Adrenal Fatigue

[Griffin]

My heart specialist (who I don't think has heard of POTS) says my adrenal test came back normal. I've noticed that many people with POTS have adrenal problems and am wondering if there are any special adrenal tests whch show up problems where the standard test might not?

[futurehope]

My endocrinologist gave me an insulin tolerance test, but I suspect this is so because he has a interest in POTS patients. IOW, this test is not routine, and POTS symptoms do not point to getting this test.

In this test, they abnormally lower your blood sugar, and watch the adrenal output as a result of this stressor. My adrenals put out cortisol, but at a subpar rate. The test needs to be done at a medical facility by knowledgeable people who are at the ready to treat abnormally low blood sugar.

I was given small doses of cortisol for a few months because of my results on the above test, and because it had helped other POTS people. I kept getting fatter, and felt no better, so I stopped taking the hormone.

I do still have the cortisol in the house and maybe on rare occasions I'll take a bit if I've been ill with something and I'm noticing low blood pressures and extreme fatigue, but this is rare and I will not take a hormone for nothing.

In my particular case, when I had been taking a bit of cortisol daily, I was also hypothyroid at the time (without knowing it). I am no longer hypothyroid, so maybe trying the cotisol now would be beneficial........If an external course of adrenal hormone is given, they need to be confident of your thyroid output, as they go hand in hand. Since my thyroid output had been low and I did not know it, the supplemental adrenal hormone made me fatter.

Anyhow, I do not think most doctors feel confident in giving hormones unless there is a test done to show a need. Otherwise, you are increasing chances of other unnecesssary side effects because of the potency of the drug.

[erik]

I'm no expert but have been hunting adrenal testing info for some time now. The various tests I've read of are:

a) One time blood sampling (usually cortisol level measured in early AM at expected peak).

Longer duration urinary samples (24 or 48 hr urinary samples, typically measuring cortisol).

c) Saliva cortisol sampling (usually looking for deviation from expected intraday pattern, high AM tapering to low midnight)

d) ACTH stimulation test (provocative test, scoping out HPA)

e) Insulin tolerance test (provocative test, scoping out HPA)

If there are others, I'd appreciate hearing about them too. My layman's impressions of these are:

One time sampling would tend to pick up major malfunctions (such as full blown addisons or cushings, or significantly damaged adrenals) but misses subtle or transient problems. The longer duration urinary sampling gets more "sensitive" to less obvious problems but is still looking for more "generalized" and consistent problems. The saliva testing can pick up some more specific hormone level problems, like dips in the day or "reverse" patterns like low in AM and higher later (which can be subtle clues to things but is tricky to interpret). The ACTH stimulation is actively probing the system and scoping out it's response, and particularly helps distinguish between origin of a problem (adrenal vs. pituitary vs. hypothalamus) albeit via rather subtle clues such as looking for a normal but slightly delayed response. I guess the Insulin Tolerance Test is rather similar (just pushing in a different way of course), but I'm not sure what it is better or worse at spotting.

I read in an overview article that the Insulin Tolerance Test is the "gold standard" for probing the HPA-axis, but haven't found too many details on it or explanation of specifically what it can spot better than ACTH stim can.