Post by Chris Jackson on Nov 19, 2008 18:40:56 GMT -5
Created by Chris Jackson Aug 19,2007.
Adrenal FAQs on STTM
www.stopthethyroidmadness.com/adrenal-info/faq/
*** Adrenal Labs - How to Interpret them *** on STTM
www.stopthethyroidmadness.com/community/viewtopic.php?t=12149
Adrenal fatigue and Cortisol 101 (submitted by moderator Phil from RTH)
hotzehwc.com/attachments/wysiwyg/2/AdrenalFatigueandCortisol101.pdf
"Aldosterone, florinef and Salt" thread on STTM
www.stopthethyroidmadness.com/community/viewtopic.php?t=8244
"Adrenal Hormones, Testing and Treatment" thread on
STTM
www.stopthethyroidmadness.com/community/viewtopic.php?t=8562
My medical book supports the cortisol blood range is flawed (in More Stickies)
www.geocities.com/chrisgj@sbcglobal.net/My_medical_book_supports_the_cortisol_blood_range_flawed.html
Frequently asked HYPOPITUITARY questions….and their
answers
If you find yourself with a very low TSH lab (TSH is a pituitary hormone),
and you have hypothyroid or other certain symptoms, you may
have hypopituitarism. Here are the most frequently asked questions
concerning this condition, with questions created by Chris, a
hypopituitary patient who has worked with other hypopituitary patients
for several years. Please note these are quick general answers so is
recommended you do your own research to learn more.
Is also recommended you join Chris's Hypopituitary Support Group on Yahoo
health.groups.yahoo.com/group/Hypopituitary_Support/ It is closed to
posting, but you can join to access the great deal of information it contains,
including over 500 links and 100 files and archived discussions.
1) What is hypopituitarism?
2) What are symptoms of hypopituitarism?
3) What causes hypopituitarism?
4) Is adrenal and/or thyroid treatment different if I am
hypopituitary?
5) What labs will detect hypopituitarism?
6) If I can’t afford all those labs, can you tell just from TSH? DHEA?
7) Can you detect hypopituitarism from saliva cortisol labs?
8) I’m already on HC, can I test cortisol or ACTH levels?
9) Is there any test for hypopituitarism once I’m already on HC?
10) If one pituitary hormone is low, does that mean all of them are?
11) My Dr or Insurance won’t approve further tests - what should I do?
12) Should I start treating the sex hormones right away?
13) Is hypopituitarism curable?
14) My doctor says my cortisol doubled during the ACTH stimulation test, so I am ok-is he right?
15) Could I have a pituitary tumor? Should I get an MRI? Is it gonna grow? Will I need an operation?
16)Are there shades of Gray on this? Does someone get sort-of hypo-pit, then next guy's labs even more so, then finally one sets off the buzzer and gets a definitive label of Hypo-Pit?
1) What is hypopituitarism? Hypopituitary is the pituitary
gland functioning below where it needs to be, and one or more hormones
can be involved. The pituitary is a pea sized gland located at the base of the brain and it runs the adrenals, thyroid, and sex hormones. It also produces growth hormone and stores oxytocin and vasopressin, both of which is made in the hypothalamus. If the pituitary doesn’t put out enough TSH, thyroid hormone production can decrease. If the pituitary doesn’t produce enough ACTH, cortisol (and DHEA) can decrease.
2) What are the symptoms of hypopituitarism? Because the
pituitary may not be sending adequate levels of TSH and or ACTH, you
could feel fatigue, weakness, have low blood pressure, feel colder
than normal, have a decrease in your appetite, headaches, and
depression. Symptoms of hypopit (concerning low TSH, low ACTH, low LH
and FSH) are the same as if thyroid-adrenals-gonads are the cause. In
most cases you can't tell by symptoms if you may be hypopituitary or
not. If you aren’t getting enough ACTH, you could have symptoms of
weight loss and nausea, plus the fatigue, low blood pressure,
weakness, and depression. Because of a deficiency of TSH and LH, women
could lose their periods, or have problems conceiving. Men could have
a decreased libido, erectile dysfunction, and loss of facial hair. If
hypopituitary occurs in childhood, the result can be a short stature.
