Cortisol normal in am, low in pm

Recently I woke up early with some kind anxiety attack - crying for hours, blood pressure of 180 over 140.  I'm normally 110/70ish.  I had to go to the hospital to bring it back down.  They did some blood work which all came back normal except for high cholesterol.  A doctor in the family suggested that I have my adrenals checked.  

Reading up on adrenal fatigue I became very interested in having it tested, thinking I'd finally found the reason why I'd been feeling like crap for the last many years.  I had soo many of the symptoms (fatigue, memory and concentration problem, never feeling rested regardless of how many hours of sleep, waking up during the night, having trouble waking up in the morning, feeling the most awake of the whole day close to bed time, feeling unable to cope with stress any more, craving salt and sweet (especially chocolate), feeling cold, even menstrual period irregularities).  Despite the sudden spike in blood pressure which didn't seem to fit with basic symptoms, I went and had my cortisol checked.

9am cortisol:  7.9 (Range 3.7-19.4)
9pm cortisol: 2.3 (Range 2.9-17.3)

I also had a thyroid test where the TSH, T3 and T4 were within normal range.  

My cortisol was under the range in the pm test, so I went to see an endocrinologist yesterday.  After 3 hours in the waiting room, she spent exactly 2 minutes on me. Checked blood pressure, listened to my heart, checked my nipples, checked my tongue. Firmly said I should put adrenal issues completely out of my mind.  Said morning result was fine, and that evening cortisol could easily just be a lab error.  And that was that.  

My question is, is she right?  Should I completely put the possibility of adrenal fatigue out of my mind?

Thank you

[rumpled]

First let me state that I am not a proponent of adrenal fatigue. So all my answers are about adrenal insufficiency or how the adrenals work. All your body is built to work for a lifetime so I just cannot fathom that a lung would get tired, or our skin... diseased yes - tired, no.

The adrenals work on a circadian or diurnal rhythm. So you should be higher in the morning and lower at night. Lab ranges are set that way. Cortisol basically wakes you up in the morning and puts you to bed at night. It has to be low at night so the body can regenerate muscle and other tissue. Those that have high cortisol at night can develop terrible issues due to the loss of the rhythm and get damage to muscles and other connective tissues - even cataracts.

Your endo is also of correct of the lab error - it should be a reputable lab. I know my diagnosis was held up by lab error and it also should take multiple rounds of testing to rule a diagnosis IN or OUT- but if you don't have signs or symptoms and the key to a low adrenal issue is an issue with sodium or potassium as AI or Addison's is that they are salt wasting diseases - in other words you need sodium either when you are sick or all the time. Now you do crave salt - what were your sodium readings? If those were low then you need a different endo as you need testing for actual Addison's disease. Most people have low BP with low adrenal issues. High BP is for high cortisol issues - and the cortisol can be higher later at night.

Unfortunately, most the symptoms you have could be a vitamin issue, auto-immune, another hormone, and doctors today do not take the time (2 minutes is so true!!!) to go over anything and really find out what is wrong. They are not living in our bodies and quality of life seems to be nothing.

[mschool]

Thank you for your reply.  I have not had my sodium tested, but I can get that done.  What would that be called at a lab?  Do I just walk in and ask for a sodium level test?  My lab tests are paid out of pocket anyway, so I don't really have to get a Dr. to order them.

Like you said, none of the doctors I've seen in recent years have had the time or inclination to figure out what is wrong.  I'd just accepted that this was going to be the extent of my quality of life as you put it.   I think I now need to be my own doctor for a bit and try to figure out what might be wrong .... till I have something solid to take back to them.  

Thanks again for your reply.

[rumpled]

The test is sodium or electrolytes. Potassium would also be good to test (incl with electrolytes) - they move with each other. It would be best to go when you are craving salt since you have some flex in going. Weird that you can walk in like that though.

A PCP can order those tests - they are standard.

Cortisol testing without sodium testing is simply not complete. If you do research on medical sites on low cortisol you will find that low sodium is a large factor. Read up on a addison's crisis. It is a salt wasting disease so salt aka sodium has to be a factor at some point. There are others as well.