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6573002 tn?1383657837

Cortisol Injection Test

Hello everyone!

I previously had my cortisol serum levels checked and they were fine 25 at 7 AM and then 10 at 7PM.

In August I started having dizzy spells and the doctors had me wear a CGM iPro for a few days and while it did show some glucose levels in the 70s and one at 62 (while sleeping) , my PCP seems convinced that my orthostatic hypotension is endocrine related.

However, my TSH and Total T3 were both normal and although they did no baseline bloodtest, they have me a cortisol injection and 60 minutes later the cortisol level said 42. It wasn't flagged so I'm guessing that's normal.

So I'm not diabetic, A1C was 5, passed glucose tolerance test...the only thing I can think this is is stress induced hypoglycemia although the endo said its prob a blood pressure issue more so than a sugar one.

She said "See you in 1-2 months". I've been sick and out of work for over a month and I want to fix this. My prescriber raised my anxiety meds and it seems to have helped and I am doing my best to stay calm.

I haven't fainted, I just feel like I'm going to when sitting for more than 1 hr or standing for more than 5 min. She put me on sodium chloride pills 2/Day and told me to see the autonomic specialist who dxed with me dysautonomia in 2007. But does dysautonomia come on and then disappear and then reappear years later...I doubt it.

I keep thinking its my cortisol levels going totally out of wack because of my increased stress at work and now I can't work at all. My heart rate and blood pressure are not okay for me to be at work...

Any suggestions? Because I don't want to keep taking these salt pills again when my HDL is 34.

Thanks! (btw, I'm female & 27)
39 Responses
Avatar universal
COMMUNITY LEADER
POTS is autonomic not neurological... and it can be the low cortisol or the renin/aldosterone hormones.

If you have the diagnosis of low glucocoritocosteroids (sp!) - that is low cortisol. That is AI. It has many names.

(My cat is laying across my arms as I type this so I am having a difficult time).

You can still pass a stim test and still be borderline - it can be the last gasp. With sodium and potassium abnormalities, it is supicious to have issues. It can still be just a renin and aldosterone issue alone or in combo with the cortisol but you need an expert not just a pcp. This is beyond what a pcp can order or interpret.

I did a set of dna testing myself - you can get quite a lot of testing for $99 that covers many diseases and they add all the time. It does have the hypothyroid and some others, not sure about the MTHFR (my mind wandered in a bad place with that one I tell you) though...

D can really be nasty when it is low. Get a good supplement and take a few thousand i.u a day. I think Enzy or another person has some posts on it and there is even a forum devoted to it now.
Avatar universal
COMMUNITY LEADER
Did they test your renin or aldosterone?
6573002 tn?1383657837
Hello! I don't think so unless they haven't shown up online.

My DHEA-S came in high at 417 which might explain my excessive hair but not sure if it can explain anything else.
Avatar universal
COMMUNITY LEADER
Without ranges it is hard to tell but if your cortisol levels were normal, you had a normal rhythm in that you had a higher morning and a lower night.

We do have a tracker here for POTS which may be helpful - if you have a smart phone it can be used on it. You can set if so you can be the only one to see it.

Are your sodium and potassium levels normal? It could be a renin and aldosterone issue, not a cortisol issue?

DHEA-s falls in with the male/female hormones, so are there other abnormalities with testosterone, estrogen, LH or FSH?
6573002 tn?1383657837
Hi there, LH and FSH were normal.

I wish I had a baseline cortisol level to go off of. I feel anxious upon awakening and honestly all day despite a high level of anxiety meds. It doesnt make any sense. I feel like instead of low, I feel like maybe its high.

If the cortisol doubled at 60 min that means my cortisol was 21 at noon time. Is that normal?
6573002 tn?1383657837
Also, my potassium seems to be on the lower side, sodium always looks normal when drawn but the dizziness feels 100000% better when I take sodium chloride now but the twitching/spasms, decreased appetite, spasms/cramps are not going anywhere or my anxiety...
Avatar universal
COMMUNITY LEADER
Did they do the stim test at noon? That, sadly, was bad - it should have been at 8am fasting...

I asked about the Na and K as they work in tandem and with a normal-ish cortisol stim test and POTS type issues, it could be an issue more along the lines with renin and/or aldosterone - aka you may need florinef?
6573002 tn?1383657837
They did the stim test at 12:30 yes with no baseline draw beforehand. They 25 & 7 levels were from 2010 (AM/PM cortisol)

New results showed up in my records online-

Free Testosterone - High 6.2 (Total T was normal at 23)
Aldosterone - High 39 (at noon time as well)

Would the Dr be looking for much more significant abnormalities?

6573002 tn?1383657837
Mind you..these were all taken AFTER the stim test..couldnt that throw all of these results off?
6573002 tn?1383657837
Actually it says:

ALDOSTERONE, LC/MS/MS 10/22/2013 12:34 PM 39 H
6573002 tn?1383657837
I am going to post past test results because after reading about thryoid and adrenals working together I thought maybe if I posted this it might help. My near fainting was in 2007 and 2013.

