Adrenal Thread

[marianco]

Originally Posted by SPE

As I understand it, the ACTH Stim is THE FINAL say wrt adrenal issues. It measures how your body reacts under stress with cortisol. If the response is low, then your response to stress is low. Individuals with cortisol levels in the normal range as identified by a saliva test, could have very poor responses to stress and therefore feel bad. This is also adrenal insufficiency.

The problem of using blood tests such as serum cortisol and ACTH-stimulation is in the interpretation and design. The tests are often designed to look for extremes such as in Addison's Disease and Cushing's Disease. It is more difficult to interpret for disorders that involve small changes from the average.

As another example, often the "normal range" for TSH (thyroid stimulating hormone) is between 2.0 to 5.0. The problem is that this norm was arrived at without excluding people with hypothyroidism. Thus the numbers are skewed. Using the normal range, a TSH under 5.0 would be thought of as being normal and not hypothyroid. But that is not the case. If the Free T3 and Free T4 are checked, often such a person would be hypothyroid. As a result, I use a TSH of > 2.0 to determine hypothyroidism - verifying it wiht the Free T3 and Free T4. In other words - the TSH is essentially useless in determining hypothyroidism. It would be best to just check Free T3 and Free T4.

When it comes to hyperthyroidism, the TSH is also not very useful. It often a TSH near zero stirs alarm when no alarm need be there. The TSH is the brain's idea of how much thyroid hormone activity there is. It is not necessarily how much thyroid hormone is actually there - because there can be a disconnect in disease states. A truer measurement of hyperthyroidism is the Free T3 and Free T4.

[marianco]

Originally Posted by SWALE

Mariqanco--Do SSRI's increase T4 to T3 conversion (outside of their ability to through stated purpose of reducing stress for the patient)?

I corrected my note - removing that reference. Mea culpa - I shouldn't write when I'm tired.

Thyroid function and serotonin activity are highly linked. Both need to be addressed to optimize function.

T3 (the active thyroid hormone created from T4 in the liver by the 2D6 enzyme) desensitizes presynaptic serotonin autoreceptors - thus leading to an increase in serotonin production. Giving T3 induces serotonin production. Similarly, in hypothyroidism, serotonin production is reduced. T3 augments the effects of serotonin-increasing medications (such as the SSRIs) by the additive effect both have on desensitizing presynaptic serotonin autoreceptors.

Serotonin stimulates hypothalamic TRH production, leading to an increase in TSH production from the pituitary. Adequate serotonin production is necessary to maintain thyroid hormone levels. Increasing serotonin levels with an SSRI may thus help improve thyroid hormone production.

A caveat: Theoretically, an excess serotonin may lead to the opposite reaction. For example, excess serotonin leads to reduction in dopamine production, which then leads to increased norepinephrine production, leading to an increased stress response and cortisol production.

High levels of cortisol (which can also be caused by high stress levels, low testosterone, etc.) can directly lead to suppression of pituitary TSH secretion, and impair conversion of T4 to T3, and can impair serotonin function (by reducing serotonin receptor density, increasing serotonin uptake via increase in serotonin transporter production, and by increasing tryptophane oxygenase production in the liver - thus reducing tryptophan, the precursor to serotonin).

It may be thus important to have an idea of serotonin levels (unless one has a good clinical feel as to a patient's clinical response to assess serotonin levels - as a psychiatrist may have) by measuring urine serotonin levels. This, somewhat, correlates with brain serotonin levels, though I am still assessing this for clinical utility.

[1cc]

Originally Posted by ASaxon

It certainly is cheaper and less of a hassle.

A saliva test that takes 4 samples during the day, which is required will cost $100. A Urine analysis for Free Cortisol will cost $25. So saliva is more expensive.

The following is from the book "Adrenal Fatigue: The 21st Century Stress Syndrome" by Dr. James Wilson page 83:

Regarding Saliva Cortisol testing:

"It is the best single lab test available for detecting adrenal fatigue and has several advantages over other lab tests in determining adrenal hormone levels."