Thirst and increased need to urinate can occur is you have an ADH
deficiency. (Note: a large body of hypothyroid patients have a “low
normal” TSH without hypopituitarism. Why? Because the man-made TSH lab is often slow to reveal the hypothyroid state. Those with
hypopituitarism will often have a TSH at 0.8 and lower for women, and
1.8 and lower for men, with accompanying hypo symptoms. See #5 and 6
below.)
3) What causes hypopituitarism? A common cause of
hypopituitarism is head injury. Even a seemingly mild bump to the head
can damage the pituitary. A Pituitary tumor can also cause
hypopituitary, though perhaps less than 3 percent have this as a
cause. Sheehan’s syndrome is another cause, severe blood
loss causes the pituitary to at least partially die from the lack of
blood. Blood loss from childbirth, or an injury can result in
Sheehan’s syndrome. Other causes of hypopit can be radiation, antibody attack, and environmental. In most cases, it can not be known for sure what the cause is.
4) Is adrenal and/or thyroid treatment different if I am
hypopituitary? In treating the adrenals and thyroid caused by low
ACTH (secondary AI) and low TSH (secondary hypothyroid), treatment is
the same as it is for primary Adrenal Insufficiency and primary
hypothyroid. Sex hormone treatment can be different with the use of
HCG (almost identical to LH) in secondaries hypogonadism (low LH and
FSH production in the pituitary which will cause low sex hormones in
men and women), whereas primary hypogonadism involves the gonads being the cause of low sex hormones, LH and FSH will go up. The treatment for primary hypogonadism is the use of testosterone (in men, sometimes along with estrogen blocker) and estrogen, progesterone and even testosterone in women. Some men with primary hypogonadism also use HCG, but is rarely used in women.
5) What labs will detect hypopituitarism? -low TSH (below 1.8
for men, below 0.8 for women)
-low ACTH (below 30 for am. Is possible to be secondary with ACTH as
high as low 40’s)
-ACTH stimulation or ITT that doubles cortisol from a low base value.
-ITT for GH stim
-low GHRH
-low TRH
-low vasopressin (hypothalamic hormone which is stored in the
pituitary)
-low renin and low aldosterone
-very low or below range prolactin-usually this test is inconclusive
for determing if other low pituitary hormones could be present.
-low oxytocin (rarely tested, is a hypothalamic hormone which is
stored and released from the pituitary)
-alpha MSH (rarely tested, is a byproduct of ACTH)
6) If I can’t afford all those labs, can you tell just from TSH?
DHEA? If not on any thyroid treatment, I go by the TSH: less than .8
for women, less than 1.8 for men for determining secondary hypothyroid. I use 1.3 and above for women and 2.2 and above for men to determine
primary hypo. In between .8 and 1.3 for women and 1.8 and 2.2 for men
is less certain to whether secondary or not. A serum TRH and TRH STIM
can help if you fall in that grey area. DHEA, if in the ower half of
the range usually, but not always, indicates possible secondary
adrenal insufficiency. Serum ACTH and ACTH Stimulation are the best tests for determining if secondary. If one has already started steroid without proper testing, the next best test for determining secondary AI is the renin test.
7) Can you detect hypopituitarism from saliva cortisol labs?
No, because the test only shows what cortisol levels are, not what
ACTH levels are doing. There is no saliva lab for ACTH as far as I
know.
8) I’m already on hydrocortisone (HC), can I test cortisol and or
ACTH levels? No, once steroid is started, those tests are not
reliable. In every case I’ve seen where a doctor use these tests for
dosing a patient’s cortisol replacement, the patient was left
undertreated. ACTH will go to pretty much zero in proper cortisol
dosing.
9) Is there any test for hypopituitarism once started on HC?
For detecting secondary (low ACTH) AI when proper testing hasn’t been
done (serum acth, DHEA-S, acth stimulation test), the renin test (with
aldosterone) is the next best thing and is highly reliable if the test
is done right (fast salt for 24 hours). Renin is low 99% of the time
in secondaries.
