Adrenal Thread

[SPE]

Originally Posted by 1cc

I agree. The more indicators that point in the same direction, the better.

With adrenal fatigue, in many instances, the clinical symptoms themselves together with a persons history (Dr. Wilson's questionnaire's) are more than sufficient to make a diagnosis. In my case I was a textbook case for Adrenal Fatigue. Doing the Saliva tests was a nice confirmation of my clinical symptoms and history. It also allowed me to see at what times I would benefit most from hydrocortisone. I was low in the morning, afternoon, and before bed. I was normal at dinner time. My serum DHEA-s was very low normal. Taking hydrocortisone and DHEA helped tremendously, and so did TRT.

I started taking Isocort about a week ago and so far I feel great. My cortisol drops between 11am and 4pm, and that's when I feel the worst. Thyroid meds only made it worse. I've been taking 4 Isocort, which is close to the equivelant of 10mg cortef and my symptoms have subsided greatly. I've also been able to increase my armour dosage and still feel good.

[Vforcer2]

Originally Posted by SPE

I started taking Isocort about a week ago and so far I feel great. My cortisol drops between 11am and 4pm, and that's when I feel the worst. Thyroid meds only made it worse. I've been taking 4 Isocort, which is close to the equivelant of 10mg cortef and my symptoms have subsided greatly. I've also been able to increase my armour dosage and still feel good.

SPE, you are learning the same stuff that I am. I ordered some Isocort yesterday, but I was unaware that it could be of the same potency of Cortef. I read where some people are on both. They say what if you up your Armour that you should take the Isocort for 3 days to week to help the Adrenals deal with the new Thryroid hormones. I just joined the forums www.stopthethyroidmadness.com a couple of days ago. You can read my conversation there with Val, who is on Armour, Cortef, and Isocort. She recommended I try the Isocort before going to the more potent Cortef steriod.

[SPE]

Originally Posted by Vforcer2

SPE, you are learning the same stuff that I am. I ordered some Isocort yesterday, but I was unaware that it could be of the same potency of Cortef. I read where some people are on both. They say what if you up your Armour that you should take the Isocort for 3 days to week to help the Adrenals deal with the new Thryroid hormones. I just joined the forums www.stopthethyroidmadness.com a couple of days ago. You can read my conversation there with Val, who is on Armour, Cortef, and Isocort. She recommended I try the Isocort before going to the more potent Cortef steriod.

I agree about starting with the Isocort first, as that's exactly what I did. It's a natural form of cortisol, like Armour. It's not as potent as Cortef OR prednisone, but why use those if you don't have to? I have noticed a side effect from the Isocort. I'm always hungry! That's a good thing though as before that my appetite was kind of non-existent.

[1cc]

Originally Posted by SPE

I started taking Isocort about a week ago and so far I feel great. My cortisol drops between 11am and 4pm, and that's when I feel the worst. Thyroid meds only made it worse. I've been taking 4 Isocort, which is close to the equivelant of 10mg cortef and my symptoms have subsided greatly. I've also been able to increase my armour dosage and still feel good.

Thats great! Glad you're feeling better. If you're going to take Isocort, then you might as well take hydrocortisone, because the only active ingredient in the Isocort is the cortisone. I think the generic hydrocortisone is cheaper as well. I have used Isocort before, and each pellet is supposed to contain approx. 2.5mg cortisol.

[Vforcer2]

Originally Posted by 1cc

Thats great! Glad you're feeling better. If you're going to take Isocort, then you might as well take hydrocortisone, because the only active ingredient in the Isocort is the cortisone. I think the generic hydrocortisone is cheaper as well. I have used Isocort before, and each pellet is supposed to contain approx. 2.5mg cortisol.

I am not complaining about the price. It requires no office visits to the doctor, and can be ordered at will. I just paid $25 including shipping here: http://www.naturalnutritionals.com/bz106.html

[love_en]

I know a overseas pharmaceutical broker who can ship hydrocortisone, prednisone, and Florinef to the US. The URL is at hand pending the results of my Adrenal test.. I think Cortef is only about $30 for 100 10mg tablets.

