Adrenal Disorders :: Addisons Crisis Or Just Low Cortisol?
Dec 30, 2015
I have Addison's disease for 10 years. Every once in awhile I feel very run down and sort of out of it if that makes sense? For the past 4 days I am having a hard time staying awake. I cannot stay up for more than 2 hours at a time and have just basically slept the days away. I have a headache and feel nauseated on top of this. A couple times I have even felt dizzy. I have been doing a lot of reading (while I am awake) on the subject of addisonian crisis and was just wanting to see what some other people think that have gone through this. I have doubled my meds but it hasn't helped yet. Although I just started that yesterday.
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I am concerned about my test I have had recently...my blood pressure is a little low and when I am sleeping it is dropping to 81/51. My cortisol is 357 at a 9.00 in the morning. I have been having some very bizarre symptoms.. I started with sudden dizziness and numbness in my arms 6 months ago they tested me for stroke tia but it was clear.. then the symptoms started to get worse fatigue, pains in my legs, back pain, feeling sick, dizziness just feeling generally unwell... does any on no what is normal for the cortisol level is at 9.00 in the morning.. I think they are testing me for addison disease.
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I had my AM cortisol tested and it came out high. I did the blood test while fasting about 1 hour after I woke up.
My AM cortisol: 33.7 (normal range 6.2-19.4)
Could the high cortisol be the cause of my symptoms:fast heart rate (gets worse with exertion), sweating, and 15 pound weight loss, trouble sleeping?
I was researching it online and my symptoms seem to fit more with those with low cortisol than high cortisol. I've been to 5 doctors and went to the ER once because I've been feeling so terrible the past 4 months. My AM cortisol is the first thing to come out abnormal. All thyroid, liver, etc. tests come out perfectly within the normal range.
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First off, I am a 30 year old female, and I've had an array of crazy symptoms for years and have gone undiagnosed (well, misdiagnosed with fibromyalgia and chronic fatigue syndrome). I've also been diagnosed with hypothyroidism, PCOS, Endometriosis, and autonomic dysfunction. My symptoms range from debilitating fatigue, hormonal symptoms, dizziness and fainting, and inability to keep a pregnancy. Over the years, I have had consistently low levels of cortisol, but now things are changing. My 8:00 am cortisol level is 2.1, and my 1:00pm is 21. It went from low to high in my results. They were suspecting secondary adrenal insufficiency before due to the consistently low levels, but with that new afternoon level, I am really confused. Also, I have extreme fatigue in the early morning (have to drag myself out of bed) but I get a giant boost of energy at night and have trouble getting to sleep. My NP thought the cortisol levels could explain that, and she gave me a prescription for Cortef in the morning and sent me to the Vitamin store to pick up Phosphorylated Serine and Adrenal Adaptogens to control the nighttime level. She didn't address why this could be happening, and I was worried about taking the Cortef with those high afternoon levels, so I recently switched to an endocrinologist who repeated the afternoon test. I've just looked at the results online and it is high again. I'm so confused.
These are the exact results shown on my endo's site:
MAY 19: 3p ACTH 19 NL; CORTISOL 21.1 ; 21 HYX AB NEG; RENIN 3.48 NL; ALDO 12 NL; NA 139 NL; DHEA-S 153 NL
I will say, I do have INTENSE dehydration and sodium loss that has caused me to become a neurological patient as well, and I down 2-3 32 oz Powerades a day and consume probably 10-15 times the normal sodium consumption levels as my neurologists have suggested in order to keep my from getting dizzy and passing out all the time, so that may explain why my sodium level looks fine. But that cortisol... how could it start the morning off low and end up high later in the day? Does anyone else have any experience with this?
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I was just wondering what comes after a cortisol stim test for diagnosing Addison's Disease ?
I had 2 Cortisol stim tests done one in the afternoon and one in the early morning .
Afternoon test read 2.8 out of 5-15
Morning test read 3.8 out of 5-25 Both low
Do i now have a Acth test done to see if its the adrenals glands or Pituitary or Hypothalamus Producing such low cortisol ?
I have abdominal cramping , hot flashes , constipation . tired , weak and major weight loss 35 + pounds in 8 months .
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Hi, I’m hoping some people can hopefully give me some advice please regarding treatment. My history: I’m 30, diagnosed with secondary adrenal insufficiency via an insulin tolerance test. I have borderline low hypothyroidism, low prolactin. No cysts. I am 40kg, 5ft tall so I am very petite.
