Seconday Adrenal Insufficiency?

January 26, 2008

I recently had an acth stim test. And was told I am " normal "

Acth 11 (5-27)

Am cortisol 14.5

30 min 31.2

60 min 33.6

I felt strangely most of the day after the stim. But, felt FANTASTIC

about 7PM. Best I have felt in weeks.

I searched on the web for sdome studies which included a ACHT range

and found that some studies used 10-46 pg/ml and 9-52pg/ml.

I think that my acth is low, but the endo does not. I am wondering

about the stim test, as I read that it does not necessary exclude

secondary AI.

What should I do?

If my acth is artifically low or supressed as a result of my

seroquel treatment (quetiapine reduces acth and cortisol), then I

may get some function back if I go off it. Yet, I am still having

too much anxiety etc, to do this. However, if I go the Isocort or

cortef route, I may end up supressing my adrenals??

Any advice?

January 26, 2008

I would do the 24 hour adreanl stress testign form www.canaryclub.org

any anxiety you may eb having is probably form low coritosl.

--

Artistic Grooming- Hurricane WV

http://www.stopthethyroidmadness.com/

http://health.groups.yahoo.com/group/NaturalThyroidHormonesADRENALS/

http://www.seewell4less.com/Valspage.htm Medical Alert Bracelets

January 26, 2008

I did do one from Diagnos TEch prior to the stim. The endo saw the

results and decided to do a acth stim.

cortisol

7-8AM 15 (13-24)

11-noon 3 (5-10) depressed

4-5PM 4 (3-8)

11-mid 2 (1-4)

It says I am maladapted Phase II

____________ _________ ______

DHEA 1 (3-10) LOW

____________ _________ _________

hormones (in context of time of meses)

borderline low:

F testosterone 7 (borderline low 5-7; normal 8-20pg/ml)

Androstenedione 97 (borderline low 75-124pg/ml)

Estrdiol 8 (luteal 7-20pg/ml) my phase at time

Estriol 14 (cycling female (12-25 pg/ml)

high:

progesterone (very elevated) 837 (luteal 65-500pg/ml)

>

> I would do the 24 hour adreanl stress testign form

www.canaryclub.org

> any anxiety you may eb having is probably form low coritosl.

>

> --

> Artistic Grooming- Hurricane

WV

>

> http://www.stopthethyroidmadness.com/

>

http://health.groups.yahoo.com/group/NaturalThyroidHormonesADRENALS/

> http://www.seewell4less.com/Valspage.htm Medical Alert Bracelets

>

January 26, 2008

That range for ACTH is low (they've been lowering it over the last

few years for some reason.) And you're result was pretty low in the

range (should be in the upper third) - indicating secondary. Plus,

your cortisol level doubled after 60 minutes - again, indicating that

when properly " asked " your adrenals *can* produce. This also

indicates secondary adrenal insufficiency.

- Janet

> I recently had an acth stim test. And was told I am " normal "

>

> Acth 11 (5-27)

> Am cortisol 14.5

> 30 min 31.2

> 60 min 33.6

>

January 26, 2008

Thanks Janet

I see the endo in two weeks again. Should I push the issue to really

sort out whether I have secondary AI?

If by chance the 25 mg of Seroquel and the long-term Seroquel

treatment has temproarily supressed my HPA axis, then maybe my body

will heal in time. I was given the Seroquel prior to my hypo

diagnosis and I cut back on it after treatment.

On the other hand, the adrenal issue may have been long standing.

I started to be unable to tolerate my thyroid meds and so I am off

them temproarily.

Of course, the anxiety level is back up and the low dose Seroquel

not sufficient.

But, I am in this seeming vicioius cycle.

Ideally, I would like the endo (or someone) to test my pituitary

function with respect to the low ACHT, or run some other more

definitive test for ACTH deficiency or the like.

What do you think?

>

> > I recently had an acth stim test. And was told I am " normal "

> >

> > Acth 11 (5-27)

> > Am cortisol 14.5

> > 30 min 31.2

> > 60 min 33.6

> >

>

January 26, 2008

An ACTH Stim test is the best test to know if the problem is adrenal or

pituitary.

--

Artistic Grooming- Hurricane WV

http://www.stopthethyroidmadness.com/

http://health.groups.yahoo.com/group/NaturalThyroidHormonesADRENALS/

http://www.seewell4less.com/Valspage.htm Medical Alert Bracelets

January 26, 2008

It might not be your pituitary. In most cases of adrenal insufficiency it is

just the adrenals. Your cortisol levels look a little low and your DHEA is

very low. High progesterone on this test could be a false reading, as many

of us are getting that even with low progesterone on our blood tests.

Testosterone low is not too uncommon with low DHEA.

Are you planning on supplementing with DHEA and cortisol?

I personal don't think the ACTH STIM is very accurate, but it probably is

the most accurate for figuring out pituitary cause...just not fool proof.

Cheri

-----Original Message-----

I did do one from Diagnos TEch prior to the stim. The endo saw the

results and decided to do a acth stim.

.