[trt4lf]

Question for Chris and Swale:

I'm still evaluating salivary testing. Often there is quite a disparity between saliva, blood and urinary levels regarding cortisol and DHEA.

How would you explain low salivary cortisol levels and high DHEA levels (salivary 1200-1600) or DHEA-S in men not on DHEA supplemention. They all have uniformly low testosterone, estradiol and elevated progesterone levels. Thyroid function is normal based on FT3 and FT4 levels. Some men are hypertensive, 10-20 pounds overweight but are otherwise active. I don't know the plasma renin or aldosterone levels. Do you have any thoughts?

[SPE]

Judging by all of the tests I've had so far, I may be hypopituitary. My pre-treatment levels were:

Total T - 302 (241-827)
LH - 1.6 (1.2-8.6)
FSH - 1.6 (1.27-19.26)
Cortisol am - 17 (2-22) Range is skewed, cortisol should be upper twenties
DHEA - 262 (280-640)
FT3 - 3.1 (2.2-4.3)
FT4 - 6.3 (4.5-12)

ALL of the pituitary hormones are LOW. Could this be the cause of my hypogonadism. Could some cases of secondary hypogonadism actually be hypopituitary?

[pmgamer18]

Originally Posted by SPE

Judging by all of the tests I've had so far, I may be hypopituitary. My pre-treatment levels were:

Total T - 302 (241-827)
LH - 1.6 (1.2-8.6)
FSH - 1.6 (1.27-19.26)
Cortisol am - 17 (2-22) Range is skewed, cortisol should be upper twenties
DHEA - 262 (280-640)
FT3 - 3.1 (2.2-4.3)
FT4 - 6.3 (4.5-12)

ALL of the pituitary hormones are LOW. Could this be the cause of my hypogonadism. Could some cases of secondary hypogonadism actually be hypopituitary?

Have you had an MRI on your Pituitary Gland.

[SPE]

Not yet.

[pmgamer18]

Originally Posted by SPE

Not yet.

Next test what do you think.

[SPE]

Yes, I agree it's something I need to do soon. Especially upon figuring much of this is pituitary related.

[love_en]

I had a pituitary MRI done. Showed nothing that would convince the endo to help me. I have low T, low LH, low FSH, and a questionable response to an ACTH stimulation test. It was nice to know I do not have a pituitary tumor, but my symptoms should have caused doctors to question if my low-normal results are really adequate to keep me healthy.

[SPE]

Originally Posted by love_en

I had a pituitary MRI done. Showed nothing that would convince the endo to help me. I have low T, low LH, low FSH, and a questionable response to an ACTH stimulation test. It was nice to know I do not have a pituitary tumor, but my symptoms should have caused doctors to question if my low-normal results are really adequate to keep me healthy.

Yeah I'm a little frustrated how two docs, one being an endo can take a look at my symptoms and NOT order a pit mri. It would definately explain my symptoms and numbers. I read something recently that said a study was done on many autopsy reports showing that as many as 1 in 5 people have pit tumors. SO I guess these things are MUCH more common than reported (1 in 10,000)

[marianco]

Originally Posted by zadok

My FT level will not raise above the bare minimum, TRT, or no TRT. TT can be v high, but FT is always v low. It is not Estrogens causing the prob cause i have eliminated that. SHBG is v.v low also. Scientifically, the test must be going somewhere, or binding to something else, which must be high. My question is what else does test bind to? My Albumin is high normal 46nmol/l (35-50), however i dont think that would be causing this problem, what else could it be?

Total testosterone consists of:
1. Testosterone strongly bound to Sex Hormone Binding Globulin - inactive
2. Testosterone weakly bound to Albumin - potentially active
3. Testosterone which is free - fully active

Measuring Bioavailable Testosterone (free and weakly bound) is important when questioning the effectiveness of TRT, if free T is low.

Albumin makes up about 70% of the circulating protein in the blood. It is highly important to maintain blood pressure and to transport other substances.