10) If one pituitary hormone is low, does that mean all of them
are? In more than 99% of cases of hypopituitary, 2 to 3 pituitary
hormones will be deficient. Keep in mind interpreting tests is
subjective. One doc like an osteopath (US) may see problems, an
endocrinologist will probably will say your tests are ok. When all
pituitary hormones are deficient to missing, this is called
panhypopituitarism. True panhypopituitarism is fairly rare. Some
definitions say not all pituitary hormones have to be deficient, but
most. I go by the the strict definition - all pituitary hormones being
deficient or absent in the anterior pituitary. I’ve seen one case of
real panhypopituitarism.
11) My Dr or Insurance won’t approve further tests - what
should I do? I recommend you first try an osteopath (DO) or holistic
type of doctor even if you have to pay it all yourself. In the US,
osteopaths are best for dealing with pituitary problems, but the rest
of the world, osteopaths are a different type of doc and usually can’t
help.
12) Should I start treating the sex hormones right away? Not
until your adrenals and thyroid have been properly treated. Treating these first may help improve the levels of sex hormones. The order
of treating hormones are cortisol, aldosterone, *vasopressin (if needed
but uncommon, always treated after aldosterone) *DHEA (if needed, but
not if sex hormones will need to be treated since DHEA breaks down
into sex hormones and you can’t control how that will happen), then
sex hormones, then Growth hormone. Low prolactin is not treated, but
sometimes prolactin producing tumor (prolactinoma) can be present in
hypopit and can also be the cause of hypopit. A drug such as Dostinex is used to lower prolactin. Know that sometimes low thyroid can raise prolactin. Treating thyroid may lower prolactin.
13) Is hypopituitarism curable? There is no cure for hypopituitarism.
14) My doctor says my cortisol doubled during the ACTH stimulation test, so I am ok-is he right? Most people with pituitary caused adrenal insufficiency, aka secondary adrenal insufficiency, do double on that test, but from a low base cortisol value. If your stim started below mid 20's for women and below upper 20s for men, but doubled or more, then that suggests possible secondary adrenal insufficiency. A serum acth must be tested just before the stim is started. From what I've seen, serum acth can be as high as lower 40's for secondary AI, but most are below 30. Keep in mind the ranges today are even more flawed than they were 2+ years ago when 99% of labs used a range of 10-60. In my opinion a good range for ACTH would be 45-55. See this sticky for a greatly detailed explanation of how to interpret your acth stim test.
en.wikipedia.org/wiki/ACTH_stimulation_test
15) Could I have a pituitary tumor? Should I get an MRI? Is it gonna grow? Will I need an operation? Most people with hypopituitarism is not caused by a pituitary tumor. I estimate that less than 3% of those diagnosed with hypopituitarism are also diagnosed with a pit tumor, but studies have shown over 20% of cadavers have some degree of pituitary tumor present. In my opinion anyone who's tests show even one low pituitary hormone should get an MRI (make sure is done with and without contrast). You can't be sure until you have one. If your doc wants you to have a CAT scan instead, then you know you are seeing the wrong doctor. In cases of pit tumor is present I recommend one see an endo who specialises in pituitary tumors. In half the cases, pit tumors don't grow to large and will stop growing. Any pituitary tumor should be monitored by MRI at least once a year. In the vast majority of cases, an operation is not necessary, but is necessary when the tumor pushes on the optic nerve or pushes against the hypothalamus or sinus cavity. Pituitary tumors usually cause decrease in some but usually not all pituitary hormones, but prolactin secreting tumors (prolactin excess aka prolactinomas) are not uncommon and can cause disruption of the other hormones of the pituitary rendering the patient hypopituitary. Tumors can also cause excess TSH (causing HYPERthyroid), excess GH and even excess gonadotropins (LH and FSH), but all of these border on rare. If you are diagnosed with a pituitary tumor, you need to check out www.Pituitarynetwork.org
16)Are there shades of Gray on this? Does someone get sort-of hypo-pit, then next guy's labs even more so, then finally one sets off the buzzer and gets a definitive label of Hypo-Pit? There are varying degrees of hypopituitarism which I see everyday. Most people who have it, don't get bad enough to have to figure this out and go to their graves not knowing. Most will have tests that are in range. I've seen everything from "I suspect slight hypopit for you but not bad enough to treat" (symptoms support, but tests showed a bit off) to a woman in Denmark who almost died from hypopit.
