Can Anyone Explain Adrenal Gland Levels For Blood And Urine Tests?

[Tammy]

Hi! Well I've recently had a blood cortisol level check, just a random test and it shows 19 in a range that 20 is the top of the normal, so that all looks good. Then they did a urine total catecholamine test, which I believe is also in relation to the adrenal glands, and it shows all normal, but on the low normal: Norepinephrine: 16 (range is 15 to 80); Epinephrine: 1.2 (range 0.0 to 20.0); and Dopamine (low) 44 (range 65 to 400). Since the blood test shows me in the high range of normal and the urine tests shows to be in the low range of normal, I'm really confused. My EP said these are normal numbers and wasn't concerned, so I guess I'm not concerned, but just confused as to how this all works. Anyone who can explain this would be helpful in my understanding of the nature of these two tests and why they don't correspond to each other. Thanks

[pat57]

sorry- not a clue

[sue1234]

If I'm thinking correctly, the urine cortisol/catecholamine levels are really only good to measure HIGH levels, as seen in cushing's disease and pheochromocytomas. The plasma cortisol can give an indication either way for low or high cortisol. Of course, an 8 a.m. cortisol is the best to check on Addison's and a midnight cortisol is best to check for Cushing's.

[morgan617]

The tests have to be done under very strict conditions or they are just skewered. Levels are typically supine and standing, a lot of med restrictions and things like that.

They have drawn mine and they were abnormal, but they were done incorrectly, so I wasn't surprised when told there didn't need to be any follow up. Even the endocrinologist I saw once, didn't know how to draw them.

So can't really help you, except they may may be weird because of that. morgan

[Sophia3]

I am not sure what is meant by strict conditions? I have had this done many times by my endo to check my adrenals.

I had high normal cortisol (19) reading once YEARS ago, after being forced to sit upright in a chair for 45 minutes WAITING for some blood work.

My endocrinologist attributed it to that upright stress, as he has since checked it a few times . Also did a lot of the urine catches in the early years.

His theory was one test does NOT an answer make. Sometimes the adrenals may spurt out too much some times, not enough others. He always examines my hands closely at our visit and years ago, HE noticed the lines in my hands had darkened (tan like) he checked me for Addisons but things were normal. Years later, hands still tan but I do not notice unless under good light and my reading glasses on. I am very fair skinned.

So I have since read and DETERMINED on my own, if I LIE DOWN for blood work I get a truer reading. Also my fasting glucose was high for the same reason and THAT was drawn supine but after a 1 hr drive to my docs, a visit with him and then I lay down as his plebot drew my blood. His girls are good and I never feel the pinck of the needle.

I know in cats, a blood draw from a cat can make glucose readings VERY HIGH from 'stress of needle draws.' So if cats have 'active autonomic systems' that would make sense. When I have gotten urine samples from my cats, for the vet they are more reliable .

(for cat owners, use washed, small sized, aquarium gravel in a clean cat litter box...works for me! Then use a syringe to draw up urine but I digress)

Anyway, when you think our issues for MOST of us are GRAVITY related with HR and or BP going sky high when we stand and may level off' I hypothesize AND have read, that makes our endocrine system cascade. SOMETIMES thus the border high readings.

oh, my glucose was 125 last year which is pre diabetes. I used a monitor my doc gave me and was totally normal after 5 sticks...even after meals.

Were you stressed that morning you had the corisol of 19? I do not remember my urine readings but we did several.

some 24 hr and a couple times, he gave me the scrip to do them 'when symptomatic'. We now determined my fluctuations after 9 years are the norm with me.

But some people here have had numbers way, WAY out of the quote 'normal zone' and that's a different matter.

hope this helps more than it confounds.

[Sophia3]

tammy

Have you seen this link about cortisol testing? I just had normal blood draws in AM. But since I sleep so late and am awake late, as long as I am fasting, he thinks I would get normal cortisol even late in the mornings and this link mentions that as well, which makes sense to me. My mom and sister have always gotten up early (between 4.30 and 5.30 by CHOICE)

I always struggled to wake up, even when working and back when I was in school age years.

My 17 years of chronic insomnia, I get to sleep between 1 to 4AM with the occassional 5AM though sometimes by 1-2pm for most of the month. Then PMS insomnia or at my age the PRE menopause (Perimenopause insomnia) keeps me up late. I will also notice food cravings at this time but most weeks do not have a good appetite.

http://www.labtestsonline.org/understandin...tisol/test.html

[flop]

Adrenal gland testing is very complicated and the results are often not helpful.

The adrenal glands secrete hormones including adrenaline. The amount they secrete naturally varies during the day and night and also in response to other stimuli, for example pain or stress can cause the release of a surge of adrenaline, the glands also respond to the levels of other hormones and drugs in our bodies (try googling for "adrenal axis" if you want to read more).

Taking a random blood level or a spot urine check is usually not helpful as interpreting the results is impossible. The only time it would be useful would be if a very very low cortisol level was found when someone was ill - that would indicate adrenal insufficiency, but wouldn't tell the physicial the cause of the problem.

24 hour urine collections can be used to check for high levels of some hormones and can be used to exclude pheochromocytoma if the readings are repeatedly normal.

It is much more useful to do a test where you attempt to either stimulate or suppress the adrenal gland by giving a drug.

A short synacthen test is done to check for Addison's disease - they draw some blood for a baseline cortisol reading then inject synacthen which should stimulate the adrenal gland to release cortisol. After a certain time they draw more blood for cortisol levels, the results of the second blood sample should be higher than the baseline showing that the adrenal gland responded to the synacthen. The actual results need to be interpreted carefully but can fairly easily exclude a diagnosis of Addison's disease.

There is also a dexamethasone suppression test, I couldn't find much info on line about this but essentially the patient takes oral dexamethasone (a steroid hormone), having that hormone in your system should prevent the adrenal glands from producing cortisol and other hormones. What I read was really complicated and said there was a difference between the adrenal gland misbehaving and the pituitary gland misbehaving and causing abnormal adrenal results! I guess this is why endocrinologists spend years learning how to do and interpret these tests!

Essentially don't worry too much about a one-off random reading, and see an endocrinologist if you think you need more detailed testing.

Flop