Aa
Please Help
I have another thread in the unknown diseases forum from a long time ago, but I though I would start another since it's not unknown anymore.
I have been feeling tired, with constant headaches above the eyes (it hurts when I look up too), dry mouth, dry eyes, dry skin, I
think hair loss started somewhere in that time too. It started six years ago, and the headaches and tiredeness have been getting
slowly but steadily worse. I also have a lot of trouble concentrating, and my memory.. well I am basically a fish. Finally, it
seems the problem is adrenal fatigue, but it seems no doctor ever heard about it in this country. Anyway, I don't want to rant, so
I'll just get on with it. Finally, an endo made some bloodwork and found something, put me in the hospital in a week for more
tests. After that, she said "well, we don't know why, but it seems you are making few cortisol. It doesn't caus your simptoms, but
we will give it a shot anyway." She then prescribed 5mg hydrocortisone, at wake up. Also, my pituitary MRI came clean.
After reading a lot, I upped the dosage to 20mg, progressively, and although I fell slightly better, it's not really that much. I
don't dare upping it more without more data, and it seems I can't find an up to date doctor in this country, so I have to resort to
the internet. I'll post all bloodwork with the date it was made. Almostg all of them were made between 8 and nine AM, except the
first, that I think was made at 12 o'clock.
Also, since it is portuguese, I'll try to translate it, but please ask if something feels worng.
Date: 02-03-2010 (Test to see if I had something, before they put me in the hospital)
FSH 2.3 (mUl/mL) < 15
LH 1.8 (mUl/mL) < 9.0
PROLACTINE 5.9 (ng/ml) < 18
TOTAL TEST. 2.0 (ng/ml) 2.7 - 11.0
ANDROSTENEDONE 1.5 (ng/ml) 0.6 - 3.7
TSH - 3rd GEN. 2.7 (uUl/mL) 0.4 - 4.0
FREE T3 4.1 (pg/mL) 1.8 - 4.2
FREE T4 1.1 (ng/dL) 0.8 - 1.9
ACTH 8.8 (pg/ml) 9 - 52
CORTISOL 2.1 (ug/dl) 5 - 25
IGF1 244 (ng/ml) 116 - 358
Next, the ones made during the week I spent at the hospital
Date: 06-04-2010
BIOCHEMISTRY (Blood)
Glucose 85 (mg/dL) 60 - 109
BUN 12.5 (mg/dL) 7.9 - 20.9
Creatinine(IDMS) 0.83 (mg/dL) 0.72 - 1.18
Urate 5.9 (mg/dL) 3.5 - 7.2
Total proteines 6.2 (g/dL) 6.6 - 8.3
Albumine 4.2 (g/dL) 3.5 - 5.2
Calcium 9.2 (mg/dL) 8.8 - 10.6
Sodium 138 (mmol/L) 136 - 156
Potassium 3.8 (mmol/L) 3.5 - 5.1
Chlorine 105 (mmol/L) 101 - 109
Osmolality 275 (mOSM/Kg) 260 - 302
ALT (GPT) 25 (U/l) < 45
Alkaline Phosph. 64 (U/l) 30 - 120
Gama GT 15 (U/l) < 55
Total Bilirubin 0.3 (mg/dL) 0.3 - 1.2
Tot. Cholesterol 169 (mg/dL) <= 190
Cholesterol HDL 33 (mg/dL) < 40
Atherogenic Ind. 5.1 <= 5.0
Cholesterol LDL 115 (mg/dL) < 115
Triglycerides 206 (mg/dL) < 200
HORMONOLOGY (??)