Adrenal FAQs on STTM
www.stopthethyroidmadness.com/adrenal-info/faq/
*** Adrenal Labs - How to Interpret them *** on STTM
www.stopthethyroidmadness.com/community/viewtopic.php?t=12149
Adrenal fatigue and Cortisol 101 (submitted by moderator Phil from RTH)
hotzehwc.com/attachments/wysiwyg/2/AdrenalFatigueandCortisol101.pdf
"Aldosterone, florinef and Salt" thread on STTM
www.stopthethyroidmadness.com/community/viewtopic.php?t=8244
"Adrenal Hormones, Testing and Treatment" thread on
STTM
www.stopthethyroidmadness.com/community/viewtopic.php?t=8562
My medical book supports the cortisol blood range is flawed (in More Stickies)
www.geocities.com/chrisgj@sbcglobal.net/My_medical_book_supports_the_cortisol_blood_range_flawed.html
Frequently asked HYPOPITUITARY questions….and their
answers
If you find yourself with a very low TSH lab (TSH is a pituitary hormone),
and you have hypothyroid or other certain symptoms, you may
have hypopituitarism. Here are the most frequently asked questions
concerning this condition, with questions created by Chris, a
hypopituitary patient who has worked with other hypopituitary patients
for several years. Please note these are quick general answers so is
recommended you do your own research to learn more.
Is also recommended you join Chris's Hypopituitary Support Group on Yahoo
health.groups.yahoo.com/group/Hypopituitary_Support/ It is closed to
posting, but you can join to access the great deal of information it contains,
including over 500 links and 100 files and archived discussions.
1) What is hypopituitarism?
2) What are symptoms of hypopituitarism?
3) What causes hypopituitarism?
4) Is adrenal and/or thyroid treatment different if I am
hypopituitary?
5) What labs will detect hypopituitarism?
6) If I can’t afford all those labs, can you tell just from TSH? DHEA?
7) Can you detect hypopituitarism from saliva cortisol labs?
8) I’m already on HC, can I test cortisol or ACTH levels?
9) Is there any test for hypopituitarism once I’m already on HC?
10) If one pituitary hormone is low, does that mean all of them are?
11) My Dr or Insurance won’t approve further tests - what should I do?
12) Should I start treating the sex hormones right away?
13) Is hypopituitarism curable?
14) My doctor says my cortisol doubled during the ACTH stimulation test, so I am ok-is he right?
15) Could I have a pituitary tumor? Should I get an MRI? Is it gonna grow? Will I need an operation?
16)Are there shades of Gray on this? Does someone get sort-of hypo-pit, then next guy's labs even more so, then finally one sets off the buzzer and gets a definitive label of Hypo-Pit?
1) What is hypopituitarism? Hypopituitary is the pituitary
gland functioning below where it needs to be, and one or more hormones
can be involved. The pituitary is a pea sized gland located at the base of the brain and it runs the adrenals, thyroid, and sex hormones. It also produces growth hormone and stores oxytocin and vasopressin, both of which is made in the hypothalamus. If the pituitary doesn’t put out enough TSH, thyroid hormone production can decrease. If the pituitary doesn’t produce enough ACTH, cortisol (and DHEA) can decrease.
2) What are the symptoms of hypopituitarism? Because the
pituitary may not be sending adequate levels of TSH and or ACTH, you
could feel fatigue, weakness, have low blood pressure, feel colder
than normal, have a decrease in your appetite, headaches, and
depression. Symptoms of hypopit (concerning low TSH, low ACTH, low LH
and FSH) are the same as if thyroid-adrenals-gonads are the cause. In
most cases you can't tell by symptoms if you may be hypopituitary or
not. If you aren’t getting enough ACTH, you could have symptoms of
weight loss and nausea, plus the fatigue, low blood pressure,
weakness, and depression. Because of a deficiency of TSH and LH, women
could lose their periods, or have problems conceiving. Men could have
a decreased libido, erectile dysfunction, and loss of facial hair. If
hypopituitary occurs in childhood, the result can be a short stature.
