cortisol
deedee
a pill, and do fasting, before having the blood test. Any one have any
ideas. My endo did not say anything about the pill, but a friend who has a
GP said that the pill was necessary for optimal results.
Since I consider this to be a once a year blood test I want to do it right.
Please advise.
Mag
stimulation, but no need to take a pill for a routine cortisol. The
screening test for your adrenal function just requires it is done at 8
AM. There is a diurnal variation with different levels AM and PM. I
don't think there is any reasonto fast, exceopt that high lipids and
the resulting icky serum can interfere with some test methods. Did
your endo give you a reason for the test? I had one done after
discontinueing prednisone after long treatment to make sure I was
making it on my own.
Mag
"deedee" <sher...@hotmail.com> wrote in message news:<ZJ_h7.15370$mv1.2...@typhoon.ne.mediaone.net>...
deT notsuH
> There is a test that checks for your cortisol response to a
> stimulation, but no need to take a pill for a routine cortisol. The
> screening test for your adrenal function just requires it is done at 8
> AM. There is a diurnal variation with different levels AM and PM. I
> don't think there is any reasonto fast, exceopt that high lipids and
> the resulting icky serum can interfere with some test methods.
Minor correction in the case of cortisol: Besides just the diurnal
cycle, cortisol levels also rise after eating (as a check on insulin).
Therefore, the 8AM spot cortisol test must be done after fasting overnight.
Btw, the spot cortisol test is a pretty useless test BECAUSE of this
food and daily cycling. The 24-h urine collection is slightly better,
but that only for hyPER-cortisol (Cushings). For adrenal insufficiency
(Addisons), the stimulation test is waaaay better. However, even the
stimulation test would be best done fasting (not necessarily overnight,
but at least several hours). The test looks at a before and after
cortisol level, that is, after stimulation. If you ate, say, an hour
before the test, you might get a false okie-dokie increase in cortisol
during the test. With food, your cortisol might rise into the
"acceptable" level, denying that you have adrenal insufficiency.
--
deT notsuH bass-ackwards ude.hcimu@pcird
Mid-life has hit you when you stand naked in front of a mirror and can
see your rear end without turning around.
Lois
: The 24-h urine collection is slightly better,
: but that only for hyPER-cortisol (Cushings). For adrenal
insufficiency
: (Addisons), the stimulation test is waaaay better.
You knew this question was coming...if I get a "normal" result
back from the 24-urine cortisol test I'm doing and I still think I
have AI based on the details in the 3-page letter I wrote to my
new endo, what references can I provide this doctor to say that
the test isn't conclusive? (I don't have a next appt scheduled
yet, but it'll probably be in a couple of weeks or later.)
Thanks, deT,
Lois
deT notsuH
The only thing I can offer is that you will need to remind this alleged
endo of yours to pick up any basic endo book and s/he will find statements
such as "the normal range for plasma cortisol and urinary free-cortisol
values overlaps the detection limits of most assays; thus, reliable tests
of AI require evaluation of the ability to respond to ACTH stimulus."
I mean, EVERY freakin' endo book I picked up in the medschool library
said this (I admit that I only picked up 4 of them.....they're big and
heavy suckers). The 24h urine free-cortisol test is designed to catch
adrenal HYPERfunction, *NOT* hyPOfunction.
In order to have additional credibility, you MUST *not* appear to be
stressed (as you will see in a couple of passages below)..... If you
are outrageously STRESSED, and return a normal cortisol result instead
of a low one, then they will tell you that you do not have AI....
From http://www.csu.cuhk.edu.hk/~cpy/wardmanual/chemman3.htm#13.2:
<quote>
13.2 Adrenocortical Hypofunction (Addison's Disease)
In general, stimulation tests are required to investigate hypofunction
because a failing adrenal gland may be able to produce adequate basal
levels of corticosteroid despite a severe decrease in its reserve.
Isolated serum cortisol levels are uninformative and urine free cortisol
is of no value.
