Confused by test results

[chelytoad]

Hi. I am a little confused by what I was told regarding recent cortisol base and cortosyn tests. As part of a large screening my doctor ordered a morning cortisol level. Mine came back critically low so she ordered the cortosyn test. I was NOT told that I needed to fast prior to this so I ate a small breakfast and had some tea. I am wondering if this affected my results. Here is what came back:
Base Cort: 11
30 minutes: 29.95
1 hour: 35.72

After a consult with endocrinology I was told I was normal but my primary care physician didn't like that so she rerean the morning cortisol. It came back as 5.1 which is low. ??? She sent me back to endocrinology and I was again told there was nothing wrong and they contributed the original cortisol readings to a lab error. Well I work in the medical lab field and know they collected the cortisol correctly.

At this point, all the doctors I am involved with have forgotten about the cortisol since the ACTH showed a tripling of the baseline but I am still wondering why mine would be so low. Is this honestly something I should forget about or do I need to dig deeper? I have other health issues so believe me I would love nothing more to have this really be normal but have learned through previous experiences that letting things go that shouldn't have been only hurts you in the end.

Thanks in advance for any information or insights! :)

[rumpled]

Oh the old you can have ONE thing wrong so we are just going to pick any old thing and let it 'splain everythng? Gotcha!

It is more helpful to test cortisol often - one test really means little as cortisol changes a lot. Since you start early, they should give you saliva testing and let you test that way but only an intelligent doctor would do that...

Plenty of us have thyroid and adrenal and other issues - *eye roll*  so they should test you for a lot of things just to make sure all is well. I know - it takes a fight.

[chelytoad]

Thanks for the information...not sure what the stim agent was. Just remember them telling me that I didn't have to fast at all but then after the test a different doctor said I should have but since things were normal it didn't matter. ???

I have never been tested at other times of the day and was asked about my diurnal rhythm as I understand folks who work night shifts can end up cortisol levels opposite of normal. I do not work night shifts, in fact my mornings usually start at 4 or 5am and my tests were all between 8 and 9. After reading up on cortisol I asked about a saliva test that would look at cortisol throughout the day but was told they aren't "helpful".

As far as symptoms go I do have fatigue, chronic diahrrea, often low sodium but it has never reached critical lows, brain fog, joint pain, vomitting, and very low blood pressure that results in orthostatic hypotension. However, I also have gastroparesis and some thyroid issues so it has been decided that they are to blame for my symptoms. While that makes sense, my thyroid disease isn't fitting a neat clinical picture of either Graves OR Hashimotos so I am just curious and looking into all the options. Beginning to wonder about my pituitary. I don't know I am just so tired of feeling like crap all the time and it seems like more and more as patients we really have to be our biggest advocates as most doctors don't really care about finding the *real* cause of issues. As soon as something diagnosable pops up that can explain most things they pick it.

Thanks again!

[rumpled]

Your docs screwed up in that the stim test should have been fasting. Depending on the agent, it may have messed up the test. Was your stim agent glucagon?

You doubled so you  *passed*, and there are those that can test really low on a normal test, and still pass the stim test. It is not usual, but it does happen...

Have you tested for cortisol at other times of day - so maybe you have a loss of diurnal rhythm?  Are your symptoms consistent with addison's?