FSH 1.5 (mUl/mL) < 15
FSH 20 min LH/RH 3.4 (mUl/mL)
FSH 60 min LH/RH 3.6 (mUl/mL)
LH 1.9 (mUl/mL) <9.0
LH 20 min LH/RH 21 (mUl/mL)
LH 60 min LH/RH 18 (mUl/mL)
TOTAL TEST. 3.2 (ng/ml) 2.7 - 11.0
Paratormone 72 (pg/ml) 9 - 72
BIOCHEMISTRY (Urine)
Urine Summary (Type II Urine)
Color Yellow
Appearence Ligh
Glucose 0.0 (mg/dL) 0.0 - 30.0
Bilirubin 0.0 (mg/dL)
Acetone 0.0 (mg/dL)
Density 1.015 1.010 - 1.030
Hemoglobin 0.00 (mg/dL)
pH 5.5 5.0 - 8.0
Proteins 5.0 (mg/dL) 0.0 - 20.0
Urobilinogen 9.2 (mg/dL) 0.0 - 0.2
Nitrites NEG
Leucocytes NEG
Urinary Sediment (Flow Cytometry)
Cilinders (??) 0.2 (/µL) 0.0 - 1.2
Leucocytes 0.7 (/µL) 0.0 - 15.0
Peeling Cells(?) 0.2 (/µL) 0.0 - 4.0
Erythrocytes 1.3 (/µL) 1.0 - 24.0
Cristals 0.0 (/µL) 0.0 - 27.0
Path. Cilinders 0.2 (/µL) 0.0 - 0.2
Celular Biology
everything fine except this:
Platelets 137 (10^3/µL) 150 - 400
Date: 07-04-2010
HORMONOLOGY (??)
PROLACTINE 12 (ng/ml) < 18.0
TSH - 3rd GEN. 2.0 (uUl/mL) 0.4 - 4.0
TSH3 20min P.TRH 9.4 (uUl/mL)
TSH3 60min P.TRH 6.1 (uUl/mL)
FREE T3 3.9 (pg/mL) 1.8 - 4.2
FREE T4 1.1 (ng/dL) 0.8 - 1.9
HGH 0.1 (µg/L) < 1
IGF1 279 (ng/ml) 116 - 358
Date: 08-04-2010
ACTH 15min 25 (pg/ml)
ACTH 22 (pg/ml) 9 - 52
ACTH 15min CRH 28 (pg/ml)
ACTH 30min CRH 31 (pg/ml)
ACTH 45min CRH 26 (pg/ml)
ACTH 60min CRH 23 (pg/ml)
ACTH 90min CRH 16 (pg/ml)
ACTH 120min CRH 18 (pg/ml)
CORTISOL 15min 11 (ug/dl)
CORTISOL 12 (ug/dl) 5 - 25
CORTISL 15m CRH 8.9 (ug/dl)
CORTISL 30m CRH 15 (ug/dl)
CORTISL 45m CRH 14 (ug/dl)
CORTISL 60m CRH 11 (ug/dl)
CORTISL 90m CRH 6.6 (ug/dl)
CORTISL 120m CRH 6.8 (ug/dl)
(SKIPPING AUTO-IMMUNE STUFF, IT'S ALL NEGATIVE)
Protein Electroforese (??)
Total proteins 5.2 (g/dl)
A/G 2.85
Albumin (74.0%, 3.85 g/dl) 3.2 - 5.0
Alpha 1 (1.1% , 0.06 g/dl) 0.1 - 0.4
Alpha 2 (7.7% , 0.40 g/dl) 0.6 - 1.0
Beta (10.4%, 0.54 g/dl) 0.6 - 1.3
Gamma (6.8% , 0.35 g/dl) 0.7 - 1.5
(I put them here because they are all low, except for Albumin)
Date: 26-06-2010 - I was already on a 20mg hydrocortisone for about a week
HEMATOLOGY
Glycated Hemogl. 5.4 (%) 4.0 - 6.0
CLINIC CHEMISTRY
Blood Sugar 5.1 (mmol/L) 3.9 - 6.1
Total Calcium 2.10 (mmol/L) 2.12 - 2.52
Sodium 140 (mmol/L) 136 - 145
Potassium 3.9 (mmol/L) 3.5 - 5.1
Chlorines 103 (mmol/L) 98 - 110
Magnesium 1.04 (mmol/L) 0.74 - 0.99
Ferro Serico (Can't Translate, Ferro = Iron) 67 (µg/dL) 65 - 170
Iron Fixation Capacity (??) 292 (µg/dL) 250 -450
Ferritin 78 (µg/L) 26 - 388
Folic Acid 4.3 (ng/mL) 3.1 - 17.5
B12 Vitamin 583 (pg/mL) 254 - 1320
THYROID STUFF
TSH 2.12 (mUI/L) 0.36 - 3.74
ENDOCRINOLOGY
FSH 2.4 (mUI/mL) 0.7 - 11.1
LH 2.0 (mUI/mL) 0.8 - 7.6
PROLACTINE 6.2 (ng/mL) 2.5 - 17.0
17Beta Estradiol 40 (pg/mL) 0 - 52
TOTAL TEST. 4.64 (ng/mL) 2.45 - 16.00 (From 20 to 49 years old)
S.Dehidroepiandrosterone 153 (µg/dL) 80 - 560
ALDOSTERONE 4.5 (ng/dL) 1.0 - 16.0 (lying down)
Morning ACTH 9.78 (pg/mL) 0.0 - 46.0