Thirst and increased need to urinate can occur is you have an ADH
deficiency. (Note: a large body of hypothyroid patients have a “low
normal” TSH without hypopituitarism. Why? Because the man-made TSH lab is often slow to reveal the hypothyroid state. Those with
hypopituitarism will often have a TSH at 0.8 and lower for women, and
1.8 and lower for men, with accompanying hypo symptoms. See #5 and 6
below.)
3) What causes hypopituitarism? A common cause of
hypopituitarism is head injury. Even a seemingly mild bump to the head
can damage the pituitary. A Pituitary tumor can also cause
hypopituitary, though perhaps less than 3 percent have this as a
cause. Sheehan’s syndrome is another cause, severe blood
loss causes the pituitary to at least partially die from the lack of
blood. Blood loss from childbirth, or an injury can result in
Sheehan’s syndrome. Other causes of hypopit can be radiation, antibody attack, and environmental. In most cases, it can not be known for sure what the cause is.
4) Is adrenal and/or thyroid treatment different if I am
hypopituitary? In treating the adrenals and thyroid caused by low
ACTH (secondary AI) and low TSH (secondary hypothyroid), treatment is
the same as it is for primary Adrenal Insufficiency and primary
hypothyroid. Sex hormone treatment can be different with the use of
HCG (almost identical to LH) in secondaries hypogonadism (low LH and
FSH production in the pituitary which will cause low sex hormones in
men and women), whereas primary hypogonadism involves the gonads being the cause of low sex hormones, LH and FSH will go up. The treatment for primary hypogonadism is the use of testosterone (in men, sometimes along with estrogen blocker) and estrogen, progesterone and even testosterone in women. Some men with primary hypogonadism also use HCG, but is rarely used in women.
5) What labs will detect hypopituitarism? -low TSH (below 1.8
for men, below 0.8 for women)
-low ACTH (below 30 for am. Is possible to be secondary with ACTH as
high as low 40’s)
-ACTH stimulation or ITT that doubles cortisol from a low base value.
-ITT for GH stim
-low GHRH
-low TRH
-low vasopressin (hypothalamic hormone which is stored in the
pituitary)
-low renin and low aldosterone
-very low or below range prolactin-usually this test is inconclusive
for determing if other low pituitary hormones could be present.
-low oxytocin (rarely tested, is a hypothalamic hormone which is
stored and released from the pituitary)
-alpha MSH (rarely tested, is a byproduct of ACTH)
6) If I can’t afford all those labs, can you tell just from TSH?
DHEA? If not on any thyroid treatment, I go by the TSH: less than .8
for women, less than 1.8 for men for determining secondary hypothyroid. I use 1.3 and above for women and 2.2 and above for men to determine
primary hypo. In between .8 and 1.3 for women and 1.8 and 2.2 for men
is less certain to whether secondary or not. A serum TRH and TRH STIM
can help if you fall in that grey area. DHEA, if in the ower half of
the range usually, but not always, indicates possible secondary
adrenal insufficiency. Serum ACTH and ACTH Stimulation are the best tests for determining if secondary. If one has already started steroid without proper testing, the next best test for determining secondary AI is the renin test.
7) Can you detect hypopituitarism from saliva cortisol labs?
No, because the test only shows what cortisol levels are, not what
ACTH levels are doing. There is no saliva lab for ACTH as far as I
know.
8) I’m already on hydrocortisone (HC), can I test cortisol and or
ACTH levels? No, once steroid is started, those tests are not
reliable. In every case I’ve seen where a doctor use these tests for
dosing a patient’s cortisol replacement, the patient was left
undertreated. ACTH will go to pretty much zero in proper cortisol
dosing.
9) Is there any test for hypopituitarism once started on HC?
For detecting secondary (low ACTH) AI when proper testing hasn’t been
done (serum acth, DHEA-S, acth stimulation test), the renin test (with
aldosterone) is the next best thing and is highly reliable if the test
is done right (fast salt for 24 hours). Renin is low 99% of the time
in secondaries.
