Additional Test Results

[margaret]

IF you have already had baseline morning ACTH, morning Cortisol (looks like you did with STim) and DHEA-S, then you should be good to go with cortisol replacement. DHEA-S is important as it will lower with HC. Do have all your pit hormones tested. Have individual sex hormones tested with LH/FSH, noting day of menstrual cycle (if applicable). The more info you get, the fewer surprises there may be down the road. Keep in mind too that one hormone may impact others. Replacing cortisol and Thyroid hormone(if needed) MIGHT result in improved IGF-1and GH. We can either send this thread over to hypopit forum or you can start new thread with brief history for background. Laurie

Hi Laurie and/or Lethal -

Do you mean have all pit hormones tested eventually (as in I can start cortisone, but should have them done at some point?)

I do have some test results from past year that I'll post below:
(Note: I was on 1 line of Progesterone beginning 8/07, but d/c'd two cycles prior to ACTH Stim test) Thank you for your help!

Here are my ACTH Stim Results (you already commented on these):

9am ACTH 13 (<46 pg/ml)
Cortisol 12.5 (-ug/dl) no range numbers provided.....

9:35 am Cortisol 27.8 (>18)

10:05 Cortisol 28.8

9/11/2008 Saliva Free Cortisol Rhythm (saliva)
(Day 19 of cycle, 1 line of Progest days 14-28)

Cortisol 7 - 8am 9 13-24nM
11 - Noon 5 5-10nM
4 - 5 pm 4
Midnight 2 1-4n(M)

DHEA 4 3-10ng/ml
Estrogen 13 7-20pg/ml
Progesterone >1000 65-500
Free Testosterone 17 8-20pg/ml


5/29/2008
Glucose, fasting 96 60-99mg/dl
TSH 1.7 0.2-5.5uIU/mL


5/5/2008 (Blood, Day 5 of cycle, Noon, On 1 line of Progest, days 14-28)

Estriol <0.10 (0.1ng/ml or less)
Estrone 36 (10-138pg/ml)
Test, Total 17 ( 2-45ng/dl)
% of Free Test 1.57 ( .5-2.0%)
Test, Free 2.7 (0.1-6.4pg/ml)
DHEA 442 (143-1277ng/dl)

Thyroid Peroxidase Ab TPO <19 (<35 IU/mL)
Thyrodlobulin ABS <29 (<29 IU/mL)
DHEA-Sulfate 127 (25-220 mcg/dL)
Free T3 249 ( 230-420)
Thyroxine Free 1 (0.8-1.8ng/dL)
TSH, 3rd generation 1.36 (.40-4.5)
Progesterone 0.8 (0.3-1.9ng/mL)
Cortisol 9.4 "4.0-22mcg/dL (7-9am)
3.0-17.0mcg/dL (3-5pm)"

2/25/2008

Ferritin 62 (22-291ng/mL)


(4/11/07 - 5/6/07), No HRT yet, Saliva

DHEA 4 (3-10ng/ml)
Testosterone, free 19 avg (8-20 pg/ml)

(Not sure what values to give for next two, but graph showed Estrogen dominance, Progesterone was never higher than Estrogen and met same level on day 19-20.)

Estradiol
Progesterone


1/26/2007
TSH 1.6 (0.2-5.5uIU/mL)
Sodium 139 (133-145mEg/L)
Potassium 4.5 (3.5-5.3mEg/L

Last Edit: Jan 8, 2009, 6:09pm (2 days 11 minutes ago) by margaret »

[justaustin]

Margaret,

That's right. As long as you have had ACTH, ACTH STim, DHEA-S--you should be good to go with cortisol. Get your pit hormones tested... eventually.... get LH/FSH with individual sex hormones.

I didn't have the opportunity to obtain baseline ACTH or ACTH stim prior to starting cortef in April. I was really bad off. We suspected hypopit prior to cortef. LOw DHEA-s, unable to produce breastmilk..... It's only been in the last few months that we have had the rest of my pit hormones tested. My LH/FSH are rock bottom (or less)...

Your Free's are pitiful. The doc needs to ignore TSH. Keep in mind that your Frees will likely drop once you start cortisol replacement.

I don't trust saliva sex hormones.

Hope this helps,
Laurie

[margaret]

Hi Laurie - Thank you, that helps. I already emailed my doc at kaiser and asked for more of the tests and she said no, she didn't think they were warranted. So, now I'll go to my other doc and focus on getting the cortisone and worry about the other tests later!