Morning Cortisol 4.82 (µg/dL) 4.30 - 22.40
(Note, there was a history made in 09-10-2009 that reported 5.56 morning ACTH and 1.94 morning cortisol)
So, do I need aldosterone? Do i need testosterone? Should I increase my cortisol dosage? If it's primary, shouldn't the ACTH Stim
test be better? Thank you.
I have been feeling tired, with constant headaches above the eyes (it hurts when I look up too), dry mouth, dry eyes, dry skin, I
think hair loss started somewhere in that time too. It started six years ago, and the headaches and tiredeness have been getting
slowly but steadily worse. I also have a lot of trouble concentrating, and my memory.. well I am basically a fish. Finally, it
seems the problem is adrenal fatigue, but it seems no doctor ever heard about it in this country. Anyway, I don't want to rant, so
I'll just get on with it. Finally, an endo made some bloodwork and found something, put me in the hospital in a week for more
tests. After that, she said "well, we don't know why, but it seems you are making few cortisol. It doesn't caus your simptoms, but
we will give it a shot anyway." She then prescribed 5mg hydrocortisone, at wake up. Also, my pituitary MRI came clean.
After reading a lot, I upped the dosage to 20mg, progressively, and although I fell slightly better, it's not really that much. I
don't dare upping it more without more data, and it seems I can't find an up to date doctor in this country, so I have to resort to
the internet. I'll post all bloodwork with the date it was made. Almostg all of them were made between 8 and nine AM, except the
first, that I think was made at 12 o'clock.
Also, since it is portuguese, I'll try to translate it, but please ask if something feels worng.
Date: 02-03-2010 (Test to see if I had something, before they put me in the hospital)
FSH 2.3 (mUl/mL) < 15
LH 1.8 (mUl/mL) < 9.0
PROLACTINE 5.9 (ng/ml) < 18
TOTAL TEST. 2.0 (ng/ml) 2.7 - 11.0
ANDROSTENEDONE 1.5 (ng/ml) 0.6 - 3.7
TSH - 3rd GEN. 2.7 (uUl/mL) 0.4 - 4.0
FREE T3 4.1 (pg/mL) 1.8 - 4.2
FREE T4 1.1 (ng/dL) 0.8 - 1.9
ACTH 8.8 (pg/ml) 9 - 52
CORTISOL 2.1 (ug/dl) 5 - 25
IGF1 244 (ng/ml) 116 - 358
Next, the ones made during the week I spent at the hospital
Date: 06-04-2010
BIOCHEMISTRY (Blood)
Glucose 85 (mg/dL) 60 - 109
BUN 12.5 (mg/dL) 7.9 - 20.9
Creatinine(IDMS) 0.83 (mg/dL) 0.72 - 1.18
Urate 5.9 (mg/dL) 3.5 - 7.2
Total proteines 6.2 (g/dL) 6.6 - 8.3
Albumine 4.2 (g/dL) 3.5 - 5.2
Calcium 9.2 (mg/dL) 8.8 - 10.6
Sodium 138 (mmol/L) 136 - 156
Potassium 3.8 (mmol/L) 3.5 - 5.1
Chlorine 105 (mmol/L) 101 - 109
Osmolality 275 (mOSM/Kg) 260 - 302
ALT (GPT) 25 (U/l) < 45
Alkaline Phosph. 64 (U/l) 30 - 120
Gama GT 15 (U/l) < 55
Total Bilirubin 0.3 (mg/dL) 0.3 - 1.2
Tot. Cholesterol 169 (mg/dL) <= 190
Cholesterol HDL 33 (mg/dL) < 40
Atherogenic Ind. 5.1 <= 5.0
Cholesterol LDL 115 (mg/dL) < 115
Triglycerides 206 (mg/dL) < 200
HORMONOLOGY (??)