January 26, 2008

Why do you feel it is pituitary instead of adrenal cortex caused? Just

wondering since your pituitary test came back normal and your labs look more

adrenal to me.

Cheri

--------------------

Ideally, I would like the endo (or someone) to test my pituitary

function with respect to the low ACHT, or run some other more

definitive test for ACTH deficiency or the like.

What do you think?

.

January 26, 2008

Val:

I wrote you last month, and you suggested at least doing a morning and

afternoon Isorcort supplementation.

I held off so as not to invalidate the ACHt stim.

Would you recommend the I take your adive now?

Thanks so much, Val.

>

> An ACTH Stim test is the best test to know if the problem is

adrenal or

> pituitary.

>

> --

> Artistic Grooming- Hurricane WV

>

> http://www.stopthethyroidmadness.com/

> http://health.groups.yahoo.com/group/NaturalThyroidHormonesADRENALS/

> http://www.seewell4less.com/Valspage.htm Medical Alert Bracelets

>

January 26, 2008

I've not heard of Seroquel, so did a quick Google - it's a benzo?

And you're taking for anxiety or depression? I don't think this

would explain your low ACTH. The main reason for finding out if you

are primary or secondary is to know of you will be on HC for life, or

will be able to wean some day. But given your low ACTH, I'd go with

secondary. You can always try to wean some day in the future, and

your body will let you know quick if that won't work.

Definitely stay off the thyroid meds until you get your adrenals

supported. And please be sure to take your temps at 3, 6 and 9 hours

after rising then calculate and plot the average (per

www.drrind.com). You want stable averages (not varying by more than

0.2 degrees from day to day) before starting back on thyroid meds.

And don't forget sea salt, vit. C and a good B multi. to support your

adrenals as well.

- Janet

January 26, 2008

> An ACTH Stim test is the best test to know if the problem is

> adrenal or

> pituitary.

>

Is there such thing as a CRH test that would determine the

response of the pit to th hypothalamus (although the pit manages some

parts of the cortisol cycle on it's own). It would be interesting to

know if people with SAD (seasonal affective disorder) have lowr-than-

normal 'H-P' function than people without. And whether long-term AF

can dampen the H-P link.

Jim

January 26, 2008

If you have done your testing I see no reason yto not start Isocort nowe.

--

Artistic Grooming- Hurricane WV

http://www.stopthethyroidmadness.com/

http://health.groups.yahoo.com/group/NaturalThyroidHormonesADRENALS/

http://www.seewell4less.com/Valspage.htm Medical Alert Bracelets

January 26, 2008

I had read that in typcial primary AI, the ACTH will usually be

high, while in secondary AI, the ACTH is typcially low or can be low

normal. It is only that the literature suggested that in cases of

secondary AI, there was pituitary involvement. It is certainly

possible I have a poor understanding of the literature, since I have

just started reading in the last month.

:-)

>

> Why do you feel it is pituitary instead of adrenal cortex caused?

Just

> wondering since your pituitary test came back normal and your labs

look more

> adrenal to me.

>

> Cheri

>

> --------------------

> Ideally, I would like the endo (or someone) to test my pituitary

> function with respect to the low ACHT, or run some other more

> definitive test for ACTH deficiency or the like.

>

> What do you think?

> .

>

January 26, 2008

Jim:

I had come across this in my readings. But it wasn't clear if it is

a commonly given test. It may be worth a try - at least I will ask

my endo.

>

> > An ACTH Stim test is the best test to know if the problem is

> > adrenal or

> > pituitary.

> >

> Is there such thing as a CRH test that would determine the

> response of the pit to th hypothalamus (although the pit manages

some

> parts of the cortisol cycle on it's own). It would be interesting

to

> know if people with SAD (seasonal affective disorder) have lowr-

than-

> normal 'H-P' function than people without. And whether long-term

AF

> can dampen the H-P link.

>

> Jim

>

January 26, 2008

If you do a search for quetiapine (Seroquel's actual name) and/or

cortisol and ACTH, there are a number of emerging studies showing

the action of Seroquel on downregulating the HPA axis by reducing

ACTH secretion and cortisol levels.

I found a press release which sums it up well re a presnetation made

at the APA (American Psychiatric Association)

The article below talks of a 300 mg dose. I am on 25 mg, but at one

time prior to my hypo treatment was on 300. Some months after I

started treatment for hypo, I slowly cut back on the seroquel and

eneded up on 25 mg for a period of a year. Since I became unable to

tolerate my thyroid meds, it has been difficult to manage the

anxiety at this dose.

The question I have, and noone in the medical fliedl is able to

answer is, should my ACTH and cortisol be what the tests state as a

result of my 35 mg Seroquel? Has the HAP axis been supressed as a

result of my Seroquel treatment? (3 years). Is this merely

incidental at this point becasue of the low dose of Seroquel and my

ACTH and cortisol have actually been a long-standing problem? Or, is

the Seroquel aggravating an already underlying problem?

It would be nice to have a more definitve answer to my endocrine

situation. I am glad at least my endo has been interested and not

pushed me off.

