Adrenal insufficiency

[Guest guest]

Dusty,

You asked:

> ... - what is the standard testing for

> functioning adrenals?

Sorry for the delay getting back to you on this. It's a complicated

subject, unfortunately with a lot of traps to fall into.

The critical thing to measure is cortisol production in response to ACTH

secretion in the pituitary (as directed by corticotropin from the

hypothalamus). The chemical feedback loop connecting hypothalamus,

pituitary, and adrenal cortex is what Gracia has referred to as the

" adrenal axis. " Measuring this is not as simple as it may at first

appear. For one thing, the corticoids are mostly in a bound form in

serum, much like our friends T4 and T3. Only the tiny free fraction

contributes to activity. Chemical assays tend to measure TOTALs rather

than the free/bound fractions, even liquid chromatography.

There are many ways to measure (total) cortisol production, through

cortisone excretion in urine or in saliva. However, cortisol activity

varies throughout the day, and a high level at any one point really does

not give you the response to ACTH, a measure of the depth of adrenal

strength. All too often a single urine or saliva test is ordered, which

really isn't very reliable unless you are already in a severe state of

adrenal insufficiency. However, this IS a good way to screen for

Cushing's (hyperadrenalism).

My impression is that most doctors screen for adrenal insufficiency by

simply looking for symptoms of 's, which is really a nearly

complete shutdown of the organ, often caused by another autoimmune

condition, although also caused by types of cancer, infections, HIV, and

a familial vulnerability.

The primary indications are weakness, abdominal pain, nausea, and

weight loss, very similar to many other conditions, too similar. If

these trigger your doctor's thinking about it, he may also look for

hypotension or shock (passing out in the doctor's office?), lack of

libido, loss of body hair in women, hyperpigmentation, and psychiatric

changes. Laboratory tests may show hyponatremia, hyperkalemia, mild

acidosis, hypoglycemia, and hypercalcemia, all of which can be induced

by the right combination of supplements from the health food store.

When folks on this list first started describing the symptoms of adrenal

insufficiency to me, I thought they were just talking about drinking too

much coffee. Caffeine is an adrenaline mimic, so drinking it is

effectively taking a non-bio-identical hormone, which can, indeed, lead

to a mild state of adrenal fatigue. This is a form from which most can

recover by simply cutting back and sleeping more. Nevertheless, some of

us consider coffee an essential nutrient.

So, if your doctor sees no obvious signs of 's, he is likely to

play the odds, discount that as a possibility, and proceed to treat your

thyroid. That is especially true if you are in an HMO or PPO. The health

insurance companies don't want to pay for the full adrenal test, which

starts with a full day of sampling to establish your baseline cortisol

cycle. Then they give you an injection of either compounded ACTH or a

synthetic corticotropin (Cortrosyn) and do more sampling for the next

day to see how the pituitary stressor changes cortisol output. Each

sample is the equivalent of a blood test for hypoT, so the cost is

fairly high.

If the cortisol response is too low, the lab can go back to the samples

and check for aldosterone, which can sometimes help localize the problem

to primary (adrenal gland), secondary (pituitary), or tertiary

(hypothalamus) failures. More often, additional tests are needed. So, in

addition to an expensive test(s), you probably need an endocrinologist

to sort all this out with MRI, CAT, etc., plus the all the other things

that could be involved. No wonder some just order a single sampling, so

they can tell you it's all in your head.

Gracia tells us that NONE of the tests are reliable, even the full 48

hours marathon, but I tend to think that if that monster test clears

you, you need to look at a different cause of the symptoms. It's the

other tests that seem doubtful, at least according to the literature.

She could be right, although I am skeptical of the approach of assuming

you have it and start taking cortisol to see if you feel better.

Chuck

[Guest guest]

For those of us taking Prednisone, the possibility of adrenal gland damage

is something to keep in mind.

My most noticeable symptom, the one that led to testing, was extreme

weakness, alternating with periods of well-being and energy.

I feel fortunate that the problem has been diagnosed.

Harper

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