FSH 1.5 (mUl/mL) < 15
FSH 20 min LH/RH 3.4 (mUl/mL)
FSH 60 min LH/RH 3.6 (mUl/mL)
LH 1.9 (mUl/mL) <9.0
LH 20 min LH/RH 21 (mUl/mL)
LH 60 min LH/RH 18 (mUl/mL)
TOTAL TEST. 3.2 (ng/ml) 2.7 - 11.0
Paratormone 72 (pg/ml) 9 - 72
BIOCHEMISTRY (Urine)
Urine Summary (Type II Urine)
Color Yellow
Appearence Ligh
Glucose 0.0 (mg/dL) 0.0 - 30.0
Bilirubin 0.0 (mg/dL)
Acetone 0.0 (mg/dL)
Density 1.015 1.010 - 1.030
Hemoglobin 0.00 (mg/dL)
pH 5.5 5.0 - 8.0
Proteins 5.0 (mg/dL) 0.0 - 20.0
Urobilinogen 9.2 (mg/dL) 0.0 - 0.2
Nitrites NEG
Leucocytes NEG
Urinary Sediment (Flow Cytometry)
Cilinders (??) 0.2 (/µL) 0.0 - 1.2
Leucocytes 0.7 (/µL) 0.0 - 15.0
Peeling Cells(?) 0.2 (/µL) 0.0 - 4.0
Erythrocytes 1.3 (/µL) 1.0 - 24.0
Cristals 0.0 (/µL) 0.0 - 27.0
Path. Cilinders 0.2 (/µL) 0.0 - 0.2
Celular Biology
everything fine except this:
Platelets 137 (10^3/µL) 150 - 400
Date: 07-04-2010
HORMONOLOGY (??)
PROLACTINE 12 (ng/ml) < 18.0
TSH - 3rd GEN. 2.0 (uUl/mL) 0.4 - 4.0
TSH3 20min P.TRH 9.4 (uUl/mL)
TSH3 60min P.TRH 6.1 (uUl/mL)
FREE T3 3.9 (pg/mL) 1.8 - 4.2
FREE T4 1.1 (ng/dL) 0.8 - 1.9
HGH 0.1 (µg/L) < 1
IGF1 279 (ng/ml) 116 - 358
Date: 08-04-2010
ACTH 15min 25 (pg/ml)
ACTH 22 (pg/ml) 9 - 52
ACTH 15min CRH 28 (pg/ml)
ACTH 30min CRH 31 (pg/ml)
ACTH 45min CRH 26 (pg/ml)
ACTH 60min CRH 23 (pg/ml)
ACTH 90min CRH 16 (pg/ml)
ACTH 120min CRH 18 (pg/ml)
CORTISOL 15min 11 (ug/dl)
CORTISOL 12 (ug/dl) 5 - 25
CORTISL 15m CRH 8.9 (ug/dl)
CORTISL 30m CRH 15 (ug/dl)
CORTISL 45m CRH 14 (ug/dl)
CORTISL 60m CRH 11 (ug/dl)
CORTISL 90m CRH 6.6 (ug/dl)
CORTISL 120m CRH 6.8 (ug/dl)
(SKIPPING AUTO-IMMUNE STUFF, IT'S ALL NEGATIVE)
Protein Electroforese (??)
