re: read endo's email please

[Guest guest]

Val et al: (below is email from my endo)

Last week my endo said that since my aldosterone is " normal " and so is my " DHEA "

that this makes it very doubtful that there is anything wrong with my adrenals

themselves. I disagree. Isn't it true that there can be cases of adrenal

insufficiency that just involve cortisol. I think I remember reading something

about the adrenal cortex being diseased will just involve cortisol. Is that

true? He's still focusing on the pituitary. He just ordered LH, FSH, prolactin

and estradiol. I had all these tests run repeatedly both last year and just

recently by my gyno who wanted to see if I was perimenopausal/ovulating, etc.

He's wasting his time and mine. I am going to copy/paste here what he emailed

me today. At least now he's changing his tune a bit and saying he's going to

explore it.....Val, please read what he says and tell me if he sounds good to

you. Thanks.

You clearly have a subnormal cortrisyn stimulation test c/w partial adrenal

insufficiency. It is well published that small amounts of steroids such as

prednisone used in COPD can prevent the full response to the cortrisyn test and

most infer that this means one might not respond to stress needs of cortisol. I

don't know if the lower dose of hydrocortisone you are taking is equivalent to

the doses in other studies, but it is in the realm of possibility that this may

cause a less than maximal response on your cortrisyn test.

Having said that, there are clearly other possibilities

1.. You may have partial ACTH deficiency from the pituitary unrelated to prior

steroids

2.. You may have partial primary adrenal deficiency with a normal pituitary

If the other pituitary hormones are fine, it would be unusual to have isolated

ACTH deficiency unrelated to steroid use. Usually we see this with sepsis or

other life threatening issues.

Your aldosterone is intact, making primary adrenal insufficiency less likely,

but I do think we need to explore this.

--------------------------------------------------------------------------------

From: Gikas

Sent: Tuesday, October 30, 2007 6:23 PM

To: Hotes, Lawrence

Subject: follow-up

Hi Dr. Hotes,

[Guest guest]

It siounds liek your doctor is being methodical and checking things as

they come up, I agree with her assessment! However how they treat

" partial " adrenal insufficiency may well be short of what you need, so

keep that in mind. Many Endos thing ;s patients with NO cortisol

of their own only need 20MG daily, and I just do nto believe this is

possible.

--

Artistic Grooming- Hurricane WV

http://www.stopthethyroidmadness.com/

http://health.groups.yahoo.com/group/NaturalThyroidHormonesADRENALS/

[Guest guest]

He sounds more open than most to me. He is acknowledging some adrenal

insufficiency but thinks it might be due to your low dose cortisone

supplementation. He is also saying you have abnormal ACTH so he wants to

check other pituitary hormones. He seems to want to get to the bottom of it

which I think is good. Maybe you can send him some research if he isn't

familiar with primary insufficiency without DHEA and aldosterone levels

abnormal.

The adrenal cortex controls aldosterone, DHEA, and cortisol. You can have

normal DHEA and Aldosterone but abnormal cortisol rhythm. If you look at the

7 stages, you should be able to match yours to one of them based on your

test results.

Cheri

re: read endo's email please

" You clearly have a subnormal cortrisyn stimulation test c/w partial

adrenal insufficiency. It is well published that small amounts of steroids

such as prednisone used in COPD can prevent the full response to the

cortrisyn test and most infer that this means one might not respond to

stress needs of cortisol. I don't know if the lower dose of hydrocortisone

you are taking is equivalent to the doses in other studies, but it is in the

realm of possibility that this may cause a less than maximal response on

your cortrisyn test.

Having said that, there are clearly other possibilities

1.. You may have partial ACTH deficiency from the pituitary unrelated to

prior steroids

2.. You may have partial primary adrenal deficiency with a normal

pituitary

If the other pituitary hormones are fine, it would be unusual to have

isolated ACTH deficiency unrelated to steroid use. Usually we see this with

sepsis or other life threatening issues.

Your aldosterone is intact, making primary adrenal insufficiency less

likely, but I do think we need to explore this.

----------------------------------------------------------

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