A few more questions....

1. How does my DHEA look?

(DHEA-Sulfate 127 (25-220 mcg/dL))

2. When you say my Frees are likely to drop when on cortisone are you saying I will have more hypothyroid symptoms?

If so, how long til I can address thyroid issues?

How are you doing? Are you getting relief from addressing these issues? I'm a little afraid to go on cortisone, I'm not suffering as much as some people do. Mostly I feel sluggish, never feel refreshed when I wake up. I'm grumpy and in a low mood a lot, wierd symptoms have come and gone over the years, but mostly just tired. My favorite thing to do lately is lie on my bed and watch tv. I'm kind of used to being this way, so it's hard to believe that there's actually something wrong w/ me physically.

I hope I'm on the right track. Thanks again!

[justaustin]

DHEA is pitiful. DHEA-S should be in upper 1/3 of range. Low DHEA,Low DHEA-S coupled with low cortisol is commonly associated with secondary adrenal insufficiency. High DHEA,High DHEA-S with low cortisol is seen with Primary Adrenal Insufficiency/ Addison's.

Cortisol is required for proper utilization of thyroid hormones. Much like insulin is required for moving glucose. YES to your answer. Expect thyroid hormone levels to change. Be prepared to have thyroid labs tested a few weeks after reaching target cortisol replacment.

Your symptoms sound SO familiar. I only feel "low" when my FT3 is low. Just tired. I am unable to work two days in a row because it drains me so. STill don't have the exercise stamina I used to. My immune system is much better. My hands no longer crack and bleed from September through March. I rarely get hypoglycemic.

Laurie

[margaret]

Went to my doctor (non-Kaiser one) today - BAD NEWS.

She doesn't think my results warrant cortisol, she doesn't buy any of this stuff.

I gave her STTM book last time. It didn't move her. She thinks cortisol is dangerous.

She doesn't think I need thyroid either based on my TSH. I thought she was more progressive, she ordered the other thyroid tests. I didn't realize she only looked at those results if the TSH was a concern. Would have been nice if she told me that so I didn't waste the money on unneccessary tests.

She thinks I have a "lifestyle issue" that may better be treated by changes to my diet, etc. (She didn't say that when she gave me progesterone!) BTW, she just took an acupuncture course and I'm sure she secretly thinks I should do acupuncture.

I am UPSET. I am doubting myself and you guys (sorry!). It's hard to hear a nice doctor tell you they think what you are doing is dangerous.

I don't even know if I should bother with all this. I function fine. Just feel tired a lot and experience other pesky symptoms that are annoying but not debilitating. Does it get worse if left untreated?

I need a pep talk and advice. What do I do now? Find another doctor and start all over? Self-treat? I thought this doc was going to help me but I was wrong.

Thank you for being here. I'm really feeling demorazlized and confused......

[justaustin]

Just cause a doc is "nice" doesn't make them competent. I'm sorry to read about your doc visit. You will just have to keep beating down doors until you find a good one. You may have to travel a distance and pay out of pocket.

Do not doubt yourself!! Trust your gut and what you have learned so far. The problem with today's docs is they focus on reference ranges. They have been brainwashed by big pharma while in medical school. They are unable to perform critical thinking and think outside the box/big picture. In the process of this they are unable to really look at the patient, listen to the patient and put it together.

How far are you willing to travel? I believe Crystallin has a doc in CO, Chris' doc in St.Louis...

Laurie

[margaret]

Okay, I'll trust my gut - that's hard sometimes.....

I live in the SF bay area and cannot afford to be flying around to doctors. I'll do what it takes, but have you heard of anyone aorund here?

Thank you.

[margaret]

I went to the new doctor today (from top thyroid docs list). He acknowledged a possible pituitary issue but did not acknowledge that my ACTH was indicative of hypopit. I'm not even sure if he was reading my Kaiser lab results correctly, understandably because they were confusing.

He wants me to do an Insulin Tolerance Test. So, in the spirit of cooperativeness I said maybe I would but they are checking on the cost and the possibility of me being in a study which would also measure my GH and get me a reduced price.

I am guardedly hopeful about this doctor. He did imply (it seemed) that he may be willing to try a trial of Cortef w/out the test, but he didn't seem eager to offer. I thought I'd check w/ you guys 1st on the ITT and see what your thoughts are.....I don't know anything about it and will do some research.

Thankyou!