply to JumpJiving]

You're a star thank you. That all sounds quite logical, there has definitely been a response to that injection. HR down to 100 now sitting down so I feel more comfortable... 120 is just too much.

Pains in the kidney areas too, mainly the left. MRI didn't show any issues like nodules or anything, but I suppose they could still be affected by antibodies or maybe be atrophied from what I'm reading. In my mind they're crying out for help if that makes sense.

I have one question for you when you have a moment I hope you don't mind me picking your brains... I want to try supplementing potassium because I'm having some trouble with this high blood pressure (apparently potassium is the key)... My question is do you think it's a bad idea? I don't think I'm 'addisons' as such but I believe they have high potassium low sodium. My blood tests usually show a decent level of both TBF, but I just want to try something.

[JumpJiving in reply to Entwicklung]

Entwicklung Regarding sodium & potassium, I would be tempted to hold off until you have the results of the SST and ideally the ACTH to confirm that you don't have primary AI. If confirmed as secondary (or tertiary) AI, then I would be tempted to ask in a blood-pressure related forum (or ask the BHF - I think they have a helpline).

I am improving diet generally to try to reduce my BP (and reduce LDL cholesterol). If that doesn't make enough of a difference, I might consider replacing salt with low sodium salt (in which 25% of the sodium chloride is replaced by potassium chloride, if I remember correctly) to help with the BP, but I am going to try general dietary stuff first. I've found it remarkably easy to change diet now that I have specific reasons to do so, next blood test next week I think to see if it is making a difference to bloods

[Entwicklung in reply to JumpJiving]

That all makes sense, I appreciate that. Hopefully the results don't take too long 🙏

That's interesting about the 'low salt' as well... I didn't know that had potassium in. I believe sodium and potassium are on a see saw effectively from what I've read.

[JumpJiving in reply to Entwicklung]

Entwicklung Certainly according to a Zoe podcast that I watched the other day, sodium levels can reportedly be reduced by increasing potassium (and v.v.). I would add a caveat to that, that I assume that relies on certain systems in the body functioning correctly, particularly (but not limited to) the kidneys

[Jumbelina in reply to Entwicklung]

So sorry you've had these symptoms. Do speak to a doctor or nurse if you're really worried.

Otherwise putting on some calm music bbc.co.uk/sounds/play/m00274vk and doing some yoga stretches may make you feel better ( -or be utterly maddening, depending on your temperament)

[Entwicklung in reply to Jumbelina]

Ah you're very kind thank you. I've been trying relaxing videos and breathing exercises etc... no luck so far.

HR is still way up and can't get it down. Bit worried but really don't fancy A&E because they'll likely just turn me away so I'll have to wait it out

[Entwicklung]

An update here.

Throughout the day and into the evening my HR was way up following the short Synacthen test, around 120 sitting still. It was uncomfortable and I tried lying down, relaxation methods you name it but it was on its own schedule. I found during some research in the night that racing heart can be the case for some people, but I'd only read about it being fine for most beforehand. If I can find the details I'll post on here for anyone reading about it in future.

[Entwicklung]

Sorry, can't remember the source.

Says on there that the racing heart will be finished by the end of the test, but that wasn't my experience.

Description of short Synacthen test

[Entwicklung]

Again, adding this response on for completeness in case it's useful to anybody in future who comes across the thread.

HR was back to my normal the next day.

SST results came back shockingly high for cortisol following my prior 9am readings (I've had 178, 313 and then 181nmol)... On the day of the SST:

Baseline: 820nmol

30 MINS post injection: 987nmol.

Still in the denial phase merged with the utter confusion phase.

Although the Endo is now looking at POTS as my potential root problem, I've also got some info about possible 'Cyclic' issues with ACTH to investigate from the super helpfulJumpJiving

Cortisol numbers ranging from around 180nmol/L to 820nmol/L