I currently take hydrocortisone after each meal 8am-4 mg, 12m-4mg, 3.30pm-4mg, 8pm- 3 mg. I have to take my medication following food to reduce the intensity of the spike. I also cannot tolerate more than 5mg at one time without getting awful side effects of anxiety and panic when the tablet peaks in my blood at 30 minutes. Each doe I take only lasts around 2.5-3 hours.If I am to take 10mg at once I feel ‘high’ and ‘rushy’ and anxious when it kicks in then after 3 hours its starts to drop and I feel low cortisol again.
I feel like I am swinging all day every day. I am still so fatigued, have very bad dizziness and brain fog, light sensitivity, blurred vision, weakness, leg and arm cramps, reactive hypoglycemia and achy.
4 weeks ago I ended up having an adrenal crises, yes it was horrendous and scary but I got through it and in a way it was a blessing because it has been a BIG wake up call that I need to stop being scared of trying new medication in fear of getting sicker and realised I have got to try and get myself well.
I have been so unwell since I was 21 I am now 30. ….i have lost so much of my life and I am sacred I am never going to get better or managed.
My consultant prescribes medrol a while ago and I have been too scared to start to but after my crises I started it. I am now taking 1mg Medrol in the morning and then 3 more doses of hydrocortisone at 4mg, 4mg and 2.5mg…
When I first started the Medrol I could feel it working but now its like I can not feel it and by 4 hours later I am feeling hypoglycaemic, weak nauseas etc… I am feeling so unwell after I eat a meal, like all my bodies energy is wiped out from digesting my food and im now lying in bed weak, giddy and lots of pain cramps in my arms and legs…
I have low blood pressure and my consultants suggested
fludrocortisone. I just don’t know what to do anymore. My consultants saying I shouldn’t feel so unwell and im just so lost.
Has anyone been on Medrol and can give advice on this. Im very petite, 5ft and 40 kg…I just feel so up and down and struggling with it all and also feel my symptoms get worse or better during certain times of the month..
i also cannot tolerate many carbohydrates because my blood glucose pikes very high at 1 1/2 hours post eating and drops every low by 21/2-3 hours.
I’ve now had to set up a backup carer to help when am unwell because i am on my own with 2 young children. I am getting help with them now and also trying to get support for taking them to school…im slowly getting there
I have also done a month of blood tests looking at progesterone and estrogen and have found a pattern in some of my symptoms.. I most definitely feel my worst when I am coming off my period, stopping bleeding where I start to feel cold and foggy and nauseous I then when ovulating feel at my worst and the 2 days when my estrogen was highest I had severe anxiety, tremor, agoraphobia, intense drowsiness after eating and these symptoms always disappear once I ovulate and start seeing progesterone mucous . Apart from these symptoms which come on with my cycle I suffer with all my other symptoms throughout the whole month with increase and decrease throughout my cycle.
I have included a lot of tests below and anyone who feels they can help would be so much appreciated. Thank you for your time
These are my most recent blood test
June 20th 2014
Autoimmune profile – normal no action
Mitochondrial antibody level – negative
Anti-smooth muscle autoantibodies – negative
Panetta cell autoantibodies – negative
Reticulum antibody titre – negative
Anti-liver kidney micro ab lev – negative
Serum vitamin D – 71 nmol/l
Erythrocyte sedimentation rate – 9 mm/h (0-15)
Total white cell count - 6.5 10*9/L (3.5-10.0010*9/L)
Red blood cell count - 4.14 10*12/L (3.8-5.0010*12/L)
Haemoglobin estimation - 119g/L (115.00-145.00g/L)
Haematocrit - 0.360L/L (0.36-0.46L/L)
Mean Corpuscular volume (MCV) - 87Fl (84-98)
Mean Corusc. Haemoglobin (MCH) - 28.7pg (27.5-32)
Mean Corpusc. HB conc (MCHC) - 331g/L (300-360)
Red cell distribution width - 15.1% (<14.50%)
Platelet count - 194 10.9/L (150-400 0010*9/L)
Neutrophil count 3.3 - 10.9/L (1-3.5010*9/L)
Lymphocyte count - 2.0 10*9/l (1-3.5010*9/L)
Monocyte count 0.8 - 10.9/L (0.31.0010*9/L)
Eosinophil count - 0.3 10*9/L (<0.401089/L)
Basophil count - 0.1 10*9/L (<0.1010*9/L)
Serum folate - 4ug/L (3-20)
Serum ferritin - 8ug/L (10-200)
Vitamin B12 - 632 ng/L (200-910)
TSH - 3.04 mu/L (0.35-5)
Free T4 - 11pmol/L (9-22)
Liver function tests
Total bilirubin level - 7umol/L (1-21)
ALT - 9 U/L (1-50)
Blood calcium level 2.16 mmol//L
Corrected serum calcium level – 2.14 mmol/L (2.20-2.60)
Serum inorganic phosphate - 1.44mmol/L (0.8-1.50)
Serum alkaline phosphatase – 54 U/L (30-130)
Serum total protein 69 g/L (60-80)
Serum albumin - 40 g/L (35-50)
Serum globulin - 29 g/L(22-40)
Serum sodium - 136 mmol/L (133-146)
Serum potassium - 4mmol (3.5-5.3)
Serum urea level - 3.8 (2.50-7.8)
Serum creatinine - 49 umol/L (20-103)
Plasma C reactive protein - 0.3mg/L (<5.00mg/l)
I paid for a whole series of blood tests. They was taken on day 4 of my period, I had fasted for 12 hours. I was salt fasted for 24 hours and remained sitting up prior to the test and during the test so the aldosterone and renin tests were accurate. The bloods were taken at 9am. I take hydrocortisone 15mg a day and took my last dose of 2.5mg at 8pm the night before the test. I was taking no supplimenst or anything else around the time of the test.
