TO: drmark, RE: Midnight Cortisol Levels

[Jimlow]

Hi drmark, I'm a Hashimoto's patient but after having some worsening symptoms after starting thyroid med about 3-years ago, I found through research that adrenal cortical insufficiency can do this if not treated before starting thyroid med. I saw your earlier post about midnight saliva cortisol levels and have a question. I took saliva tests in March 2004, Oct., Dec., & March 2005. In a range of "0.03 to 0.50", mine on all four tests never got above "0.06". In fact it was borderline on one "0.03", clinically low on another "<0.03"(non-detectable) and "0.05" on another. I also had the 24-hour urine done and my reading was "10.7". The reference range (actually to test for Cushings), was <119 for males age18 and over (I'm 42).
I'm gettin results in the next day or two, on an adrenal antibodies test. If this test is negative, how in the world will I ever know what is causing my low cortical levels? What test do you believe would be next? ALSO: does Hashi's disease cause low-cortisol of itself? I suggested low-dose Cortef to add to my thyroid med. regimin but my latest Doc felt it was too risky. I don't have high BP, in fact my resting BP & heart rate is usually low (BP 110/64, heart rate 52 to 55), so I actally have resting-bradycardia.
I'm not putting you on the spot for diagnoses, I already know I have hypo-cortisolism, just wondering about testing/treatment possibilities.
Your response would be very appreciated!!!

[Mark Lupo, M.D.]

The normal ACTH stim test is very helpful to exclude significant adrenal insufficiency.  The baseline level of 10.7 is pretty normal.  There is some belief in adrenal fatigue syndrome (who knows, we may call this subclinical hypo-adrenalism in the future) but I have not been compelled to put patients on steroids for it as the side effects are much more problematic than starting synthroid for a borderline thyroid pt.

The midnight salivary cortisol is best used to detect Cushings and should not be used to determine hypo-adrenalism.  (ie, it's only helpful if it is elevated).

I will be curious about adrenal antibodies....

Hope that is helpful.....

[Jimlow]

I forgot to mention I had the ACTH Stim. Test, passed it with flying colors. Baseline cortisol was 10.7 but went up double after 30 mins, then tripled after 1-hour, almost as if my adrenals are just waiting to be stimulated. Possibly ACTH deficiency?