<endquote>
From http://www.merck.com/pubs/mmanual/section2/chapter9/9b.htm
(I would think that the Merck manual would be a respected resource):
<quote [EMPHASIS ADDED]>
Adrenal insufficiency can be diagnosed by demonstrating failure to
increase plasma cortisol levels, or urinary-free cortisol excretion, upon
administration of ACTH. Urinary-free cortisol excretion in the absence of
exogenous ACTH stimulation is unreliable as an index of adrenocortical
functional capacity, since baseline excretion does not adequately separate
the low-normal from the abnormally low value. A single determination of
plasma cortisol or 24-h urinary-free cortisol excretion [IS NOT USEFUL AND
MAY BE MISLEADING IN DIAGNOSING ADRENAL INSUFFICIENCY]. However, if the
patient is severely stressed or in shock, a single depressed plasma cortisol
determination is highly suggestive. An elevated plasma ACTH level in
association with a low plasma cortisol level is diagnostic.
<endquote>
And from
http://www.labcorp.com/datasets/labcorp/html/chapter/mono/sr011300.htm#sr011300
These are the folks that produce the test kits used in many labs...
in regard to the 24h free-cortisol, urine, test....
<quote [EMPHASIS ADDED]>
Use Evaluate adrenal cortical function, [ESPECIALLY HYPERFUNCTION];
evaluate obese or hypertensive subjects with glucose intolerance, plethora,
round face, hirsutism, striae, backache, irregular menses in various
combinations, most of whom do not have Cushing syndrome. Elevation of
urinary free cortisol in a properly collected specimen in the [UNSTRESSED]
patient is sufficient to diagnose Cushing syndrome, and a normal result is
strong evidence against that diagnosis. This is the [TEST OF CHOICE FOR
THE DIAGNOSIS OF CUSHING SYNDROME]. Urinary free cortisol is a more accurate
reflection of cortisol secretion than a single serum specimen.
<endquote>
And now to a new topic: Did you know that cortisol is made in your very
own body from....(drum roll).....LDL cholesterol? Me neither until I
flipped thru one of those hefty endo books to find info about insulin
resistance (which is why I really wanted to look at them anyway, but
I figured while I was there I might as well look up AI). But it begs
the question: How is your LDL? As a mostly vegetarian, I imagine it
is low/low-normal.....
I have to end with an AI joke: (A)rtificial (I)ntelligence is no match for
natural stupidity.
Lois
: The only thing I can offer is that you will need to remind this
alleged
: endo of yours to pick up any basic endo book and s/he will find
statements
: such as "the normal range for plasma cortisol and urinary
free-cortisol
: values overlaps the detection limits of most assays; thus,
reliable tests
: of AI require evaluation of the ability to respond to ACTH
stimulus."
: I mean, EVERY freakin' endo book I picked up in the medschool
library
: said this (I admit that I only picked up 4 of them.....they're
big and
: heavy suckers). The 24h urine free-cortisol test is designed to
catch
: adrenal HYPERfunction, *NOT* hyPOfunction.
Thanks, ET. That's pretty clear. In addition to the sources that
you quoted for me (snipped for space reasons), here's one more,
from the endo book a former internist gave me when he retired:
"The assay of unbound cortisol excreted in the urine is an
excellent method for the diagnosis of Cushing's syndrome....
"This test is not useful in adrenal insufficiency, because of the
lack of sensitivity of the method at low levels and because low
cortisol excretion is often found in normal persons."
(_Basic and clinical Endocrinology_, Third Edition, 1991, ed. by
Francis S. Greenspan, p. 336)
: In order to have additional credibility, you MUST *not* appear
to be
: stressed (as you will see in a couple of passages below).....
If you
: are outrageously STRESSED, and return a normal cortisol result
instead
: of a low one, then they will tell you that you do not have
AI....
I stayed relaxed yesterday, but I wish I had studied more for the
test. ;-) I mean, should I drink less so that there's
less...cortisol? Or drink more so that it's diluted?