10) If one pituitary hormone is low, does that mean all of them
are? In more than 99% of cases of hypopituitary, 2 to 3 pituitary
hormones will be deficient. Keep in mind interpreting tests is
subjective. One doc like an osteopath (US) may see problems, an
endocrinologist will probably will say your tests are ok. When all
pituitary hormones are deficient to missing, this is called
panhypopituitarism. True panhypopituitarism is fairly rare. Some
definitions say not all pituitary hormones have to be deficient, but
most. I go by the the strict definition - all pituitary hormones being
deficient or absent in the anterior pituitary. I’ve seen one case of
real panhypopituitarism.
11) My Dr or Insurance won’t approve further tests - what
should I do? I recommend you first try an osteopath (DO) or holistic
type of doctor even if you have to pay it all yourself. In the US,
osteopaths are best for dealing with pituitary problems, but the rest
of the world, osteopaths are a different type of doc and usually can’t
help.
12) Should I start treating the sex hormones right away? Not
until your adrenals and thyroid have been properly treated. Treating these first may help improve the levels of sex hormones. The order
of treating hormones are cortisol, aldosterone, *vasopressin (if needed
but uncommon, always treated after aldosterone) *DHEA (if needed, but
not if sex hormones will need to be treated since DHEA breaks down
into sex hormones and you can’t control how that will happen), then
sex hormones, then Growth hormone. Low prolactin is not treated, but
sometimes prolactin producing tumor (prolactinoma) can be present in
hypopit and can also be the cause of hypopit. A drug such as Dostinex is used to lower prolactin. Know that sometimes low thyroid can raise prolactin. Treating thyroid may lower prolactin.
13) Is hypopituitarism curable? There is no cure for hypopituitarism.
14) My doctor says my cortisol doubled during the ACTH stimulation test, so I am ok-is he right? Most people with pituitary caused adrenal insufficiency, aka secondary adrenal insufficiency, do double on that test, but from a low base cortisol value. If your stim started below mid 20's for women and below upper 20s for men, but doubled or more, then that suggests possible secondary adrenal insufficiency. A serum acth must be tested just before the stim is started. From what I've seen, serum acth can be as high as lower 40's for secondary AI, but most are below 30. Keep in mind the ranges today are even more flawed than they were 2+ years ago when 99% of labs used a range of 10-60. In my opinion a good range for ACTH would be 45-55. See this sticky for a greatly detailed explanation of how to interpret your acth stim test.
en.wikipedia.org/wiki/ACTH_stimulation_test
15) Could I have a pituitary tumor? Should I get an MRI? Is it gonna grow? Will I need an operation? Most people with hypopituitarism is not caused by a pituitary tumor. I estimate that less than 3% of those diagnosed with hypopituitarism are also diagnosed with a pit tumor, but studies have shown over 20% of cadavers have some degree of pituitary tumor present. In my opinion anyone who's tests show even one low pituitary hormone should get an MRI (make sure is done with and without contrast). You can't be sure until you have one. If your doc wants you to have a CAT scan instead, then you know you are seeing the wrong doctor. In cases of pit tumor is present I recommend one see an endo who specialises in pituitary tumors. In half the cases, pit tumors don't grow to large and will stop growing. Any pituitary tumor should be monitored by MRI at least once a year. In the vast majority of cases, an operation is not necessary, but is necessary when the tumor pushes on the optic nerve or pushes against the hypothalamus or sinus cavity. Pituitary tumors usually cause decrease in some but usually not all pituitary hormones, but prolactin secreting tumors (prolactin excess aka prolactinomas) are not uncommon and can cause disruption of the other hormones of the pituitary rendering the patient hypopituitary. Tumors can also cause excess TSH (causing HYPERthyroid), excess GH and even excess gonadotropins (LH and FSH), but all of these border on rare. If you are diagnosed with a pituitary tumor, you need to check out www.Pituitarynetwork.org
16)Are there shades of Gray on this? Does someone get sort-of hypo-pit, then next guy's labs even more so, then finally one sets off the buzzer and gets a definitive label of Hypo-Pit? There are varying degrees of hypopituitarism which I see everyday. Most people who have it, don't get bad enough to have to figure this out and go to their graves not knowing. Most will have tests that are in range. I've seen everything from "I suspect slight hypopit for you but not bad enough to treat" (symptoms support, but tests showed a bit off) to a woman in Denmark who almost died from hypopit.