adrenals - need doc in NY or NJ

[Guest guest]

I have the results of my adrenal tests. Does anyone in New York

(preferably New York City) or New Jersey have a doctor who has

diagnosed and is treating their adrenal insufficiency they can

recommend? My nephrologist friend, Dr. A, is not happy with how the

tests were run (the Cortisol specimen sat for over a week) and

considers the results could still be problematic. My endo who had

these run hasn't contacted me, I had to ask for the results, so I

guess he thinks everything is fine.

ANyway, the results:

(These were run in the afternoon):

ACTH, plasma - 15 (5-27)

Cortisol, total, serum - 5.6 (Cortisol PM 3.0-17.0)

21-hydroxylase AB - <1.0 (<1.0)

A note on the labs said the adrenal antibody (21-hydroxylase), the one

my endo supposedly invented, has not been approved by the FDA.

More below on what Dr. A says, if it's of interest... I think most of

you know this already:

--

ly- I'm personally not really happy with the test conditions or

the results. The low level antibody is fine- good to know there isnt

an adverse antibody of any type floating around causing mischief. The

Cortisol is within the normal range they provided but on the low end

while your inherent stimulatory agent is not on the lower end but

middle range. My big problem with the this is that morning levels

(when things are supposed to be in a stimulatory phase) really reveals

what the adrenal gland is capable of responding to. By afternoon

things are supposed to be lower so I dont get a good feel for if the

gland is capable of being stimulated when asked to - or if it just

churns along at a low grade response most all the time.

Say for instance all engines are running at full capacity and you can

only rev up to a certain level - that may be fine if the gland isnt

asked to do more - BUT - during times of stress or higher demand it

needs to rev WAY up to help the body cope with the neccesary adaptive

responses. Thats why a stimulation test is valuable- it gives you a

graph of the glandular response to increased demand. I've run several

tests where the BASELINE values are normal (like yours) but when you

try to stimulate the gland it initially starts to produce more- but

then tapers off. It can walk, it can jog... but it cant RUN if asked

to. Thats valuable information.

I personally think the test should have been run in the morning and

that one baseline level doesnt tell the whole story- BUT that having

been said your baseline values do appear to be normal. Your also right

in your concern about the time th etubes may have sat. I'm not really

happy about that either. Most labs only run unfamiliar tests on

certain days of the week. In the hospital we ran cortisol, ACTH etc on

Tuesdays and Fridays - So we only drew the test on those days to get

acurate results. A stat rapid cortisol was available through the ER

(for adrenal crisis patients) but the results werent as accurate. If

it sits for a long time, depending on the temperature where it sat

either the ACTH or the cortisol (or both) may have degraded.

Give me a little time to think more about this....

Those are my off the cuff remarks- I dont think you should be overly

concerned because the baseline values you got back are OK. Theres

obviously nothing GROSSLY out of whack- but in a case like yours-

where it seems we may be dealing with a more subtle imbalance I'd

prefer we be more discriminating and careful than usual.