HORMONE PROFILE
Aldosterone 399.0 pmol/L Upright 100 - 800 pmol/L Supine 100 - 8450pmol/L
RENIN 66.2 mU/L Upright 5.4 - 60 mU/L Supine 5.4 - 30 mU/L
Aldosterone: Renin ratio 6 <80 Conn's Unlikely
FSH 6.1 U/L
LH 11.9
Oestradiol 106 pmol/L
Prolactin 144 mU/L 102 - 496
Cortisol (basal) 449 nmol/L (171 - 536) (BASAL 171-536, EVENING 64 - 327)
Free T3 4.8 pmol/L (3.1 - 6.8)
Thyroid stimulating hormone 2.310 mU/L (0.270 -4.200)
Free T4 14.0 pmol/L (12 - 22)
FULL BLOOD COUNT
WBC 4.90 x10^9/L (4.0 - 11.0)
RBC 4.43 x10^12/L (3.80 -5.80)
Haemoglobin 135 g/L (120 - 150) R
HCT 0.41 ratio (0.36 -0.46)
MCV 93.0 fL (80.0 -100.0)
MCH 30.4 pg (27.0 -32.0)
MCHC 326 g/L (315 - 345)
Platelets 241 x10^9/L (140 - 440)
RDW 11.8 (0.0 - 14.0) **
MPV 9.3 fL
Neutrophils(Abs) 2.58 10^9/L (2.0 - 7.5)
Lymphocytes (Abs) 1.69 10^9/L (1.5 - 4.0)
Monocytes (Abs) 0.44 10^9/L (0.2 - 0.8)
Eosinophils (Abs) 0.22 10^9/L (0.0 - 0.4)
Basophils (Abs) 0.02 10^9/L (0 - 0.1)
CRP< 0.3 mg/L (0 - 5)
BIOCHEMISTRY
Sodium 139 mmol/L (133 - 146)
Potassium 4.2 mmol/L (3.5 - 5.3)
Urea 4.9 mmol/L (2.8 - 7.8)
Creatinine 56 umol/L (45 - 84)
estimated GFR (eGFR) >90 ml/min
LIVER FUNCTION TEST
Total bilirubin 5 umol/L (0 - 21)
Alkaline phosphatase (ALP) 65 Iu/L (30 - 130)
ALT 11 Iu/L (0 - 33)
GGT 8 Iu/L (UP TO 40)
Total Protein 78 g/L (60 - 80)
Albumin 49 g/L (35 - 50)
Globulin 29 g/L (18 - 35)
AST 16 Iu/L (UP TO 32)
Lactate dehydrogenase 171 Iu/L (135 - 214)
Serum Calcium 2.39 mmol/L (2.2 - 2.6)
Albumin 49 g/L (35 - 50)
Adjusted Calcium 2.30 mmol/L (2.20 -2.60)
Uric Acid 278 umol/L (140 - 360)
Glucose 3.8 mmol/L (4.2 - 6.1) **
LIPID PROFILE
Cholesterol 3.94 mmol/L (0.0 - 5.2)
Triglycerides 0.54 mmol/L (2.26) *
HDL cholesterol 1.41 mmol/L (> 1.68)
Cholesterol/HDL ratio 2.8 ( <5)
Low density lipoprotein 2.28 mmol/L (2.5 - 4.5) **
% HDL/Total Cholesterol 35.79 %
B12 687 ng/L (191 - 663) **
Folate (serum) 5.4 ug/L (4.6 - 18.7)
IRON AND UIBC
UIBC 60.0 umol/L
Iron 17.0 umol/L (6.6 - 30.4)
Total iron binding Capacity 77.0 umol/L (41-77)
Transferrin saturation 22.1 % (20-55)
Ferritin 13.1 ug/L (13 - 400)
Ferritin 13.1 ug/L (13 - 400)
Vitamin D 24.5 nmol/L Reported
<25 nmol/L: Severe Vitamin D deficiency
25-75 nmol/L:Borderline ranging to insufficiency
75-200 nmol/L: Optimally replete
>250 nmol/L:Possible toxicity, if sustained
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I just got my blood drawn at 8 am for my cortisol levels were at 1.2 is this low?