For the rest of the passage, please read the book (it's too long to type).

[marianco]

Originally Posted by 1cc

A saliva test that takes 4 samples during the day, which is required will cost $100. A Urine analysis for Free Cortisol will cost $25. So saliva is more expensive.

The following is from the book "Adrenal Fatigue: The 21st Century Stress Syndrome" by Dr. James Wilson page 83:

I heartily recommend James Wilson's book. It's a great start regarding adrenal fatigue.

Here are some costs for comparison between blood and saliva tests:

Salivatest.com/ZRTLabs
- Cortisol x 2 (AM/PM) Saliva Test $60
- Cortisol x 4, DHEA x 4 Saliva Test $150

LEF.org/Life Extension Foundation
- Cortisol x 2 (AM/PM) Blood Test $72 members, $96 non-members
- Cortisol x 1 Blood Test $39 members, $52 non-members
- DHEA-S x 1 Blood Test $61 members, $82 non-members

Sanesco.net/Sanesco International
- Cortisol x 4, DHEA x 2 Saliva Test $89

Quest Diagnostics
- Cortisol x 1 Blood Test $127
- DHEA-s x 1 Blood Test $136

The blood test give an idea, when combined with other lab tests about the presence of adrenal fatigue. One can do four blood tests in a day to get better sensitivity - but then what patient wants to get poked with a needle four times in a day?

The saliva tests - involving multiple samples in a day - are much more sensitive in helping diagnosis adrenal fatigue than an AM/PM Cortisol blood test along with a single DHEA-s.

Be-that-as-it-may, some patients cannot afford to pay out of pocket, even for a saliva test, yet they have health insurance coverage - even if it is Medicaid or Medicare. I will take whatever test I can get to help the patient.

Some patients don't have health insurance at all and are poor but not poor enough to get government health insurance. In this case, I use my clinical skills and experience to arrive at the diagnosis and treatment. With informed consent, I would treat the person if the benefits of treatment outweigh the risks - of course, if not, I would not. Medicine, most of the time, is an art. As we generally learn in medical school, 90% or more of the diagnosis is arrived at by the history and physical - when one has clinical-saavy and medical street-smarts. It certainly is nice though to get labs. It gives you clear road-signs and specific goals to achieve. Whether or not it can be done depends on the patient.

[1cc]

Originally Posted by marianco

Sanesco.net/Sanesco International
- Cortisol x 4, DHEA x 2 Saliva Test $89

Thanks for the info. This is an excellent price. The best price I could find for the equivalent was $125.

[ASaxon]

Oh well, I thought for sure the saliva tests would be cheaper but perhaps it’s too new a method for that to be true. At least it’s more convenient. :-)

The following is from the book "Adrenal Fatigue: The 21st Century Stress Syndrome" by Dr. James Wilson page 83:

Regarding Saliva Cortisol testing:

"It is the best single lab test available for detecting adrenal fatigue and has several advantages over other lab tests in determining adrenal hormone levels."

Hmmm, I’ve read differently but perhaps my information is outdated. Don’t know if this makes a difference but my research was in relation to diagnosing Cushing’s Syndrome (high cortisol) and not Addison’s Disease (low cortisol.) Perhaps the saliva tests are better for adrenal fatigue but I’ve read differently from other sources so I guess until I see the data I can’t see it as being as reliable as a 24-hour urine test which has been the gold standard for years. Perhaps recent data now shows that it’s more accurate than it was a few years ago. Either way it certainly is more convenient. It did suck carrying a jug around with me all day.

[SPE]

You all are awesome, thanks for the help!

[Vforcer2]

Originally Posted by marianco

The problem of using blood tests such as serum cortisol and ACTH-stimulation is in the interpretation and design. The tests are often designed to look for extremes such as in Addison's Disease and Cushing's Disease. It is more difficult to interpret for disorders that involve small changes from the average.

