Confusion

[Terca]

Hello all... wasn't sure if I should start new thread, but didn't want to piggyback on anyone else and minimize their postings since I wasn't sure where I fit in, if at all.
Here's the scoop - I was diagnosed with celiac disease about 6 years ago, and for past two years feeling like I may as well go back to eating gluten because I felt the same... tired to the point of napping on the floor in my office (everybody wondered why I had such a nice shag rug in my office, little did they know!!), dizzy at times, headaches at times (both migraines with the cool spots and not) short of breath, really really cold all the time but sweating lots, and cranky...
about 5 months ago, got really sick, high fever, technicolor yawns, couldn't swallow well, got bronchitis and my blood pressure dropped below 100. slowly got better.
About 3 months ago, my TSH jumped from 1.5 average over the years to 4.65, and my PCP found a bump on my thyroid she didn't like. Ended up at an endocrinologist, who thought maybe Addison's in addition to possible hypothyroidism (or Hashimoto"s)... my blood pressure goes from 115/75 to about 95/70 after standing, still, to this day.. And my surgeon, since my thyroid lump came back needing surgery to fully diagnose didn't want to operate on my until they had me stabilized...
Here's the weird part, read up on Addison's, totally fit, consulted with family and even some medical family friends, therapist, etc... all said, yes, finally figured out what's wrong with you. But, I'm told I'm not and I'm back to it's all in your head, even though I'm left still feeling yucky to the point where even trying to function on a daily basis is a struggle...... any info/feedback/tips?

BUN: 4
Cortisol fasting AM - 4.3
ACTH: 7
Aldosterone : 3
Plasma Renin: 4.0

and my STIM?? test where they test cortisol an hour after injection of something : 20
and my thyroid tests for Hashimoto's : normal ranges.. (not sure what else to post)

Am I missing anything or the doctor's missing anything? Is it possible all to be thyroid but have the "feel" of Addison's? (oh, and yes I'm completely compliant with the gluten-free diet, they've even blood tested me to make sure... I just dream of fast food! lol)

Thanks in advance for any responses... and know that I have an amazing amount of respect and admiration for all who have posted here and are so strong to have overcome so much and still be running marathons and loving life! I am truly in awe....

[Idaho Dusty]

Lisa,

So you're not diagnosed with Addison's?  They decided that your stim test results did not constitute adrenal insufficiency?  Did you have the low dose (1 mcg) or high dose (250 mcg) stim test?  Do you have the actual results?  If not, you should get them.  You did not stim very high.   Most doctors don't or won't diagnose adrenal insufficiency until 90% of the adrenal function is lost.  That puts many people in a grey area where they suffer needlessly.  If your thyroid is being treated and you do have untreated adrenal insufficiency, you can feel AWFUL!

Get your stim test results
Put your results here with ranges
Do you take any drugs?  At what times and doses?
Have you had a pituitary MRI with contrast?
Anti adrenal antibodies tested?

Remember, I'm not a doctor and I don't play one on TV!

Sorry you are feeling so awful.

Do you have a good, open minded GP or gyn who would order blood work for you?  If so, that's where I'd get an appointment and make of list of blood work (we can help you make that list here) to ask for.

There's hope!  I think prediagnosis is the worst part of being sick.  Once you figure out what you're fighting with, you can overcome it.

Keep asking and answering questions, you'll get ideas and get hope that there's a light at the end of the tunnel.