They did a tilt table test in 2007 which only showed "Postural tachycardia" but nonetheless the doctor said "POTS", put me on Thermotabs - symptoms disappeared - but back then I was falling after standing. That's not happening now - now I've got the muscle spasms, weird visual stuff- blurry for a second like my eyes are refocusing, HIGH anxiety which was very sudden, sweaty palms (sudden), heat intolerance (normal), low BP, Low blood sugar... somehow..the answer must be more than POTS...

TSH:

10/22/2013     1.230
04/11/2013     0.678
01/22/2013     1.00
05/22/2012     1.300
07/29/2011     1.290
03/11/2010     1.030
11/02/2009     0.778

Total T3:

10/22/2013     133
07/29/2011    155.1
03/31/2010    175.1
12/07/2009    159.0

Free T4

07/29/11     1.14
03/31/10     1.38
11/02/09     1.35
10/25/07     1.20

VITAMIN D 25-HYDROXY TOTAL (Normal >30)

10/22/13  25 L
12/11/12  20 L
05/22/12  26 L
03/31/10  31
12/07/09  22 L

Ferritin - 70s - nprmal
Prolactin  - 8.4 (Normal 6-23) 01/22/13 3:27P
SHBG  28 (Normal 26-110) -  01/22/13 3:27P
CRP 3.7



IGG SUBCLASSES 1,2,3,4 (BLOOD)
06/17/09 11:20A  
QUEST DIAGNOSTICS INC. CAMBRIDGE, MA
Test                          Result              Reference Range/Units
----                          ------              ---------------------
IGG 1                         431                 382-929 MG/DL
IGG 2                         400                 241-700 MG/DL
IGG 3                         80                  22-178 MG/DL
IGG 4                         112  H              4-86 MG/DL
IGG                           951                 694-1618 MG/DL



Avatar universal
COMMUNITY LEADER
The DHEA-s and testosterone being elevated to me, means they should investigate more along those lines - dhea-s converts to testosterone or estrogen.

Have they put you on D3?

So with the high aldosterone and the POTS - you should get a better endo, and think about getting on fludrocortisone - florinef - so that you hold sodium and your dizziness may be resolved to some extent. The fludro can also help with the low BP that is also related to aldosterone.

Have you looked up hyper-aldosteronism?

BTW I take salt tabs but not thermo-tabs as those are buffered with potassium but are not so high in sodium with each tablet. I take 1 gram tablets so I get a higher boost of sodium and carry them with me so that when I feel wonky, I can take one. Summer is especially hard and I take more. I take 2 daily as it is, and more as needed! You may want to consider upping your salt intake (salt food, salty food) and carrying the thermotabs to take as needed when you feel off and see if it helps.
6573002 tn?1383657837
Hi again!

The endo actually put me on 1GM of sodium chloride 2x daily now and for the most part the dizziness is gone..until it wears off after I take the first tablet at around 7/8AM and then between 2-4 I start to feel weird again and have to take the anxiety and the other salt. Within min, I start feeling better. (The sodium is so gross tasting BTW) I have been home sick since August and not too active because of the previous blood pressure/sugar drops.

The sodium does something amazing however. Whatever its doing, its working. I was told I did have POTS in 2007 and then twice that I don't. Both tilt table tests showed postural tachycardia and orthostatic hypotension that did recover after a period so I am not certain that I had or have POTS and the test said the result was "borderline" and not indicative of a neurological issue. So my PCP said - then it is probably adrenal.

In my medical records it says: GLUCOCORTICOID DEFICIENCY

This may be because I tested mildly postivie for the 21 Hydroxylase test. My endo is a diabetes doctor and waved her hand and said it was a 3 and normal is less <1 and its a vague test and not helpful.

I wonder why they are not rechecking morning/evening serum cortisol levels. All they have to go on is from 2010 and the AM and PM werent even done on the same day! Ack. One was at 7AM and the other in the afternoon. The Cortisol Stimulation, since there was no baseline was obviously not helpful but I would still think a 42 would rule out Addisons as the issue.

The DHEA-S and Tes might explain all the extra hair I have. The doctor looked a little alarmed at even my hair on my legs and thighs and Ive developed a few random ones in btwn breasts, on face (cheek) and some are dark and THICK and I have to keep plucking them.

So at least for now, I can avoid the sudden feeling like Im a deer in headlights. Its like my eyes are trying to readjust to the light and I get a weird tingling in my head which prompts me to take deep breaths. But it'll happen for absolutely no reason. I'll just be sitting there..and suddenly I'm in panic mode ... take the salt - panic goes away...Weird huh?
6573002 tn?1383657837
As for the D3 - I seem to have less spasms when I DONT take the D3 than when I do. I also sleep with my legs elevated. This does wonders for my heart rate and seems to calm me down and I'm talking about two couch pillows and a bed pillow so that they are significantly elevated. I get pooling in my feet (theyll turn purplish bluish red if I set them on the floor so I always sit on them or elevate them) When they had me on 50,000 IU of Vit D2 1 / week for 12 weeks I felt irritable and then when they checked it afterwards it was at 20 so I don't think it was doing anything.