As another example, often the "normal range" for TSH (thyroid stimulating hormone) is between 2.0 to 5.0. The problem is that this norm was arrived at without excluding people with hypothyroidism. Thus the numbers are skewed. Using the normal range, a TSH under 5.0 would be thought of as being normal and not hypothyroid. But that is not the case. If the Free T3 and Free T4 are checked, often such a person would be hypothyroid. As a result, I use a TSH of > 2.0 to determine hypothyroidism - verifying it wiht the Free T3 and Free T4. In other words - the TSH is essentially useless in determining hypothyroidism. It would be best to just check Free T3 and Free T4.

When it comes to hyperthyroidism, the TSH is also not very useful. It often a TSH near zero stirs alarm when no alarm need be there. The TSH is the brain's idea of how much thyroid hormone activity there is. It is not necessarily how much thyroid hormone is actually there - because there can be a disconnect in disease states. A truer measurement of hyperthyroidism is the Free T3 and Free T4.

After reading a great deal in the thyroid forums and speaking to those there with a lot of experience, I came to the same conclusions that TSH is of little use. Free T3 and Free T4 are the important tests.

[Vforcer2]

Originally Posted by marianco

I heartily recommend James Wilson's book. It's a great start regarding adrenal fatigue.

Here are some costs for comparison between blood and saliva tests:

Salivatest.com/ZRTLabs
- Cortisol x 2 (AM/PM) Saliva Test $60
- Cortisol x 4, DHEA x 4 Saliva Test $150

LEF.org/Life Extension Foundation
- Cortisol x 2 (AM/PM) Blood Test $72 members, $96 non-members
- Cortisol x 1 Blood Test $39 members, $52 non-members
- DHEA-S x 1 Blood Test $61 members, $82 non-members

Sanesco.net/Sanesco International
- Cortisol x 4, DHEA x 2 Saliva Test $89

Quest Diagnostics
- Cortisol x 1 Blood Test $127
- DHEA-s x 1 Blood Test $136

The blood test give an idea, when combined with other lab tests about the presence of adrenal fatigue. One can do four blood tests in a day to get better sensitivity - but then what patient wants to get poked with a needle four times in a day?

The saliva tests - involving multiple samples in a day - are much more sensitive in helping diagnosis adrenal fatigue than an AM/PM Cortisol blood test along with a single DHEA-s.

Be-that-as-it-may, some patients cannot afford to pay out of pocket, even for a saliva test, yet they have health insurance coverage - even if it is Medicaid or Medicare. I will take whatever test I can get to help the patient.

Some patients don't have health insurance at all and are poor but not poor enough to get government health insurance. In this case, I use my clinical skills and experience to arrive at the diagnosis and treatment. With informed consent, I would treat the person if the benefits of treatment outweigh the risks - of course, if not, I would not. Medicine, most of the time, is an art. As we generally learn in medical school, 90% or more of the diagnosis is arrived at by the history and physical - when one has clinical-saavy and medical street-smarts. It certainly is nice though to get labs. It gives you clear road-signs and specific goals to achieve. Whether or not it can be done depends on the patient.

I did my 4 X per day saliva test a couple of weeks ago. I will discuss my results with my N.D. on Tuesday. The test was from Neuroscience Labs and was $74.

[SWALE]

I have met Dr. Wilson, and certainly respect him, but reliance on saliva testing is frought with peril.

24 hour urines give you the total amount produced during an entire day. Saliva is a spot check. Urinary testing is as accurate as testing gets; saliva is well-known to be highly innaccurate. However, the 24 hour urines will not demonstrate fluctuations throughout the day, as spot testing--whether saliva or serum--will.

If somneone cuts you off in traffic on the way to the draw point, that will falsely elevate your cortidol level. So may the sight of the needle.