Total proteins 5.2 (g/dl)
A/G 2.85
Albumin (74.0%, 3.85 g/dl) 3.2 - 5.0
Alpha 1 (1.1% , 0.06 g/dl) 0.1 - 0.4
Alpha 2 (7.7% , 0.40 g/dl) 0.6 - 1.0
Beta (10.4%, 0.54 g/dl) 0.6 - 1.3
Gamma (6.8% , 0.35 g/dl) 0.7 - 1.5
(I put them here because they are all low, except for Albumin)
Date: 26-06-2010 - I was already on a 20mg hydrocortisone for about a week
HEMATOLOGY
Glycated Hemogl. 5.4 (%) 4.0 - 6.0
CLINIC CHEMISTRY
Blood Sugar 5.1 (mmol/L) 3.9 - 6.1
Total Calcium 2.10 (mmol/L) 2.12 - 2.52
Sodium 140 (mmol/L) 136 - 145
Potassium 3.9 (mmol/L) 3.5 - 5.1
Chlorines 103 (mmol/L) 98 - 110
Magnesium 1.04 (mmol/L) 0.74 - 0.99
Ferro Serico (Can't Translate, Ferro = Iron) 67 (µg/dL) 65 - 170
Iron Fixation Capacity (??) 292 (µg/dL) 250 -450
Ferritin 78 (µg/L) 26 - 388
Folic Acid 4.3 (ng/mL) 3.1 - 17.5
B12 Vitamin 583 (pg/mL) 254 - 1320
THYROID STUFF
TSH 2.12 (mUI/L) 0.36 - 3.74
ENDOCRINOLOGY
FSH 2.4 (mUI/mL) 0.7 - 11.1
LH 2.0 (mUI/mL) 0.8 - 7.6
PROLACTINE 6.2 (ng/mL) 2.5 - 17.0
17Beta Estradiol 40 (pg/mL) 0 - 52
TOTAL TEST. 4.64 (ng/mL) 2.45 - 16.00 (From 20 to 49 years old)
S.Dehidroepiandrosterone 153 (µg/dL) 80 - 560
ALDOSTERONE 4.5 (ng/dL) 1.0 - 16.0 (lying down)
Morning ACTH 9.78 (pg/mL) 0.0 - 46.0
Morning Cortisol 4.82 (µg/dL) 4.30 - 22.40
(Note, there was a history made in 09-10-2009 that reported 5.56 morning ACTH and 1.94 morning cortisol)
So, do I need aldosterone? Do i need testosterone? Should I increase my cortisol dosage? If it's primary, shouldn't the ACTH Stim
test be better? Thank you.
Wow - you typed a lot. A LOT...
Primary means your adrenals do not work - Secondary means your pituitary is at fault.
The stim test tells what is not working and you had the CRH test too... both can show location. I don't see a high ACTH on you so did they say you have secondary? No matter, it is all treated the same. I am not sure I am reading the tests correctly.
As for upping the cortef - ah... I think you need to read up on how a normal body works and also how to take cortef. Most people take it in two doses throughout the day, with the big dose in the morning, a small dose in early afternoon.
I just attended a conference and the *old* preferred dose was 20-30mg. Now they are saying 10-15mg (mind you, this is a conference, your dose should be managed by your doctor, NOT me) based on testing normal people and those that took replacement doses, they tested the hair of everyone and found that those that take replacement doses, in particular males, are over-replaced. However, when you take cortef, there is some loss. I have no adrenals and I take a total of 15mg.
As for the rest of the meds - florinef aka aldosterone is usually a good idea and your sodium is on the low side, but your renin was not tested. Do you crave salt? Testosterone is low - but it may convert to estrogen. They did not test DHEA sulfate. That may raise all the androgens. That is an adrenal hormone.
Primary means your adrenals do not work - Secondary means your pituitary is at fault.
The stim test tells what is not working and you had the CRH test too... both can show location. I don't see a high ACTH on you so did they say you have secondary? No matter, it is all treated the same. I am not sure I am reading the tests correctly.
As for upping the cortef - ah... I think you need to read up on how a normal body works and also how to take cortef. Most people take it in two doses throughout the day, with the big dose in the morning, a small dose in early afternoon.
