24 hr. urine cortisol Was:Armour and chest pains

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----- Original Message -----

From: " Skipper Beers " <lsb149@...>

Lynn McGaha wrote: > >I don't understand why you say the 24 hr. cortisol

test really isn't for insufficiency,

> I could be wrong. However, below are some sources. Doctors today have

> trouble reading between the lines. The 24 hour test does tell you some

> things, or course. Does it tell you that at 8Am it's @6 units, when it's

> supposed to be at the highest point of the day, and at 12PM it's still at

> the same level? No it doesn't, not a perfect test and there really isn't

> one.

From what I've read, what causes people to have higher cortisol values later

in the day is either Cushings disease or a time-lag of adrenal response to

ACTH earlier in the day. If Cushings, the 24 hr. urine will show a high

cortisol value. If it's a poor response by the adrenals, I suspect the 24

hr. urine will show a low value. Treatment for adrenal insufficiency

appears to involve giving higher doses of hydrocortisone early in the day

and tapering down towards afternoon, for everyone.

> http://www.labcorp.com/datasets/labcorp/html/chapter/mono/sr011300.htm

> Cortisol, Urinary Free, by ICMA

> Evaluate adrenal cortical function, especially hyperfunction; evaluate

obese

> or hypertensive subjects with glucose intolerance, plethora, round face,

> hirsutism, striae, backache, irregular menses in various combinations,

most

> of whom do not have Cushing syndrome.1

>

> Low values do not necessarily mean adrenal hypofunction.

That sentence is followed by: " Vagaries of improper urine collection or

renal disease may lead to misleading results. " I think they're saying that

a low value could also be explained by improper urine collection or renal

disease, so if those conditions exist, then the low value may not mean

adrenal hypofunction.

This is followed by: " Urinary free cortisol is a more accurate reflection

of cortisol secretion than a single serum specimen. "

> http://www.merck.com/mrkshared/mmanual/section2/chapter9/9b.jsp

> A single determination of plasma cortisol or 24-h urinary-free cortisol

> excretion is not useful and may be misleading in diagnosing adrenal

> insufficiency.

They say that a single determination of plasma cortisol or 24-hr urinary

free-cortisol excretion without ACTH stimulation is not useful because it

doesn't distinguish between low-normal and below-normal values of 's.

Conventional medicine doesn't propose to treatment hypoadrenalism, only the

adrenal failure of 's. So they would not find value in a test that

showed low-normal values, because they wouldn't treat for it. So for

allopathic doctors low-normal may not be useful, because they don't know

what to do with the information.

> http://enotes.tripod.com/adrenainsuff.htm

> The urinary free cortisol excretion rate has become a valuable index of

> adrenal hyperfunction. It is less reliable for the detection of

> hypoadrenalism.

I believe they too prefer ACTH stimulation. I don't have links to give you,

but have read that the ACTH stimulation test is not sensitive enough to

detect mild to intermediate levels of adrenal insufficiency. Same reasons

as above apply here.

> Yes, but as I'm sure you realize it doesn't tell you the snapshot values

at

> the various times of day, so you could have high cortisol at night, but

not

> in the morning. Which could cause trouble sleeping at night, and

> functioning during the day. Also, if the morning value is around normal,

> but it never decreases, it doesn't tell you that. Yet, you suffer because

of the trend.

I don't have anything to support this, but I suspect it's more likely that

if one has adrenal insufficiency that the 24 hr. cortisol output will be

decreased, than the aberration will be captured in a snapshot value.

Cortisol values that would be considered high at night quite often means the

individual has low cortisol in the morning. Your proposed 8 AM serum

cortisol test or ACTH stim test wouldn't tell you if someone had a high

cortisol at night.

> It is also going to be higher if you have a stressful day, and lower if

you

> don't. Normal values are somewhat relative because of that. If the

" normal

> values " are taken when people are under stress, and you spend the day

> sleeping, yours would be artificially low. So, what are people doing

while

> they're taking these tests?

Hanging around home so they can pee in their pot. Stress confounds any

test, but I think stress is induced more by experiencing going somewhere to

have blood drawn at 8 am or going through an ACTH stim test than collecting

urine at home. You also have the problem of stress unduly raising someone's

normally low cortisol and hiding the fact that they have adrenal

insufficiency.

Lynn