By weakly binding Testosterone, Albumin protects Testosterone from being destroyed in the liver. Free Testosterone itself may last only about 70 minutes before being destroyed. Testosterone bound to Albumin may be considered the body's way to create a natural extended-release form of testosterone - just as medications often come in an extended-release version.

High albumin level is primarily associated with dehydration.

Dehydration and high albumin level is one possible clue that adrenal fatigue or insufficiency is occurring. In adrenal fatigue or insufficiency, besides cortisol and DHEA, not enough aldosterone is produced. Aldosterone is important in maintaining sodium level, fluid and salt balance in the body, maintaining blood pressure.

Adrenal fatigue or insufficiency may contribute to sexual dysfunction (and other conditions) and can lower testosterone production.

[marianco]

Originally Posted by zadok

No doctors can get my FT to raise above v.v low levels. My TT can be very high, but FT will not go up. (SHBG is vv low as well) Actually the higher TT goes, the lower FT goes. I had E2, Estrone and Estriol tested and they are all low normal. I am so frustrated, I have been like this for 1.5 years, no sign of getting better.

When bioavailable testosterone levels and total testosterone levels and estrogen levels are good but sexual dysfunction/depression/anxiety/frustration/etc. persists, then the most important step I've found is to check for adrenal fatigue.

When many of my patients describe feeling "frustrated", "desperate", "crabby", "grouchy", "moody", "snappy", "touchy" - when they are irritable, have frequent mood swings, have frequent panic - I look for adrenal fatigue.

Whenever a patient repeatedly calls me in a crisis, I look for adrenal fatigue.

The inability to maintain a stable temper or mood often indicates that one's ability to adapt to stress is overwhelmed or impaired.

The adrenal glands - which are specialized components of the peripheral nervous system like the hypothalamus is a specialized component of the central nervous system - are one of the main components of our body which allows us to adapt to stress.

When the adrenal glands are well-functioning, but stress is very high, the excessively high cortisol levels produced can cause depression, mood instability, and psychosis. The high cortisol levels can cause insulin resistance, which then lower testosterone production and cause sexual dysfunction.

When the adrenal glands are worn down by chronic stress, the low cortisol levels produced (as well as low levels of the about 150 different neurotransmitters and hormones produced), lead to mood instability, depression, anxiety, low testosterone production - and sexual dysfunction.

[marianco]

Originally Posted by mxim

are you saying a longer acting stimulant would protect me from potential adrenal fatigue ? is it only seen with short acting drugs like ritalin? can using these drugs cause PERMANANT damade to the adrenal glands?

Would you please point to the post where you came to your conclusion? Thanks.

All stimulants (both short and long-acting) demand more output from the adrenal glands. One metaphoric way of looking at this issue is that the adrenal glands are like the engine of a car. Using a stimulant is like pressing the accelerator pedal of the car.

All stimulants can eventually wear down the adrenal glands causing adrenal fatigue. Longer-acting stimulants can also cause adrenal fatigue. However, because the peak blood levels are lower, there is a lower risk of doing so. However the higher dose dose, the higher the risk of adrenal fatigue.

I do not know if they can cause permanent damage to the adrenal glands. I have yet to see a case of that in my more than 15 years of practice.

Total failure of the adrenal glands - an Addison's Disease crisis - quickly causes death (in about a day) since cortisol is absolutely necessary for life.

I haven't seen cases of Addison's disease (severe adrenal insufficiency) in patients treated appropriately with stimulants.

[marianco]

Originally Posted by zadok

Cortisol is low normal, so it cant be that....

When a person has a low normal blood cortisol level, Adrenal Fatigue may be suspected.

The problem of using blood tests to determine the presence of Adrenal Fatigue is that the tests are designed for determining the extremes of adrenal function - such as Addison's Disease (where there is near zero cortisol produced) or Cushing's Disease (where there is excessive cortisol produced).

Adrenal fatigue is a deviation from the mean which is not recognized by endocrinologists as an illness because it is not extreme, but which can cause devastating behavioral symptoms and impairment, nonetheless. The signs of Adrenal fatigue are not far from normal - thus a primary care physician may not find anything wrong.