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I just had a AM cortisol lab of 1.1. Over the last 6 months I have been told I have Hashimotos.
What does this mean?
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My Cortisol level after doing dexamethasone test is below normal at 1.2
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Is a 0.6 cortisol level dangerous?
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How high do very high cortisol numbers go?
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I was diagnosed Hashimotos this year.
Here are my adrenal stress test results:
Sample 1 - 3.4 (12-22)
Sample 2 - 6.1 (5.0-9.0)
Sample 3 - 4.8 (3.0-7.0)
Sample 4 - 3.2 (1.0-3.0)
DHEA:Cortisol Ratio - 2.62 (within range)
Latest thyroid function test results:
TSH - 2.50 (0.2-4.2)
Free T3 - 4.6 (3.9-6.7)
Free T4 - 15.7 (12-22)
Apparently my doctor says these are normal, yet when I am taking the Levothyroxine my Free T3 drops and my hypothyroid symptoms return. Am I missing something or am I the only one in the world with this problem? I presume the latter.
I am currently dairy and gluten free and my fatigue and constipation have cleared up since on the diet, however I retook my Levothyroxine and within 2 hours I was constipated. The only change I had made was retaking the Levothyroxine but I did increase my fluid intake, too. The reaction I had from the medication is making me doubt the benefits of it. Or could I be undermedicated at 125mcg? The nurse taking my blood last time said 125mcg is a lot for a little person like me to be taking!
So, in order to wipe the slate clean and start afresh with my care, I have since changed doctors and will be asking for the following at my first appointment:
Sex hormone profile - not just the testosterone, FSH, LH and prolactin my endocrinologist carried out but I would like to include the ones she has *missed* - the oestrogen, estradiol and progesterone. I am sure there are others in there...
Full mineral/vitamin profile - but excluding the folate, Vitamin D and Vitamin B12 which were done recently and including a full iron panel.
Repeat thyroid test - why oh why am I experiencing hypothyroid symptoms AFTER I take the Levothyroxine? When I reported this to my previous doctor they have told me they will end my script for Levothyroxine since they are under the impression I get no ill effects without the medication! Are they right?
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Does anyone else have these with addison's , or is it mostly cushing's?
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I have always enjoyed salty foods but over the past few years I really crave them all the time. Could it have something to do with my adrenal glands?
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My daughter is 19. About 18 months ago she started having panic attacks, feeling nauseous and shaking and becoming quite distressed. After counselling and medication it became controlled. She still suffered episodes of shaking and feeling as if her blood sugar was dropping. She has had episodes of lightheadedness and passed out at work , being out for about 10 minutes. All her tests have shown as normal to now, however something is suddenly causing these events. She has had bp, eeg, fasting bloods- glucose and thyroid function, all normal. She is awaiting a 24 hour eeg now. I read about adrenaline crashes and Addison's disease recently and its connection with irregular periods, which she gets and Vitiligo, which she has a small patch of. Is it worth discussing tests with her GP? they seem quite happy to put her regular visits there down to anxiety though.
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Why are my T4 levels and Cortisol levels low?
I have been having symptoms of depression, fatigue, low libido and weight gain over the last few years. I am 50 and have gone through menopause. My latest lab results are:
TSH 1.064 (0.358-3.74)
Free T4 9.7 (9.8-18.8)
ferritin 16 (3-105)
B12 498 (156-672)
Cortisol 28 (155-570)
RBC's normal
I am not taking any thyroid meds......only nexium and Cymbalta.
What do these results mean? Can someone give me some insight into the results please?
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I had surgery to remove a kidney stone last month, I was given cyclIzine to take home along with pain meds. After a day of taking the cyclizine tablets all of a sudden I felt really on edge and strange and had gone from being quite sedated from pain meds to breathing unusually. I had involuntary movements in my face and neck. It progressed into difficulties talking, my gp told me to stop taking cyclizine immediately. 2 days later the symptoms were worse so my gp gave me procyclidine to stop the symptoms. The following night they got even worse and apparently it's called oculogyric crisis, felt like I was fitting. Being treated with sedatives now which have really helped, it's a month later now though and I had a series of episodes last night of oculogyric crisis. Has anyone else had similar experiences and how long did your symptoms last?