:) Dusty

[Terca]

Hi Dusty -thanks so much for taking the time to write back, and of course I recognize that you're not a doctor, but I do know form years of being "medically challenged," that our peers who have gone through various struggles before us and researched things can help me not have to try to re-invent the wheel and get caught up in my own biases! Thanks again!
Let's see  - No, they told me I do not officially have Addison's, and basically since I have had hypothyroidism for the past few months and have to have thyroid surgery in 8 weeks, they just dropped it after the stim test. The pressing concern was if I had it officially to get me going on prednisone prior to the surgery...
As far as recent blood work - (and I'm 34 if age makes a difference in any of this puzzle!)
Cortisol, AM fasting 4.3 (range 6.2-19.4)
Aldosterone with plasma renin act. ratio aldosterone    3 (range < or = 28
Plasma renin activity: 4.0 (range .65 to 5.0)
Aldosterone/Plasam Renin Act Ratio 0.8 (range 1.5-18.2)
The cortisol, AM fasting day of stim 3.8 (range 6.2-19.4)
Other stuff tested:
Cholesterol: total 228 (range 0-199)
                     LDL 140 (range 0-100)
                     HDL 66 (range 50-80)
                     Triglycerides 112 (range 0-150)
        (funny thing on high cholesterol is I have celiacs so I eat healthier than anyone I know, and it popped up about a year ago)
BUN (blood urea nitrogen 4 (range 7-18)
potassium 4.1 (range 3.5-5.1)
sodium  139 (range 136-145)
calcium 9.0 (range 8.5-10.1)
Cortisol 60 min post Cosyn injection 20.1 (no range on form)

The whole thing came to light because my TSH is usually 1.5-2 on average, and it popped in April to 4.65, and the endocrinologist said the range top should be 2.5)
Oh, and my blood pressure was usually about 110 or 120 over 70 or 80... and then over past five months, it's dropped to about 100 over 70 or 80, and even 90 over 70 even they make me stand up and then take it... that also got his suspicions..
(sorry, I know this is getting long to read)
no pituitary tests done, period
and nothing else done adrenal gland related.

Let's see meds: none related to adrenal stuff or thyroid stuff (yet, after the surgery if they find the lump is cancer and take out all of it or with even half of it my levels drop low I'll have to start a course of something)
I'm on the duragesic pain patch 25 mg related to chronic pain in my jaw (broke my jaw as a kid and undiagnosed celiac disease made it not heal right)

I do have a good GP that would help me out, and even the endocrinologist is good, just seems like since I'm not bad enough that I got diagnosed, and he "ruled out" Addison's and full blown Hashimoto's, so he's off the hunt! Whereas, anything over part-time work wipes me out and I can't maintain, and even part-time is tough now and I'm feeling so yucky, so it's more my priority!
Don't know if any of this is making any sense, having a scattered day... but thanks for your bearing with me!
Lisa

[Joel]

Both your a.m. cortisol and ACTH seem low, especially if you feel your body is under stress.
Normally these are highest in the early morning.
This would suggest secondary Addison's which the stim test would not necessarily show up.
Also not a doctor, but have seen many.

Joel

[Idaho Dusty]

Hi Lisa, sorry for my delayed response.  Looks to me like you have some decline in adrenal function from your stim test results.  Was it a 250 mcg ACTH stim test?  I too had cortisol double but to a minimal amount with the stim test, luckily  I was willing to be treated and my doctor was willing to treat me.  It's unfortunate that the adrenals virtually have to be DEAD for a doctor to diagnose us with Addison's.  How would they like to be nearly dead for weeks or years before their adrenals fizzled out??  Here's some info from another post that was similar to yours...more coming in another post.

Directly from Cecil's medical text (a mainstream medical school text book p. 606)  Bold is mine.

In a patient with chronic symptoms, a 1-hour cosyntropin
test should be performed. In this test, 0.25mg
ACTH (1–24) (cosyntropin) is given intravenously, and
plasma cortisol is measured 0, 30, and 60 minutes later.
A normal response is a plasma cortisol concentration
higher than 20mg/dL at any time during the test. A
patient with a basal morning plasma cortisol concentration
of less than 5mg/dL and a stimulated cortisol
concentration below 18mg/dL probably has frank
adrenal insufficiency and should receive treatment. A
basal morning plasma cortisol concentration between
10 and 18mg/dL in association with a stimulated cortisol
concentration lower than 18mg/dL probably indicates
impaired adrenal reserve and a requirement for
receiving cortisol replacement under stress conditions
(as described later). Recently a 1-mg cosyntropin test to
assess partial adrenal insufficiency has been described.
This test may identify more patients who need cortisol
replacement under stress conditions, but should not be
used to determine which patients need daily cortisol
replacement.

you need to get the antiadrenal antibodies test done to determine whether your body is attacking your adrenals.  If so, you're definitly Addison's.  I'd say when you're given a 250 mcg stim test and you don't stim (you didn't really stim, should DOUBLE baseline or get to 20 at 30 or 60 minutes), you're Addison's.