Blood test findings may include (not all may be abnormal - its the pattern that clues us in):
1. low normal cortisol
2. low to low normal DHEA
3. low to low normal progesterone
4. low potassium
5. low sodium
6. low normal blood sugar
7. low normal hemoglobin A1c - with a low normal mean blood sugar

The best test I've found so far is doing a saliva test at least four times in a day for cortisol and DHEA. The saliva test is more sensitive than the blood test for deviations near the mean. Here, adrenal fatigue sticks out like a sore thumb.

In adrenal fatigue, the adrenal glands have not failed - like in Addison's Disease. Rather, then "sputter" - unless severe - where they may sometimes work, and sometimes not.

Other clues to adrenal fatigue (without other illnesses such as diabetes or hypertension):
1. low normal blood pressure (for which a person would receive praise and told they will live long - with the primary care physician totally missing the presence of adrenal fatigue by not doing further investigation).
2. sugar cravings
3. salt cravings
4. fatigue or sleepiness in the late afternoon
5. insomnia
6. occasionally feeling lightheaded when changing position
7. feeling cold often; low body temperature
8. a tendency to tremble, particularly under pressure
9. feeling better after a meal (unless severe)
10. low libido
11. lack of energy - in the morning making it difficult to get out of bed.
12. wanting to sleep in late
13. feeling better when stress is reduced - such as by going on vacation
14. needing coffee or stimulants to function
15. frequent colds
16. PMS symptoms in women
17. depressed or anxious mood, irritability, difficulty handling strress
18. irritable bowel symptoms
19. asthma-like symptoms
20. difficulty in concentrating, impaired memory

Many symptoms of adrenal fatigue are similar to the symptoms of having low testosterone - e.g. low sex drive, depression, fatigue, poor concentration, anxiety, irritability, etc.

One of testosterone's roles is to prevent overdriving the adrenals. It limits the stress response so that stress is not chronic. It reduces pituitary ACTH secretion, which reduces cortisol production. It also directly reduces adrenal gland output, independent of ACTH.

Thus, when a person develops low testosterone (or low progesterone for women), such as with age, he is also susceptible to developing adrenal fatigue.

[SPE]

How to address testosterone in the presence of adrenal insufficiency/hypothyro?

1. low normal cortisol - yes, 17 for am range 2-22
2. low to low normal DHEA - BELOW MINIMUM W/O SUPPLEMENTATION
3. low to low normal progesterone
4. low potassium - VERY LOW
5. low sodium
6. low normal blood sugar
7. low normal hemoglobin A1c - with a low normal mean blood sugar


2. sugar cravings - as a kid I lived on sugar
4. fatigue or sleepiness in the late afternoon - yup
7. feeling cold often; low body temperature - upon waking this morning it was 96.7
10. low libido - yes!
11. lack of energy - in the morning making it difficult to get out of bed. - used to HATE mornings before starting isocort and armour
12. wanting to sleep in late - see above
14. needing coffee or stimulants to function - I would live on quad shot iced americanos. The stronger the better
15. frequent colds - sinus infections
17. depressed or anxious mood, irritability, difficulty handling strress - yes
20. difficulty in concentrating, impaired memory - yes

Which brings me to my question. Prior to any supplementation, my levels hormone levels were as follows:

Test - 302 (241-827)
LH - 1.6 (1.6-9.1)
FSH - 1.6 (1.4-17)
DHEA - 218 (250-650)
Cortisol - 17 (2-22)

Looking at these, many progressive doctors would say I have secondary hypogonadism. BUT, my cortisol and DHEA are both low. Which brings me to treatment. Upon going on testosterone and getting my levels into the UPPER 3/4's, I still felt blah. It wasn't until the addition of armour, then isocort that I really began to feel better. In a case such as this, WHY ARE TESTOSTERONE LEVELS TREATED WITH TESTOSTERONE? Isn't this treating the secondary effect and NOT the cause? Would treating testosterone with an LH analog be more appropriate? I have now doubt that improving both cortisol and thyroid will improve the above testosterone number. Adding in something like HCG, Selegiline, or tamox/clomid would address part of the cause, wouldn't it? Maybe I'm just rambling.