Posted by tealady on October 19, 2003, at 6:03:14
In reply to Re: cortisol, testosterone » tealady, posted by Larry Hoover on October 17, 2003, at 15:21:12
> >
> > Well the AM test can tell a bit. The urine test is usually only useful for cushings
> > If you were diagnosed with chronic fatigue, did they do a morning cortisol?
>
> Yes. I was "within normal range".So informative! The "rule of thumb" (hehe) which seemed to work for most was if over 15 (morning basal cortisol) (US) ..multiply by 28 (27.59) for our units...meant you were OK to start thyroid meds probably.
http://www.unc.edu/~rowlett/units/scales/clinical_data.html
http://www.sydpath.stvincents.com.au/other/Conversions/ConversionMasterF3Mid.htm
Personally I felt it should be 17 to be sure, 15 was OK and under 12 was iffy..usually indicating need of adrenal support before and while start thyroid meds.
My non medically educated Opinion ONly formed from is a couple of years observations.I've just gone looking and found this study (seeing as you like studies) (I think the "normal " ranges in the US are roughly 6-22 or 6-25 from memory
Evaluation of the integrity of the hypothalamic-pituitary-adrenal axis by insulin hypoglycemia test.
Erturk E, Jaffe CA, Barkan AL.
Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109, USA.
We retrospectively reviewed dynamic ACTH and cortisol responses to insulin hypoglycemia in 193 subjects with suspected ACTH deficiency to ascertain the predictive values of various diagnostic criteria. Based on the achievement of a peak cortisol level of 18 micrograms/dL or above, 133 subjects were classified as having an intact hypothalamic-pituitary-adrenal (HPA) axis, and 60 subjects were determined to have ACTH deficiency. Baseline and peak cortisol concentrations were strongly correlated (r = 0.63; P < 0.0001). Peak cortisol increased in parallel to ACTH increments, but plateaued at approximately 22 micrograms/dL at peak ACTH levels above approximately 75 pg/mL (r = 0.61; P < 0.0001). BASAL CORTISOL VALUES ABOVE 17 micrograms/dL or below 4 micrograms/dL were highly predictive of an intact or impaired HPA axis, respectively, but intermediate values had only limited sensitivity and specificity. The criteria of HPA axis integrity, defined as an increment in plasma cortisol of more than 7 micrograms/dL above the baseline or as a doubling of the baseline cortisol value, were associated with high false positive and false negative rates. We conclude that 1) the baseline morning serum cortisol concentration has very limited predictive power in differentiating between normal and impaired HPA function; 2) the use of criteria based on incremental changes in serum cortisol from baseline leads to unacceptably high false positive and false negative rates; and 3) insulin hypoglycemia is still the best indicator of the integrity of the response of the HPA axis to stress.
PMID: 9661607 [PubMed - indexed for MEDLINE]
(it's got a free full text..but I haven't read it)
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9661607&dopt=Abstract
Note..it also said 17 was a safe level for predicting normal adrenal function....love it when studies agree with observationsNow WHY am I going on about basal adrenal levels needed before commencing thyroid meds....because when you start thyroid meds it really hits your adrenals hard as probably when your metabolism kicks in your adrenals are called to work harder then they are used to, and without these levels one goes into some degree of a kinda adrenal crisis..one crashes and one does not tolerate the thyroid meds..can get racing heart beats/or irregular racing and pounding etc, tendonitis, tight muscles, aches and pains all over, just crash in a heap, extreme fatigue, difficulty breathing... you have a great choice of symptoms
So how does this relate to you? I suspect that improving nutrition and taking phenylalanine etc would have a similar though lesser effect as commencing thyroid meds..so any adrenals which aren't functioning optimally will be put under a bit of strain...not as much as commencing thyroid meds..but the same kinda thing
> I can't make an appointment first. Our system will not permit that approach. Only with a referral can you make an appointment.
Well you ain't supposed to here either! I just give them a referring doc's name then look for the referral. I was forced into this after wasting at least 10 years of my life not being aggressive enough and just accepting some more AntiD's etc. I think I learnt to be more aggressive and to voice my symptoms etc. from the forums on the net.
>
>
> > It just seems to work better this way, otherwise I can't get the referrals. You're right emergency rooms would not answer.
>
> They're the only other doctors I have a right to see, sans referral.me too
> >
> > Lar, that's a lovely definition of intuition..
> Glad you liked it.
<grin>>
> >> hmm..one would expect that to increase your cortisol level as it's known to have systemic effects, as you say. Do you take all the time, or only occasionally?
>
> I used to take it all the time, but recently, I've not felt the need.That's good sign that fish oil is working, huh.(and the good nutrition, vits, amino acids etc)
Now, rather than increase cortisol, would it not have a suppressing action?
No. well not exactly.
Inhalation corticosteroids are cortisone-like medicines so if you cut back too fast it's similar to cutting back cortisol too fast.
I had come across some studies earlier this year on this.
Just went looking again
Here goes
"RESULTS: A decreased adrenal reserve was observed 1 month after withdrawal of GCs in 50% of the chronically treated patients. Adrenal cortex function returned to normal in 55% of patients within 6 months, in 24% within 12 months, and in 14% within 15 months of discontinuation of systemic GCs administration. A significant positive correlation between the time taken for return to normal adrenal cortex function and duration of the disease and of GCs therapy was found. "
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12713606&dopt=Abstract
Adrenal cortex function in asthmatic patients following the discontinuation of chronic therapy with systemic glucocorticosteroids.
