Gland issue? Tests?

[compnet]

Hello Doctor Mark Lupo,

Some history:

My TSH, Free T3, and Free T4 are all in-range.  The TSH went slightly high, out-of-range; retested in-range.  Some family history of thyroid cond. and my symptoms.

As for my adrenals, I've had the serum cortisol, ACTH, sodium, and potassium tests.

My symptoms seem hypoadrenal and possibly hypothyroid.

Mainly:  1) mental fatigue (with poor attention, memory, concentration, retention, etc.) with ADHD and other learning disabilities. 2) Physical fatigue (times of low blood pressure, feeling "lazy," poor motivation, easily winded-feeling, unrefreshed, need to sleep long hours, unalert until late morning/afternoon, naps, brief sleep interuptions, post nasal drip, etc.) 3) Easily stressed, affecting mental/emotional/physical, twice even leading to brief agitation and atypical psychosis.  I take things too seriously/defensive.  Sometimes anxiety.

I had a cortisol serum test of 10.6 ug/dl, morning.  **Emedicine said this is indeterminate or suggestive of adrenal insufficiency.  In my teens, my cortisol was said to be low.  A hair mineral analysis showed the most advanced stage of adrenal exhaustion.

My ACTH was on the high-normal end of the range.

Vyvanse for ADHD helps me some with energy.
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What tests would best prove even mild underfunctioning adrenal glands?

I've been wondering about these tests, in addition to the others:

ACTH Stimulation Test
Catecholamines Test
insulin-induced hypoglycemia test
24 hour cortisol -- urine, or blood, or saliva

As for the BLOOD SERUM version of the 24 hour cortisol, is this test widely available?

How do the blood, saliva, and urine for 24 hour cortisol compare in effectiveness?  Do they test the exact same substances?

What symptom('s) could my doctor use to order such adrenal tests?  And what might I point out to my doctor to convince him to do some of those tests?

Thank you tremendously.

[compnet]

Doctor Lupo,

I've come across many kinds of this test.

Short, rapid; high-dose, low-dose; long, prolonged; four-hour, eight-hour, two-day.

Which do I need, especially if my case is mild?

Thank you.

[Mark Lupo, M.D.]

Would see a general endocrinologist to guide you through this.
Usually an ACTH stim test would be the best way to exclude adrenal insufficiency.