I just attended a conference and the *old* preferred dose was 20-30mg. Now they are saying 10-15mg (mind you, this is a conference, your dose should be managed by your doctor, NOT me) based on testing normal people and those that took replacement doses, they tested the hair of everyone and found that those that take replacement doses, in particular males, are over-replaced. However, when you take cortef, there is some loss. I have no adrenals and I take a total of 15mg.
As for the rest of the meds - florinef aka aldosterone is usually a good idea and your sodium is on the low side, but your renin was not tested. Do you crave salt? Testosterone is low - but it may convert to estrogen. They did not test DHEA sulfate. That may raise all the androgens. That is an adrenal hormone.
thank you for your comment, as for dosage, for what I know it should be multi dosed, at least four times a day. Some people may need more. Right now I'm on 10 - 5 - 2.5 - 2.5, starting at 8am, second dose at 12 o'clock, third dose 4pm and the final one just before going to bed. for what i read, up to 30-40mg per day, it is still considered a low ‘physiologic’ supportive dose.
One of my questions is exactly that, is it ptimary or secondary? cortisol production is obviously bad, but ACTH wasn't stellar either. also, I forgot to mention that my submaxillary salivary glands are also shot, i made a scintillography back in 2008, and those ones were almost dead, didn't even respond to the stimulation. Is there any way this is related to the adrenals? Will my salivary glands come back after some treatment time? and should I do DHEA and renin?
sorry for writing a lot, and thank you
One of my questions is exactly that, is it ptimary or secondary? cortisol production is obviously bad, but ACTH wasn't stellar either. also, I forgot to mention that my submaxillary salivary glands are also shot, i made a scintillography back in 2008, and those ones were almost dead, didn't even respond to the stimulation. Is there any way this is related to the adrenals? Will my salivary glands come back after some treatment time? and should I do DHEA and renin?
sorry for writing a lot, and thank you
I don't know where you read that 30-40mg is a replacement dose and that it is low... or that 4 times a day is normal dosing! Yikes!
Over 20mg puts you in Cushing's syndrome territory and fully suppresses the adrenals you have. Taking anything later than say, 3-4pm, may interfere with sleep as the half-life of cortef is 6 or so hours. However, there are a few people I know that need a little boost of 2.5mg shortly before bed to sleep well - there are no hard and fast rules - you have to know your body.
A normal body reaches peak at around 8am and falls throughout the day, reaching near zero at midnight - that is how you sleep and wake up - your dosing schedule dose may not allow the body to sleep properly and thus repair bone, muscle etc. Hence more side effects. Most people do two doses, and take less UNLESS they have another disorder that requires the cortef. Often then they will be on prednisone.
I am not so skilled at reading your tests - but given that you did not stim on either, it appears pituitary to me. Maybe someone else will chime in.
I don't know if this is related to the salivary glands - it would seem not in my non-medical opinion.
Other medications are at the option of your doctor.
Over 20mg puts you in Cushing's syndrome territory and fully suppresses the adrenals you have. Taking anything later than say, 3-4pm, may interfere with sleep as the half-life of cortef is 6 or so hours. However, there are a few people I know that need a little boost of 2.5mg shortly before bed to sleep well - there are no hard and fast rules - you have to know your body.
A normal body reaches peak at around 8am and falls throughout the day, reaching near zero at midnight - that is how you sleep and wake up - your dosing schedule dose may not allow the body to sleep properly and thus repair bone, muscle etc. Hence more side effects. Most people do two doses, and take less UNLESS they have another disorder that requires the cortef. Often then they will be on prednisone.
I am not so skilled at reading your tests - but given that you did not stim on either, it appears pituitary to me. Maybe someone else will chime in.
I don't know if this is related to the salivary glands - it would seem not in my non-medical opinion.
Other medications are at the option of your doctor.
Have an Answer?
You are reading content posted in the Adrenal Insufficiency Community
We tapped the CDC for information on what you need to know about radiation exposure
Endocrinologist Mark Lupo, MD, answers 10 questions about thyroid disorders and how to treat them
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