I took the collection into the lab this morning, and then I got
the news that I have to do it all again. :-( Yesterday was a
holiday, so I slept in, and my 1st collection (you aren't supposed
to collect the 1st...er, bathroom visit sample b/c it contains
cortisol from the day before) was at noon. My last collection was
at 6:30 this morning b/c I had to get to work, and that doesn't
add up to 24 hours. So, I'm doing it again next Sunday, and I'll
get up early for it. And if I feel stressed about anything, I'll
leave the test for another day.
After what you told me, I don't expect much from this test, but
the doctor is a new one for me, and I don't think I'd gain much by
arguing about the test at this point. At least it's painless. I'll
be armed with your and my sources the next time I see him, though.
He said that he preferred to start with the 24-hour urine cortisol
test to check for adrenal insufficiency b/c it measures more
something, but I don't remember what. If I push for the ACTH
stimulation test, what might it not measure? Secondary AI? Is the
insulin tolerance test (described at
http://www.merck.com/pubs/mmanual/section2/chapter7/7b.htm)
possibly useful for me? After my crash from the glucose tolerance
test in June, though, its description makes me nervous.
: And now to a new topic: Did you know that cortisol is made in
your very
: own body from....(drum roll).....LDL cholesterol? Me neither
until I
: flipped thru one of those hefty endo books to find info about
insulin
: resistance (which is why I really wanted to look at them anyway,
but
: I figured while I was there I might as well look up AI). But it
begs
: the question: How is your LDL? As a mostly vegetarian, I
imagine it
: is low/low-normal.....
Sara mentioned that a low LDL cholesterol level is related to AI,
but I couldn't find this at Dr. Rind's site. My LDL in July
was...(drum roll)...1.24 in a range of 1.5-3.39. My other
cholesterol #s were low too, but this one was out-of-range low.
When I mentioned the low LDL to the doctor as I was leaving, he
said that cholesterol wasn't his specialty area, and he could
refer me to someone who knows about it, or something like that.
Uh, I don't want to just patch up the problems; I want to treat
their source.
The heavy endo book I have puts cortisol and cholesterol in the
same paragraphs on p.7 and p. 326, but there are so many words I
don't know between them that I wouldn't have made that connection.
Maybe if I study them and learn how to get words like
"fasciculata" and "adrenodoxin reductase" to roll off my tongue,
I'll be able to explain it, but for now, I'll quote you.
Thanks so much for looking up all those sources for me,
Lois
Sara Avery
> When I mentioned the low LDL to the doctor as I was leaving, he
> said that cholesterol wasn't his specialty area, and he could
> refer me to someone who knows about it, or something like that.
OMG, this is so ridiculous, it's funny. But completely maddening at the
same time. Didn't he go to human medical school? Wouldn't his specialty be
the human body, which can't live without proper levels (not too high OR low)
of cholesterol???????? ARghhhhhh!!!!!!!!!!!!!! I'm seeing my friend today
who is in DO school and is truly going to be a holistic doc... he'll get a
kick out of this AND be properly mad at the same time.
Sara
Lois
: > When I mentioned the low LDL to the doctor as I was leaving,
he
: > said that cholesterol wasn't his specialty area, and he could
: > refer me to someone who knows about it, or something like
that.
Sara responded:
: OMG, this is so ridiculous, it's funny. But completely
maddening at the
: same time. Didn't he go to human medical school? Wouldn't his
specialty be
: the human body, which can't live without proper levels (not too
high OR low)
: of cholesterol???????? ARghhhhhh!!!!!!!!!!!!!! I'm seeing my
friend today
: who is in DO school and is truly going to be a holistic doc...
he'll get a
: kick out of this AND be properly mad at the same time.
Let's hope this doctor is open to my bringing info to him. Is the
mention of LDL and cholesterol at Dr. Rind's site? I couldn't find
it there. I'm having trouble understanding Endo-ish (the endo book
I have uses vocab way beyond me), but Dr. Rind writes in a way
that I can understand. I can't bring a reference unless I know
what it's saying.
Thanks,
Lois