Also , it is usually found that those on long term corticosteroids for asthma may develop "cushingoid" features..aka weight gain..which they lose on discontinuation ...perhaps a part reason for some weight loss?When I said "No,not exactly"..there is an effect with cortisol (as with thyroid meds) that continuous long tem administration, especially if too high, may shut down the adrenal production also.
http://www.mja.com.au/public/issues/178_05_030303/mac10571_fm.html#i1082551
Note the cushingoid appearance in the PAST..when it goes past this stage , you can get adrenal suppression (similar to chronic stress for years)"Although he had been noted to have a cushingoid appearance in the past, he was normal on physical examination, his height and weight were on the 3rd percentile, and his growth velocity was normal. He was found to be hypoglycaemic and hyponatraemic, with a low serum cortisol level "
"Ongoing treatment involved giving regular hydrocortisone while reducing the dose of ICS, with no deterioration of asthma control. Four months after his presentation he was taking 500 μg fluticasone daily and being weaned off hydrocortisone"
OR another case "Treatment and clinical course: Therapy with replacement hydrocortisone was begun while the ICS dose was gradually decreased to two puffs of Seretide 50/25 twice daily (giving 200 μg fluticasone daily); hydrocortisone therapy was continued for four months and is now taken as stress cover for intercurrent illness"So here they give hydrocortisone to build adrenal levels while reducing the dose of asthma meds
Also look at this
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2548097&dopt=Abstract
This is what I think happened to me ..for many years since a child..to cause the thirst.
I'm not AS thirsty anymore. Hydrocortisone has mild mineralocorticord properties too..and my blood tests confirm this. (PS. This answers the question you posed to me about thirst and diabetes way back, no I don't have sugar diabetes,..but I suspected I might have had this kind..never could get tested though, so just assumed it)
"Hydrocortisone has some mineralocorticoid action, and its use as sole replacement therapy was sufficient to restore electrolyte balance in these instances"
Larrian told me I must have something up with vasopressin and angiotensin when I was discussing PMS migraines..so I've been trying to link it all. I accept better if I know why...at least to my own wierd explanation which fits. I guess I've always been a pain in wanting to know why...Perhaps my reduction in the use of busedonide has become a part of my current problem?
No, I think it's a good idea. Just don't do it too suddenly..what you haven't done already that is.
taper.. (see above) and use the fish oil/amino acids/high dose vitamins for support like you've been doing or very low cortisol doses.
(Phsyiological doses are up to 20mg usually that folks may start on (some need 30mg, usually with pituiaty damage)..I used 3mg compounded with thyroid meds after I cut down for a month or so..and I can tell the difference with just that amount!I used pulmicort too. Do you have the dark brown and light brown..(different strengths) over there too?
>
> > Did you read that Dr Derry thread on the thyroid forum..BTW if you do ever read it, click on "advanced view" at bottom of page to view 20 messages in one go
Doesn't matter. It was only for your interest...I'm still suffering from real bad B12 reaction, and I don't think the google is working on this forum in the past couple of days (BTW I've figured by "blue" they mean purple..I'm purple..especially soles of feet, hands, lips, eyes..butsoles of feet can go redder at times)
>
> Could you give me the link again, please? I've had some problems getting my new computer configured, and it would be nice if I could start anew.Hope you haven't lost too much. You can get people to recover stuff from HDDs if not too corrupted.
>
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> > > Everything is linked to everything else. Messing with hormones directly is kind of scary for me.
> >
> > Should be too...that's why I think testing and a good specialist, even if out of area..is the preferable way to go
>
> I'll have more info soon. I paid for some special bloodwork.
>
> > > > Ok, all above is from my memory only
> > > > Here's a post on the forum
>
> > It was 10mg/g(1%) and there was 50g in the tube..so I started with about 1/10 of a tube..50mg as I doubt you absorb it all.
>
> I guess I can do that math. I did think so too...evens <g>
>
> > (in truth, I think the first day I probably used more than this..then cut back). You can judge what percentage of the tube you use..and there is no real reason to be that exact, as long as you taper off gradually.
>
> I'm going to wait a little bit, and see what the specialist says.Good idea
>
> > It actually works quite well as is not as "sudden" as hydrocortisone tablets..it seems to release slower in a smaller dose. I used it in the end to get a smoother dose....rubbed on my inner elbow and inner lower arm mainly...although sometimes outer lower arm and just above elbow.(actually this was where my muscles were really sore anyway the time) I have heard there is very good absorption in the neck area..but it may be too much except for an occasional needed sudden desperation -type boost.
>
> Funny, but I've never given much thought to topical steroids.....I've got a fair bit of them around the house. You can also buy 1% hydrocort creams.That's the stuff..hydrocortisone creams..but you have to get the thick clear ones..or at least the transparent ones ..others don't absorb well systemically (observation only again)
> > > Thanks. You've convinced me to pay for the testosterone panel too.
Sure hope you read up on it, found a good lab(it does make a difference), and high fat carbs loaded..like fries,potato gems, doughnuts etc beforehand for a couple of days, no fish oil,....oh and got it taken at the lowest time of day possible too.?
It makes a difference usually..and if trying to convince docs to treat is sometimes necessary...to get below range
(You have to know for monitoring also.)
With TSH, I always tell folks to go first thing in morning..highest time of day. the docs haven't figured this out as far as I can tell. Oestrogen is highest at noon. testosterone..no idea.
> > >
> > Just sounded like you'd given up in a previous post for some reason..and one has just got to just keep trying with all of this.
>
> Not given up.....frustrated, though. I know enough to want to get mucking around, but I need a medical collaborator. No such luck, as of yet.Guess that what I meant frustrated to the point of sounding like you were giving up
>
"You're special, ya know" <corrected <g>>
Jan
Disclaimer:-(not medically trained..all opinions only)
poster:tealady
thread:259730
URL: http://www.dr-bob.org/babble/alter/20031003/msgs/270754.html