A Question About Adrenal Function.

[jump]

Hello all,

I've read that there is sometimes a connection to adrenal function and dysautonomia. When I read up about it, enough of the symptoms seemed to apply to me (extreme fatigue, unexplained weight gain, and then the dysaut) that it seemed worth testing for. When I mentioned it to my doctor, she said that adrenal function was really difficult to test for, and instead tested my potassium levels, and said that if there was anything wrong with my adrenals it would show up as a potassium imbalance.

This doesn't seem to quite fit with what I've read on the internet, but I know the internet is at best imperfect. Is my doctor right? Are there other tests I should be considering, or is the potassium test good enough?

Thanks,

jump

[Ernie]

Hi,

I had catecholamines tested and found out my adrenals are hyperactive.

[EarthMother]

I had an ACTH stimulation test (measures levels of cortisol in blood before and after an injection of synthetic ACTH.) I also had 24-hour urine test for epinephrine and norepinephrine. Also some blood test for catacholamines. All were normal in my case.

[Heiferly]

Addison's shows up as low cortisol, low sodium, high potassium, *I think* (I am SO not a doctor so I could totally be wrong somewhere in there). That is UNDER functioning of the adrenal glands, right gang? But there is a test for Addison's and it's not just testing potassium it's that adrenal gland stimulation test that someone else mentioned above. That's the association I know of between potassium and adrenal gland, although I'm guessing there's more to it . . . anyone else know more on this and can fill in my blanks?

[firewatcher]

jump,

I had what I think was a full adrenal panel test done:

ACTH stimulation test (measures cortisol, done for addison's (low) and cushings (high).

Renin/Aldosterone

Catecholamines (dopamine, epinephrine and norepinephrine)

CT-scan

Potassium would be off if your Renin/Aldosterone were off, which is COMMON in POTS and its frequent urination. So, I don't think that just checking that would be enough.

Do you have other markers? Like darkened skin on scars and knuckles?

There are many tests for adrenal function, it sounds like your doc was lazy or his people aren't skilled enough to do the tests right.

[jump]

Thanks for the info on the tests. I thought what my doc said sounded a little off from what I had read.

I'm not sure I do have "classic" symptoms of adrenal insufficiency, but, from my reading, it seems like I might have symptoms of some kind of adrenal abnormality. I do have very dark circles under my eyes that nothing seems to help (I've tried iron and other vitamins, and sleeping more). I have hypothyroid disease, but I'm on medication for it and my blood work says that it's perfectly under control. Yet I continue to have symptoms associated with low thyroid hormone -- complete and utter exhaustion, weight gain even though I hardly eat anything, no appetite. I've read that hypothyroidism can sometimes go hand in hand with adrenal issues, and that POTS often goes along with adrenal issues. I'm not sure if my symptoms warrant pursuing this with my doctor. Any advice?

[futurehope]

Thanks for the info on the tests. I thought what my doc said sounded a little off from what I had read.

I'm not sure I do have "classic" symptoms of adrenal insufficiency, but, from my reading, it seems like I might have symptoms of some kind of adrenal abnormality. I do have very dark circles under my eyes that nothing seems to help (I've tried iron and other vitamins, and sleeping more). I have hypothyroid disease, but I'm on medication for it and my blood work says that it's perfectly under control. Yet I continue to have symptoms associated with low thyroid hormone -- complete and utter exhaustion, weight gain even though I hardly eat anything, no appetite. I've read that hypothyroidism can sometimes go hand in hand with adrenal issues, and that POTS often goes along with adrenal issues. I'm not sure if my symptoms warrant pursuing this with my doctor. Any advice?

My experience has been that my endocrinologist gave me a cosyntropin stimulation test. I went from about 8 to 20. Nothing abnormal there. My endo knows I have POTS and he also requested an Insulin Tolerance Test - a test we usually do not hear about. It is done in a hospital setting. They inject you with insulin to deliberately lower your blood sugar. Mine went way down to 32 at the lowest. Remember, this was done deliberately. They then do blood draws to see how my adrenals responded to the stress of low blood sugar.

During my low blood sugar, my adrenals responded with added cortisol, like they're supposed to, except .... here is the key.... the adrenal response was less than ideal.

The upshot is, I do not have Addison's disease, which denotes a severe deficiency of adrenal function. But I do demonstrate a below normal response to stress, as proven by my insulin tolerance test.

My endocrinologist has some POTS patients on very low doses of adrenal hormone and feeling much better.

I do not think this is a "cure" for POTS, just something to help with the symptoms.

In my case, I stalled for years and didn't begin taking additional Cortef (hydrocortisone), but within the last month, after my yearly endocrine visit, I decided that I had many symptoms in common with low functioning adrenals. I had low blood pressure (lower than I used to have), easy exhaustion, weakness. I decided to try the Cortef again. It is a very small amount, a 5 mg pill. It had to be special ordered.

I take 1/2 pill with breakfast, 1/2 pill with lunch and 1/2 pill at 4 PM. I always take it with food as it increases my heartburn. The side effect of heartburn is what kept me from taking the pills before. I stayed at 1/2 pill for 1 week. Then I added the luncheon dose. And a week after that, I added the 4 PM dose.

Result: My blood pressure is normal 120/80. I do not feel like a "dead" person and actually feel better. I have become much more aware of a "crash", my terminology for when the pill wears off.

I also have thyroid issues and need to keep my synthroid at the correct levels.

I plan on taking this minute amount of adrenal hormone as it definitely is helping me. I do not feel cured. I feel like I'm "managing" the POTS. This is only one piece of what I do, but I felt that this info might help you. Best wishes.

[Tessa]

Basal cortisol and aldosterone test

Aldosterone-Renin test

ACTH stim test

Complete blood test (including electrolytes and thyroid)

Information on Testing cortisol and aldosterone

Hormone support group

Love,

Tessa

[Heiferly]

Tessa, YOU ROCK!! After reading through the first link you put up, and following up with a little more reading on wikipedia, I think I finally found an explanation for my mismatched test results!! Thank you thank you thank you for posting that link!!!!!!!!!

FYI, in case anyone else is floundering like I've been with mis-matched test results that didn't seem to "fit" any of the adrenal disease definitions but still indicated a problem, at the bottom of wikipedia's article on ACTH stimulation test is a chart which shows what constellations of test results mean what. It might not solve every case, but it was an AHA for me. I never even knew about secondary or tertiary explanations of adrenal problems before!

http://en.wikipedia.org/wiki/ACTH_stimulation_test

Again, Tessa, THANKS!!!

[Tessa]

You are welcome.

I?ve gone through a lot to get where I am now (secondary Adrenal Insufficiency)... And can fully understand other?s sufferings to get answers and clues.

I am glad to have been of any help.

There is plenty of information for you to check & a place to solve your doubts (adrenal help forum) following the links. (do not feel ashamed to use the forum I?ve forwarded. They are most helpful).

If you can, I would be grateful if you can keep me updated on your progress.

Take care,

Love,

Tessa