_________________________________________________________

Low Cortisol Caused by Quetiapine: Presented at APA

http://www.docguide.com/news/content.nsf/news/852571020057CCF6852572E

4004AAFBC

By a R.

SAN DIEGO, CA -- May 23, 2007 -- Some patients taking the atypical

antipsychotic quetiapine (Seroquel) are being diagnosed with

ambiguously-presenting adrenal insufficiency, according to findings

presented here at the American Psychiatric Association 2007 Annual

Meeting (APA).

Specific management of adrenal insufficiency caused by antipsychotic

use has not previously been studied.

" Adrenocortical insufficiency oftentimes presents ambiguously and

with our case study, we had looked at many different causes for [the

patient's] malaise before we ran an endocrine panel, " said presenter

Rasgon, MD, PhD, associate professor and director,

behavioural neuroendocrinology program, Stanford University, and

codirector, women's wellness program, department of psychiatry,

Stanford University, Stanford, California, United States.

A 54-year-old male with a history of depression and posttraumatic

stress disorder, who had previously been treated with psychotropic

medications, quetiapine 300 mg/day and bupropion 225 mg/day,

restarted his medications some 6 to 8 months after initial

cessation. A previous recent admission to the hospital was for a

urinary tract infection (UTI) and was treated with ciprofloxacin. He

later presented to the hospital with fatigue, warmth, chills, loose

stools, mild headache, and chest wall pain. Physical exam was

relatively normal except for tenderness to palpation in the

midclavicular line at the fifth rib. Laboratory results were also

normal, except for elevated eosinophils levels that had previously

been within normal limits.

The results of the man's work up for infectious, malignant, and

rheumatological causes were all negative. " We decided at that point

to look for endocrine causes as his symptoms became clearer, " Dr.

Rasgon said.

Early morning cortisol levels were low at 2.5 ug/mL. Cosyntropin

stimulation test was performed with cortisol levels appropriately

increasing from 4.2 mcg/mL to 20.4 mcg/mL, which made a primary

adrenal insufficiency unlikely. Brain magnetic resonance imaging was

negative for signs of a pituitary microadenoma, and testosterone,

prolactin, and insulin-like growth factor concentrations were within

normal limits; however, the adrenocorticotrophic hormone (ACTH)

level was less than 5 pg/mL, suggesting secondary or tertiary

adrenal insufficiency as the cause.

" At that point, we thought the 300-mg dosage of quetiapine had

reduced the patient's ACTH and cortisol levels, " Dr. Rasgon noted,

so the patient was given a dose of prednisone 20 mg qam and another

10 mg qhs, " a significant dosage. " The patient's condition improved

quickly and markedly, at which point he was discharged and referred

for follow-up to an endocrinologist and his psychiatrist.

Most symptoms of adrenal insufficiency are nonspecific, and

misdiagnosis or failure to diagnose is a common occurrence, with

about half of presenting patients having signs and symptoms of

primary adrenal insufficiency for more than 1 year before a

diagnosis is established.

Symptoms of adrenal insufficiency include weakness and fatigue,

abdominal distress, anorexia, nausea and vomiting, myalgia or

arthralgia, postural dizziness, salt craving, headaches, memory

impairment, and depression.

Physical exam findings include increased pigmentation, postural

hypotension, tachycardia, fever, decreased body hair, vitiligo,

amenorrhoea, and intolerance to cold.

Quetiapine's 5-HT2 receptor blocking properties are thought to cause

a strong inhibitory effect on ACTH and cortisol secretion. Other

receptors blocked by quetiapine including dopaminergic, adrenergic,

or histaminergic receptors might also be involved, according to the

researchers.

" Although discontinuing the offending agent would seem appropriate,

the risks of worsening the patient's psychiatric symptoms versus

benefits of preventing adrenal insufficiency sequelae should be

weighed, " the study suggested.

Quetiapine is approved by the US Food and Drug Administration for

the treatment of depressive episodes associated with bipolar I or II

disorder.

_________________________________________________________

>

> I've not heard of Seroquel, so did a quick Google - it's a

benzo?

> And you're taking for anxiety or depression? I don't think this

> would explain your low ACTH. The main reason for finding out if

you

> are primary or secondary is to know of you will be on HC for life,

or

> will be able to wean some day. But given your low ACTH, I'd go

with

> secondary. You can always try to wean some day in the future,

and

> your body will let you know quick if that won't work.

>

> Definitely stay off the thyroid meds until you get your adrenals

> supported. And please be sure to take your temps at 3, 6 and 9

hours

> after rising then calculate and plot the average (per

> www.drrind.com). You want stable averages (not varying by more

than

> 0.2 degrees from day to day) before starting back on thyroid

meds.

> And don't forget sea salt, vit. C and a good B multi. to support

your

> adrenals as well.

>

> - Janet

>

January 26, 2008

Hey Val,

MY ACTH stim test still didn't tell the endo whether my adrenal insufficiency

was adrenal or pituitary. He still doesn't know what's causing it, although he