cortisol levels

[dawnmarie420]

My doctor had my cortisol levels tested she thought that it might be low and I might have a adreneal problem but the test results came back higher then the normal range, she didnt seem concerned and didnt really say anythng about it. Can anyone tell me what this might mean. Does the cortisol levels have to do with anxiety. What do these levels mean. Mine came back at 25.7 and the normal range listed is 4.0 - 22.0 for the am. Does high cortisol levels cause symptoms of any kind?

[Carmen_Sandiego]

There is no obvious concern here as it pertains to Hypercortisolism. That was the OP's main concern. The level is grossly normal. If this matter is still of concern, obtain a 24-hr urinary Cortisol collection. One must look at the entire 24-hr period, rather than just a fraction of it.

It is also important to realize that this was an AM serum level that was drawn. Cortisol secretion follows a diurnal rhythm, and will *always* be elevated in the AM. If a PM level was obtained to complement the AM level, it would likely reveal a normal result. The best initial diagnostic test is to measure all Cortisol excreted over a span of 24 hours. This is of far greater diagnostic value than a random blood serum measurement. Additionally, I would note that a urinary collection is less invasive - the veinipuncture from a blood collection induces enough pain to transiently increase the level.

Elevated Cortisol in and of itself does not damage the thyroid gland. An underactive thyroid, however, can trigger the release of ACTH as a compensatory response, and this can raise Cortisol. Given the elevated thyroid-peroxidase antibodies, this suggests Hashimoto's Thyroiditis or a similar autoimmune condition that would induce a state of Hypothyroidism. If this proves to be the case, replacement therapy consisting of L-Thyroxine is the standard treatment. Repeated measurements of T4 and TSH are used to confirm the diagnosis.

[Paxiled]

I would just caution against the synthroid to deal with the adrenals.  Long-term usage of synthroid will cause the thyroid to die off.  If you need to protect a healthy thyroid, better to turn to seaweed for iodine supplementation, but better still to deal with the adrenal problem if you in fact have one, which so far you don't.  As i said, there are herbs that can balance your adrenals, including ashwagandha, eleuthero, and holy basil, to name three.

[mammo]

I would address the high level with your Endo because if it stays high it can damage the thyroid gland.  They normally will start you on a low dose of Synthroid to help with this.  If she brushes it off, find another Endo.  Good luck to you and take care!

[Carmen_Sandiego]

Your Cortisol level is a normal variant. Cortisol levels follow a diurnal rhythm and fluctuate wildly throughout the course of a day. Levels are generally highest upon awakening (5-30 micrograms), and diminish during nightfall (2-15 micrograms). A solitary elevated Cortisol level is a non-specific and non-diagnostic finding, unless the level is grossly elevated. Trivial elevations were once widely used diagnostically to suggest an emotional overlay (particularly depression), however, elevated Cortisol levels are no longer employed to diagnose depression given the wide range of fluctuation and complete lack of specificity.

High AM Cortisol levels (50+) would suggest Cushing's Syndrome. The chief symptoms are fatigue/lethargy, severe weight gain, elevated glucose/glucose intolerance, excessive hair growth, high blood pressure, formation of stretch marks and psychological disturbances (depression/psychosis). The symptoms would be similar to the side effects of a synthetic corticosteroid, such as Prednisone.

Consider a comprehensive endocrine work-up if the initial impression was adrenal dysfunction, as other endocrine causes may present with similar symptomatology. Aldosterone, ACTH, Fractioned Catecholamines, Metanephrines, Prolactin, PTH, TSH/Free T3-T4, Vasopressin, 5-HIAA and Histamine. Those individual tests will exclude Hyperaldosteronism, Conn Syndrome, Cushing's Syndrome, Pheochromocytoma, Hyper or Hypoparathyroidism, Hyper or Hypothyroidism, Diabetes Insipidus,  Syndrome of Inappropriate Antidiuretic Hormone Secretion and Carcinoid Syndrome respectively.

[Paxiled]

For people who get anxiety attacks, cortisol rises when you have the attack, not all the time.  There are herbs for helping control cortisol, and in essence anything that relaxes you will reduce temporary highs of it.  Relaxation techniques also help lower cortisol highs.  But that doesn't mean you have a permanent cortisol problem, everyone releases extra cortisol in situations requiring more adrenaline, but with anxiety sufferers, we do it when we don't need it.  But that still isn't the same as a permanent problem with the adrenals.

[dawnmarie420]

Thank you, the endocrinologist is the one that ordered the test. My thyroid levels are normal except for the antibodies which were at 140 and a normal range is below 35.  I have constant fatigue also. Should I get tested again to see if I have consistent high levels?

[mammo]

Levels are higher in the morning and as a result of stress.  High levels are not healthy for us in the long run.  But you should see an Endocrinologist because when your cortison levels are high there is usally a thyroid or adrenal gland problem.  They are benign and easily treatable.  If your number stays up it will cause fatigue, abdominal fat, weight gain, insulin resistance, and the list goes on.  So it's important to determine if your cortisol is staying up and why.  High cotisol levels also lead to Cushing's Syndrome.  If your dealing strictly with your GP on this, see and Endo, this is their specialty.  Take care.