Please help - Could this be low cortisol or adrenal fatigue?

[marxxx]

Hello all,
I really need some help from the community here.

I managed to get pretty healthy in 2009 with lots of exercise and lifestyle changes. Maintained it for a few years until  2012 we had a really stressful year (literally for 12-14 months).  I will spare everyone the details, but I gained a ton of weight and suffered from constant fatigue. In 2013 I once I again tried to improve my health modifying the lifestyle further going vegan, exercise (whatever I could muster up) etc.

Late 2013 I got a series of blood tests that found I  am hypothyroid,  havelow vitamin A, B12, D, magnesium, iodine and also found out I have sleep apnea.
I started a series of supplements and corrected the vitamin D insufficiency and started thyroid treatment and sleep apnea treatment. I am slightly better overall, but don't feel good. I find most any activity is overwhelming. Just a few hours of cleaning one day will wear me out for the next couple days. I have lost some weight, but it has been really rough to lose and I gain it back very easily.

My Dr thinks I may have adrenal fatigue. I have started a supplement for this, but it doesn't seem to be helping much. I am giving it a few more weeks, but wanted some advice on further tests/treatment.

I have had a few related tests.  
1/2014
ACTH was 21 ref range 8-42

Separate test
ACTH stim test (3 point)
Cortisol base - 6.3 ug/dl    Ref range 3.4 - 26.9
Cortisol 30 minutes   21.6 ug /dl
Cortisol 60 minutes   24.9 ug/dl
Notes - peak value of at least 18 ug/dl is a normal response to cortrosyn stimulation.

The next test was 7/2014
Cortisol 6.2 ref range 2.5-20

Both test had a morning cortisol of 6.2 - 6.3
Does this indicate a problem? Possibly low cortisol?

[marxxx]

Wow, that sounds terrible. I am sorry it's been so difficult for you. My symptoms are not nearly that severe (thank God) though I have had symptoms off and on for nearly 10 years now. Each time I go to the dr they would treat the symptoms and not find the root cause.

Hopefully this time around we can get to the bottom of it.

Best of luck to you.

[Red_Star]

No problem. :)  

I had severe adrenal fatigue from severe vitamin B12 deficiency and it took 18 months to recover back to "normal" adrenal fatigue (untreated hypothyroidism no doubt causing issues).  

Adrenals worsened again due to Hashitoxicosis (in my case due to Graves antibodies showing up) and when I was hypothyroid again I had to start thyroxine immediately due to severe breathing issues.  I knew I'd have to ride out the symptoms of untreated adrenals but I didn't know how bad it would be! I was in bed for at least 15 hours a day and when conscious in bed I could barely move or speak (able to slur out a few words at best), dizziness, numbness/tingling. A very bad month!

[marxxx]

Thank you for your help!

[Red_Star]

The following is information on how to interpret ACTH stimulation results that i have put together from reading various websites.

*Healthy adrenal function:

Cortisol levels should double from a normal base cortisol range within 60 minutes.  

*Primary adrenal insufficiency:

Cortisol does not double from the low base cortisol range within 60 minutes.  ACTH will be at the top of the range or above range.

*Secondary adrenal insufficiency:

Low base cortisol range can double, triple, quadruple within 60 minutes.  ACTH will usually be in the bottom half of the range to the very bottom, but not usually below the range.

*Mild primary adrenal insufficiency (low adrenal reserve):

A normal baseline cortisol range with a subnormal response to ACTH stimulation.

*Mild secondary adrenal insufficiency:

A low or low normal baseline cortisol range with a normal response to ACTH stimulation.

NOTE: "The Addison's Clinical Advisory Panel state that if a person is unwell, the diagnosis of adrenal insufficiency cannot be excluded by a serum cortisol level [Wass et al, 2009]. CKS therefore recommends seeking specialist advice in this situation."