Aldosterone and renin should be done properly (30 minutes laying down before and during the test OR 30 minutes ambulatory before and during the test) or they don't say too much.



To convert nmol/L to µg  multiply by 27.59

8.8 µg baseline=242.79
13.4 µg stimmed=369.7

Normal response 200 nmol/L over baseline (442.79) or at least 550
 
 
 
       

CMAJ • February 15, 2005; 172 (4). doi:10.1503/cmaj.1041542.
© 2005 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association. This Article
 
 
 

 
--------------------------------------------------------------------------------
Correspondance

Short ACTH stimulation test for adrenal reserves of cortisol, not adrenal function
R. Deeba Syeda*, Farheena N. Mecci and Akheel A. Syed
Devraj Urs Medical College and Research Centre, Kolar, India,* Dr. Ambedkar Medical College, Bangalore, India, University of Newcastle, Newcastle-upon-Tyne, UK

The classical description of Addison's disease in a 15-year-old girl1 is a timely reminder of this well-known but uncommon disorder. In their description of the investigative work-up and discussion, Chantelle Barnard and associates1 imply that the short adrenocorticotropin hormone (ACTH) stimulation test is diagnostic of primary adrenal insufficiency. This is a common misapprehension.

In the test, an intravenous (or intramuscular) injection of 250 µg of synthetic ACTH (tetracosactrin) results in release of preformed cortisol from adrenal stores, which is measured in the serum 30 (and/or 60) minutes later and compared with the baseline concentration. An abnormal response (a serum cortisol peak below 550 nmol/L or an increment of less than 200 nmol/L from baseline or both) identifies adrenal insufficiency but cannot distinguish Addison's disease (primary adrenal failure) from secondary hypo-adrenalism. In pituitary disease (ACTH deficiency), for instance, the result of the test may be abnormal because of reduced stores of cortisol, even though the adrenal glands themselves have normal biosynthetic and secretory function. In this situation, a prolonged ACTH stimulation test using 1 mg depot tetracosactrin, with serial measurements of serum cortisol concentrations over 24 hours, would allow sufficient time for the otherwise healthy adrenal glands to mount an adequate cortisol response, whereas the test result would be abnormal in Addison's disease (particularly in preclinical disease, in which the result of the shorter test may be normal).

As the authors correctly point out, the hyperpigmentation seen in Addison's disease reflects increased ACTH and melanocyte-stimulating hormone due to dysinhibition of the hypothalamic–pituitary axis, which is in turn a result of low circulating cortisol concentrations. This is a relatively specific sign, and there is therefore little doubt that the hypoadrenalism in the patient described was due to primary adrenal failure. However, an elevated plasma ACTH concentration at baseline reliably distinguishes between primary and secondary causes and would have provided incontrovertible evidence of Addison's disease,2 besides being far simpler than the prolonged ACTH stimulation test.


Footnotes

Competing interests: None declared.


References


Barnard C, Kanani R, Friedman JN. Her tongue tipped us off.... CMAJ 2004;171(5):451.[Free Full Text]
Oelkers W, Diederich S, Bahr V. Diagnosis and therapy surveillance in Addison's disease: rapid adrenocorticotropin (ACTH) test and measurement of plasma ACTH, renin activity, and aldosterone. J Clin Endocrinol Metab 1992;75(1): 259-64.[Abstract]




eLetters:
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Short ACTH stimulation test indeed tests adrenal function not adrenal cortisol reserves
Suhail A. R. Doi
cmaj.ca, 3 Jun 2005 [Full text]

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Copyright 1995-2005, Canadian Medical Association. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of
the Canadian Medical Association.  

