Adrenal Insuffiency???

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Adrenal Insuffiency???

Postby stolar » Mon Nov 10, 2008 2:45 pm

After losing a lot of weight, having serious anxiety issues, dizziness and so forth I was given an ACTH stimulation test.

The results seem kind of strange to me.

My baseline was 14.6 and did not change much (went to 14.8) an hour after the injection.

The doctor is just calling this possible adrenal insuffiency. He's not very good at communicating the issues so I was wonder if anyone here could shed some additional light on this.

Since my baseline was normal, it would seem to me that I don't have Addisons... yet my body apparently does not produce more cortisol as a result of additional ACTH. So, is this Addisons or can something else be causing this to occur that I need to get checked out?

Is it possible that my body just doesn't react to ACTH and that my cortisol levels pretty much just chug along at max all the time?

Could stress cause my reaction to be muted?

The additional results were as follows:

Creatinine, Serum : 1.23
Sodium: 141
Chloride: 97
albumin: 5.0
Alkaline phosphatase: 59
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Re: Adrenal Insuffiency???

Postby gkardel » Thu Nov 13, 2008 10:35 pm

Did you have your ACTH level checked also? Looks like a positive test for Addisons - it's the delta from the baseline that's key. If you were taking any steroids besides dexamethasone before the stim test can invalidate the results. If your ACTH level is low could point to secondary Addisons.

Glenn
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Re: Adrenal Insuffiency???

Postby stolar » Fri Nov 14, 2008 7:38 pm

Thanks. I did not get the ACTH test for some reason. I'm going to go to a different endo as the one I'm dealing with seems to know a lot about diabetes but not much about Addison's. I'll get that test next.

I have had no recent exposure to steroids , but was on 60mgs/day of predisone for a week last year after suffering sudden hearing loss in my left year (no cause ever was identified and the hearing did not return...)

All my issues started after a period of intense stress and I guess I'm curious if stress could have drained my adrenal reserve and thus this may be a temporary issue... although I've had these bouts off and on for about 15 years after stress. They usually last a few months and then I return to normal unless another huge stressor occurs...
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Re: Adrenal Insuffiency???

Postby gkardel » Sat Nov 15, 2008 9:56 am

Did they taper you off of the 60mg prednisone dose or did you stop all at once?
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Re: Adrenal Insuffiency???

Postby stolar » Sat Nov 15, 2008 10:16 am

It was fairly abrupt. But I have had similiar issues (weight loss, anxiety, low blood pressure, rapid pulse) off and on a few times before that sure sound like adrenal problems now that I know about it. Maybe the abrupt withdrawal just made it worse then it already was???

It really bugs me that my Doctor just wrote a prescription and sent me on my way without any info on this disease. I'm not sure he is convinced I have it because I don't have any obvious skin pigmentations. Of course, he didn't check my whole body. I do have some dark freckles on my shoulder, and some darkening in a "sensitive" area that I've had for 15 years.

From recent readiings on the internet I apparently have to be aware of lots of aspects to this (higher dosage when sick), medical bracelets, and so forth.
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Re: Adrenal Insuffiency???

Postby gkardel » Sat Nov 15, 2008 5:54 pm

The abrupt withdrawal of the higher doses of prednisone can cause secondary Addisons. In secondary Addisons, blood pressure, sodium and potassium levels aren't usually impacted. Low ACTH would support secondary Addisons theory. Skin pigmentation is also not a feature of secondary.

Glenn
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Re: Adrenal Insuffiency???

Postby stolar » Sat Nov 15, 2008 6:49 pm

In secondary addison's wouldn't I have reacted to the ACTH stimulation test? My cortisol levels didn't increase so I figured it had to be primary.
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Re: Adrenal Insuffiency???

Postby gkardel » Sat Nov 15, 2008 11:34 pm

Yes, that's a good point. I'd get the plasma ACTH test and perhaps prolonged ACTH stim test or insulin tolerance test. Definitely talk it over with the new endo.

Glenn
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