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About two months ago, I had mentioned to my personal trainer that I was feeling very tired with low blood pressure. This had been going on for a couple months, on and off every couple of weeks. He mentioned that it could be cortisol-related.
I went home and did a lot of researching about the issue and found that I matched a lot of the symptoms of low cortisol. I went in to see my doctor a couple days later. When I mentioned that I thought it was low cortisol, he said that the adrenal glands usually do the job and that it probably wasn't that. He tried to prescribe me anti-depressants which I declined, and then ran a few blood tests, along with an AM only cortisol test (it was about 11AM).
The test came back with a level of 17 mg/dL of cortisol taken at 11AM. However, he said my blood sugar was 54 which was very low. Also, my Vitamin D was below normal ranges. Some other counts were off, but nothing that really pointed to anything that could be causing what I was feeling.
I took a multivitamin for a few weeks. I had also been congested in the back of my throat for two months, so I went back to see the doctor if he could do anything about that. He determined it was a sinus infection, and prescribed Cefuroxime for two weeks to get rid of the congestion. I asked if that could help my fatigue to which he said it could help.
So I finished the two week round of antibiotics, and now it's two weeks later and I still feel horrible. Here's the main things that I am experiencing. I really don't feel depressed and feel like I enjoy life a lot.
- Inability to wake up for work. I wake up around 9AM, and feel like I haven't slept at all. I previously had to wake up around 5AM to get everything done in the morning
- Feeling of drowsiness through the morning, up until noon. Sometimes like today it will last all day.
- Extremely low blood pressure while standing. This starts around 2PM every day and lasts until around 5PM. I usually don't fall down and just black out, but recently I fell because after standing up and injured my knee.
- Fluctuations in appetite, I will eat a TON of food with out gaining any weight (5-6 meals a day), but I exercise a lot so this isn't super concerning. My weight is constant.
- Itchy red eyes when I wake up
- Exhaustion when sitting, feels like I should lay down but not low blood pressure
- Hypoglycemia, my blood sugar is really low in the mornings, and then again in the evenings before dinner. Between that it feels fine but I don't do regular testing on this to know for sure.
Also I am 20 years old male and a competitive cyclist. I eat very healthy foods (although a lot to keep up my activity). I live at a high altitude (7,400ft).
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A few thoughts and questions after reading Penelope Leach on not leaving babies to cry and not subjecting them to over rigid routines. Well, I'm on her side entirely. Why add to the sum total of human misery? Bossy I may be but I'm not a control freak and some of these child experts are really scary.
But that is by the way. For PMR/ GCA sufferers I thought the interesting part was her information on the effect on the brain of overproduction of cortisol. I expect most of us are past the developing brain stage which is so vital in babies but we'd like to preserve what we have. I can certainly vouch that the 78 year old brain is definitely NOT unaffected as I have posted elsewhere. ( No Prednisolone )
Mrs. Leach also mentions that cortisol is an easy hormone (? ) to monitor through saliva tests. Given that unwanted reaction to prednisolone is not unusual, I wonder is anyone has ever been interested enough to run some tests. Maybe some of us who are not very big are over prescribed. Maybe we could benefit from taking the drug other than at breakfast. Eileen H's Alternate Day Therapy looks interesting.
I'm willing to donate some saliva and take the swabs and record the results. God forbid! I am not medically qualified. As a long time teacher I just hate to think of all the wasted evidence that could be freely available. I must say that I have always found vets much more open to and ready to share information but I guess they have more time for which we willingly pay than NHS doctors who are rationed to 10 minutes a patient. This is not a criticism of NHS or doctors, just a belated recognition of how right my old headmistress was in 1947 when she said "This will not work; it takes no account of human nature. She was an expert on human nature. Of course, she was not entirely right. It DOES work very often but it is abused and therefor has never been able to develop its full potential.
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What was your cortisol level when you were diagnosed with Addison's? I'm guessing it was 0.
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By way of background I have typical cushing's symptoms but my early labs including 24 hour urine were normal. So of course doctors have been dismissive. I had a brain MRI for tinnitus and convinced the radiologist to include the pituitary and a microadenoma was found. Now doctors are taking me seriously thank goodness. I had a an ACTH stimulation test a couple of days ago and these are the results posted online:
Base cortisol 42.0
30 min cortisol 26.0
60 min 49.2
Normal range for morning (test done at about 9 am): 6.2-19.4
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