[Idaho Dusty]

PUBMED:  http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed
MEDSCAPE (you have to sign up but it's free):  http://www.medscape.com/medscapetoday

CECIL'S Medical Textbook chapter on adrenals is excellent!:  http://www.goodhormonehealth.com/adrenal-cecils.pdf  Page 606 discusses the ACTH stim test results specifically

Here is an excellent portion of an article that discusses the ACTH stim tests (you will need to sign into MedScape to gain access):  http://www.medscape.com/viewarticle/565766_6

I too had a blunted response to the ACTH stim test.  Here is an excerpt from the paper (and complete references at the bottom) I wrote to get myself diagnosed:

ACTH Stimulation Test
The ACTH stimulation test was done on July 2, 2001(Appendix C, p 38-40-Test Results) because my baseline cortisol level was 8 ug/dL (range of 6-23 ug/dL) (Appendix C, p 41-Test Results) .  The 250 mcg Synacthen test with a baseline measurement of ACTH and 30 and 60-minute measurements of cortisol was the test was performed.  Please note:  AURP recommends testing baseline cortisol, 30-minute cortisol and 60 minute cortisol.   My results to this test have been interpreted as normal and borderline abnormal.  AURP ACTH testing guidelines are in Appendix D, p 51-Lab Test Protocol.

“The ACTH stimulation test examines adrenal responsiveness but may not examine the entire hypothalamic-pituitary-adrenal (HPA) axis…”  The ACTH stimulation test may not be reliable for assessing hypothalamic-pituitary disease, however, it can be a strong indicator of a problem with the HPA axis depending upon which cut-off level is used for the 30 minute reading.   This was determined in a study where 30 patients with known hypothalamic or pituitary disease were given the insulin hypoglycemia test and the ACTH stimulation test.  A cut off 550 nmol/L for the ACTH stimulation test was only a 70% indicator of hypothalamic-pituitary disorders.  At 30 minutes, my response to the ACTH stimulation test was 433 nmol/L, well below the 550 nmol/L cut-off used in this test.  “The short Synacthen may be misleading if used as a screening test…”

In “Defining the normal cortisol response to the short Synacthen test:  implications for the investigation of hypothalamic-pituitary disorders” in Clinical Endocrinology (Oxf) a normal cortisol response at 30 minutes was a cortisol range of 510 to 626 nmol/L (18.5-22.7 ug/dL) for men and women.  In addition, cortisol responses were gender dependent with females showing significantly higher responses regardless of the basal cortisol values .  My response was 433 nmol/L, which is nearly 20% below the low end of the normal range (which was not gender correlated) as determined in this study.  My cortisol response to exogenous ACTH stimulation was not normal and was worthy of follow up testing.

My ACTH stimulation test result of 433 nmol/L is abnormal as defined by recent medical literature.  Abnormal cortisol rise during exogenous ACTH stimulation is indicative of adrenal hypofunction or problems further up the HPA axis.  “It is suggested that partial ACTH deficiency may prevent involution of the adrenal cortex and preserve the cortisol response to ACTH stimulation. ”  The adrenal hypofunction could have been caused by decreased stimulation of the adrenals by ACTH for an extended period of time.   I say this because my ACTH level was 4 pg/mL (range 6-58 pg/mL) the one time it was tested (Appendix C, p 40-Test Results).  Lack of ACTH production indicates a problem with either the hypothalamus or pituitary.   The ACTH stimulation test is not a reliable indicator of hypothalamic-pituitary problems because the adrenals can still function normally and give results in the ‘normal’ range despite the fact that they are not able to function normally without exogenous stimulation .
  Fiad, TM, et al., “The overnight single dose-metyrapone test is a simple and reliable index of the hypothalamic-pituitary-adrenal axis,” Clinical Endocrinology (Oxf), 1994 Nov;40 (5):603-609.
  Orem, SM, et al., “Comparison of tests of stress-released cortisol secretion in pituitary disease,” Clinical Endocrinology (Oxf), 1997 May;46(5):643-644
  Clark, et al., “Defining the normal cortisol response to the short Synacthen test:  implications for the investigation of hypothalamic-pituitary disorders,” Clinical Endocrinology (Oxf), 1998 Sep;49(3):287-292.
  Soule, SG, et al., “Failure of the short ACTH test to unequivocally diagnose long-standing symptomatic secondary hypoadrenalism,” Clinical Endocrinology (Oxf), 1996 Feb;44(2):137-40.
  Greenspan, FS and Forsham, PH, Basic & Clinical Endocrinology (Los Altos, CA:  LANGE Medical Publications, 1983) p. 277
  Berkow, Robert, et al., p. 700.

