Help with cortisol test results

[chrystasrose]

Hi. I am thinking that I have Adrenal Insufficieny (or fatigue). I had a saliva test done at 8am, 12noon, 4pm, and 11pm.  I got my results but I don't know how to read them and the numbers for under the normal range has a pretty big space inbetween the numbers, so I don't feel like I can really get any information from them. Another problem I have is that my results said the normal ranges were like this (ex: 0.5) where as everywhere I see on the internet it says (ex: 5.0). I don't know which was in correct, the one with the decimal in front of behind the number. Also when I took the test my sleeping schedule was messed up but I couldn't fix it in time for the test. I was sleeping through the day and I just woke myself up for the 12 noon and the 4 pm test and then went back to sleep. I don't know if that makes a difference. Also my test resulst don't give me times, but I believe this is the proper order. My issue is that I don't want ranges or  to have my doctor giving my ranges for what is Addisons, Cushings or what is considered 'normal'. I want to know if the results I have mean that my adrenal glands are not working up to par, or are fatigued and sending out insufficient hormones. I would really appreciate help. Are my levels low? Do they show low adrenal function?

Here are my results.

8:00 am - 0.08 mcg/dL

12:00 noon - 0.07 mcg/dL

4:00 pm - 0.23 mcg/dL

11:00 pm - 0.10 mcg/dL

Then there is also something that says 24.1 ug/dL*PAZ

I really appreciat the help! I really want to finally figure out what is wrong my body. Why I am so tired and weak. By the way, I am an 18 year old female.

[rumpled]

The urine test is normal. However, one urine test is not diagnostic for most doctors - aka good doctors.

The dex test shows suppression. For an expert, it can show either normal or that if you showed issues, it would be pituitary location. It is rather odd that you took 1.0 dex - most take the low dose dex test which is .5 to start.

The lab reference does apply for this test since you took the dex. You are testing for Cushing's?

[madhu1702]

My lab says reference range is 4.40-22.40, while my cortisol test says 0.63...my test was done 8AM in the morning after taking 2 tablets of 0.5 mg dexamethasone  previous night at 11PM...Could you tell me if my test result is normal or abnormal?

[fciscoga]

   Could someone tell me what this test means?                      



In Range   Out of range   reference range

cortisol,free
24-hour urine lc/ms/ms
total volume                  1750             ml
cortisol,free,urine            22.1             mcg/24  h

                                          reference  range:
                                          4.0-50.0
Analysis performed by Tanden Mass Spectrometry
CREATININE,URINE                1.27        g/24     h

                                           reference range;
                                            0.63-2.50

[rumpled]

Your ACTH would have to be super high - like really high - to be ectopic. It would have to be like mine, and mine is currently 3000 (6-48). Ectopic is pretty easy to spot that way. I am post-op adrenal, and my ACTH is raised since I do not have the feedback loop and my tumor that grew back is happy and pumping out ACTH like crazy... it should be around 300-600 but alas, I have a tan.

ACTH can be deceptive. Mine was always normal and while a normal ACTH and higher cortisol can point to adrenal, and higher ACTH and higher ACTH points to pituitary source, mine was pituitary. It takes an expert to sort it all out. Also, you can have higher ACTH with low cortisol (me!)- so you have to really know what you are dealing with.

[chrystasrose]

No, those other things weren't tested. And yes, I am going to find another Endo.

I've researched and high cortisol and high ACTH suggests a pituitary or ectopic tumor related to Cushing's. Does that sound right too you?

[rumpled]

Yes. That is high. You need to have other tests as well though.

I suggest you find yourself a really good endo - a neuro endo. Were any other pituitary hormones tested - IGF-1, FSH, LH, etc.?

[chrystasrose]

Also, I just looked at a paper that I had missed before. I was tested for ACTH plasma. The normal range is 5-27 pg/ml. My score is 57. So obviously that is quite high.

[rumpled]

Addison's and Cushing's are opposite ends of the same spectrum. I have lived and do live both. I had Cyclical pituitary Cushing's and now have no adrenals so I know how it feels.

Cortisol has to come and go in the body at the right time - if it does not, the body does not function correctly. Cortisol is cortisol - the testing is the same. I do the same testing now with no adrenals as I did with them.

Fatigue is a symptom of both high a low. But I have to say, you are pretty low, but you were high at the wrong time and that is a bad thing.

One set of tests does not a diagnosis make - you need more. I was so wild in testing that it took a long time to figure me out. You really have to find a good doctor. And no matter what, the ranges you need are on the slip you have with your tests.

[chrystasrose]

I just don't know if my lab only finds a problem if you have Addison's or Cushing's and not if there is problem inbetween there. I've read a book on Adrenal Fatigue and there was a whole chapter on how most labs only test for the worst and will tell you that you are normal if you don't have Addison's or Cushing's. So, just because I am in my labs 'normal' range, doesn't mean that I have normal levels because I don't know if they are looking for only Addison's or Cushing's. I just don't want my doctor and everyone else to say that I am normal because I am in the 'normal' range, if normal doesn't nessecarily mean a healthy level for me. I hope that makes sense, I can't word it all that well.

Anyway my symptoms are: fatigue, un-refreshing sleep, night sweats, heat intolerance, tendency to startle easily, breast soreness during cycle, reddish skin  tone, gain weight easily, brittle nails, cold hands and feet, light sleeper and weakness.

My main problem is fatigue. I am so tired all the time. And I sleep so much. I usually am only awake for about twelve hours and then I go to sleep for ten to twelve hours. Sometimes I can be awake for only a couple of hours and then go back to sleep and sleep for another tweleve hours. One time I was awake for eight hours and then went to sleep and woke up seventeen hours later. Another time, with the exception for a couple hours here and there in between I slept about twenty five hours.

I always sometimes get really weak. I feel like I can't hold myself up. Sometimes even if I am laying down, I have to lay so I am not supporting myself at all because I don't have the strength.

Two years ago I was diagnosed with PolyCystic Ovarian Syndrome and Hashimoto's Thyroiditis and I am under treatment for both.

[chrystasrose]

Yes, the results are in the correct order.

[chrystasrose]

Hi. Like I mentioned, I am not 100% sure that the results are in their right order. The pages don't have numbers and they don't give times, which is stupid. I need to call the doctor and confirm the order of results. But even so, are you saying there is a problem because of the order of the numbers? If the results were in a different order would that mean that I am ok? Or are the numbers out of balance no matter what order?

Also this is what my lab says normal ranges are:

8:00 AM: 0.04 - 0.56
A range is not listed for 12 noon.
4:00 PM: < or 0.15
11:00 PM: < or 0.09

For the other result the normal range is 1.1 - 27.2   Which is a very large space.

[peggy64]

please include the reference range. that is needed to interpret the test.

[rumpled]

Every lab has different ranges, so looking at the internet is not useful in this case. Only the range on your lab slip is what is useful.

However, just looking at what you have, I can see that you lack a normal diurnal rhythm and that is not normal. A normal cortisol is highest at 8am and then falls throughout the day and you can see that your results are highest in the afternoon - that is abnormal.

I don't know what your symptoms are, but if that one in the afternoon is out of range, then that can put you in the cyclical cushing's arena, otherwise, you appear to be in the adrenals are not working arena. If so, then you would need tests to find out if the problem is pituitary or adrenal. That can be accomplished by ACTH and ACTH stim tests.