Adrenal Insufficiency

Hello,

I am a 27-year old female on long-term oral steroids due to severe and uncontrolled asthma. It is known that I have problems absorbing the steroids, however, at 20mg of prednisolone a day my chest condition can be reasonably controlled.

However, over the last couple of months I have been having increasing problems with nausea, vomiting and postural hypotension, especially when unwell or tired.

After exploring various GI conditions, the doctors finally did a short synacthen test, that gave the following results:
09:00   43 (nmol/L cortisol)
09:30   172
10:00   202

Please could you explain a little about what this means? I understand that it is the increase that is significant, but here the base level appears also to be quite low, especially given I had already taken my prednisolone dose for the day.

From these results, do you think the steroids have affected my adrenal glands, or does it look as though my adrenals are not functioning properly in any case? Do you think these results could explain my symptoms?

Many thanks.

[Kevin Pho, MD]

A level of 500 nmol/L before or after the ACTH stimulation test would be indicative of normal adrenal function.

One can consider a high-dose or low-dose ACTH stimluation and there is controversy as to which is the better test.  

An increase of 90 nmol/L is indicative of normal function - however in your case, the baseline readings are low at 43 nmol/L, suggesting possible adrenal insufficiency at baseline.  

I would consider an endocrine referral to further interpret the findings.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_b