My aunt has a bad case of POTS. She also has the MTHFR mutation and a Vitamin D mutation and adrenal issues and hypothyroid. My mom has hypothyroid and reactive hypoglycemia. We're all a mess. My PCP won't test me for the MTHFR since my mother hasnt tested for it and has no interest in doing so. She can be quite stubborn.

6573002 tn?1383657837
So I told my PCP about the error about not doing a baseline test for the tests that were run since ALL of them were done after a cortisol injection and so far it looks like my free testosterone was prob off because of the injection (unless that is supposed to happen). Ironically it just so happens that these tests were taken at almost to the minute of the time they were tested on 10/22 so even though its not in the AM it might be close enough to give them a good idea of what happened after the cortisol shot.

Total Testosterone - 34 (range -6-82)
Albumin - 5.0 (range 3.5-5.5) Compared to 6.2 after injection on 10/22
SEXBH - 31 (no range provided)

Glucose - 87
6573002 tn?1383657837
I found a range for the SEXBH/SHBG

Blood values[edit]

Reference ranges for blood tests for SHBG have been estimated to be:[9]

Patient type Range
Adult female, premenopausal 40 - 120 nmol/L
6573002 tn?1383657837
Okay without stimulation but at noon just like the previous tests..looks like my adrenals are ok... *sighs* I am very sad. I thought I had found the answer. ACTH and Aldosterone havent come in but...I have a sinking feeling my PCP might be wrong about the adrenals. I wish the endo had thought to test the other things BEFORE giving the ATCH shot...*sighs*

@FREE TESTOSTERONE PROFILE

ALB        5.0           (3.5-5.2)
TESTT     34           (6-82)
TESTFREE    6      (1-11)      ***Compared to 6.2 with stim**
SEXBH    31          (no range)

CORTISOL   5.9   (@Noon-1231)  **Compared to 42 1hr after stim)**

DHEA SULFATE 292 (45-320)  **Compared to 417 1hr after stim**
Avatar universal
COMMUNITY LEADER
Cortisol done at noon should be lowering - but I don't test at noon - it is not a diagnostic time unless you are testing all around the clock to see if you have a loss of diurnal rhythm (low in morning, high at night) or whatever - a random afternoon test unless super duper high or low is not so useful...

I don't know if DHEA is effected by the stim test. Not the same hormonal loop... maybe? Never got it tested the same day. None of my docs do testing after a stim test.

Have you tried taking D3?
6573002 tn?1383657837
Hello there, well my Aldosterone came back at 2.

I know it was 39 1hr after stimulation which is how my cortisol seems to respond by multplying many times (5 to 42 for cortisol and 2 to 39 for Aldosterone) Because the test was at noon I am unsure if its abnormal or not but I would think if the aldosterone is supposed to go down all day it shouldnt be at a 2 at noon... I wasnt able to salt fast for it because I would probably have fainted if I had..

Who knows I guess..
6573002 tn?1383657837
Morning Cortisol today @ 720AM - 27.5
Avatar universal
COMMUNITY LEADER
I sounds to me, a layman, more like hypo-aldosterone (I think I mis-typed before hyper LOL... ). Aldosterone does not have a rhythm like cortisol - so there is no preferred time of day for that one.

Your doc should look more into the renin/aldosterone loop?
6573002 tn?1383657837
I agree, my PCP called and said my AM Cortisol was high and said he wants the endo to take this from here. No mention of aldosterone - perhaps because I couldnt salt fast for it and it was done at the wrong time.

ACTH-HIGHLY SENSITIVE, PLASMA  (range 6-50)

11/04/13 1231 1104:S00063R 16  (1)
   1. Reference range applies only to specimens
      collected between 7-10am.
      Test Performed by Quest, Chantilly,
      Quest Diagnostics Nichols Institute,
      14225 Newbrook Drive, Chantilly, VA 20151
      Kenneth Sisco, M.D., Ph.D., Director of Laboratories
      (703) 802-6900, CLIA 49D0221801

ALDOSTERONE,SERUM

11/04/13 1231 1104:S00064R 2  (1)
   1. *** Unable to flag abnormal result(s), please refer
          to reference range(s) below:
      Adult Reference Ranges for Aldosterone, LC/MS/MS:
          Upright  8:00 - 10:00 am    < or = 28 ng/dL
          Upright  4:00 -  6:00 pm    < or = 21 ng/dL
          Supine   8:00 - 10:00 am       3 - 16 ng/dL
      Test Performed by Quest, Chantilly,
      Quest Diagnostics Nichols Institute,
      14225 Newbrook Drive, Chantilly, VA 20151
      Kenneth Sisco, M.D., Ph.D., Director of Laboratories
      (703) 802-6900, CLIA 49D0221801
6573002 tn?1383657837
Although it seems that it might be hyper somehow and my sodium tabs lowered it? Because it discusses using a low sodium diet for treatment of hypo and yet the salt tabs are what brought me back to life...
Avatar universal
COMMUNITY LEADER
You typed more than you needed - is the ACTH 16, and Aldo 2?

You would be supine for aldo - no one stands for them unless you have a crazy doc who wants a super accurate test (have had one!!!). So that one is low.

You don't have to type the rest of the stuff...
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