[Idaho Dusty]

Have you had anti adrenal antibodies tested?  You might want to ask your GP for this.

Let me know what other questions I can try to answer for you.  I'm not sure I answered any questions in the first place, only overloaded you with info!!

:) Dusty

[Terca]

Hello! You definitely didn't leave me more confused, I love the information! Always believed knowledge is power and felt somewhat powerless with all this because I didn't feel like I had enough knowledge to take it on...
I am wondering, since I have a pre-op physical coming up, to test for a secondary addison's or at least find out if it's possible if I'm in the beginning stages of a primary addison's, what would be the blood tests to ask for? I think I can get my GP to just add them to the sheet!
I definitely feel like I'm in the right ballpark with this, and can't just walk away with a cortisol AM of 3.6 to 4.3 and go, okay, my adrenals and everything are fine and just write off my symptoms that mirror Addison's.
Thank you ever so much for sharing portions of your own fight for treatment documentation and being a support through this! Lisa

[Terca]

Hi Joel...
Just wanted to say thanks for your input and wondering, as I just posed this back to Dusty as well, if in your experience with doctors, if you know of which tests are used to differentiate between primary and secondary that are blood tests, if there are any. I am going to see my PCP in a bit, and I can get her to add a few tests to her blood work sheet. Not sure if it's a secondary or beginning primary, but I know I am somewhere on that continuum, even if the doctors don't seem to fully agree yet...
Thanks for answering! Lisa

[Idaho Dusty]

Lisa,

Glad I didn't overwhelm you.  :)

The 1 mcg ACTH stim test is supposed to be a more sensitive test for determining adrenal insufficiency than the 250 mcg test.  Pubmed and Medscape have lots of abstracts that you might want to take to your doc.

If you think the issue is secondary, request a pituitary panel (LH, FSH, PRL, TSH, ACTH, oh crap there's one more and I can't think of it right now!) and an MRI with contrast.

If you think the issue is primary request the 1 mcg stim test, DHEA-S, aldosterone, CMP, renin (done according to protocol, it's rarely done right and is useless make the lab people look it up and do it by the book.  This means you will have to be ambulatory or laying down for 30 minutes prior to the test), antiadrenal antibodies, adrenal 21 hydrolase autoantibodies.

Sorry it took me so long to answer!

:) Dusty

[dollsie]

Hi Lisa,

Just wanted to chime in.

My first stim test was "normal". I had undiagnosed hypothyroidism at the time. My current endo told me that hypothyroidism will artificially elevate cortisol levels (because your body is metabolizing your own cortisol too slowly). Other factors that artificially raise cortisol levels are estrogens, radioactive injections, etc. I was on the pill during my first test and had a CT w/contrast the day before. The ACTH should be delivered through an IV line and over a specific amount of time (needle-sticks will raise cortisol levels). The doc that performed my first test injected me with the 250mgs all at once, and boy did I feel it! Very unpleasant experience, similar to the early stages of crisis. I also became more "tan" within hours of that test, if you can believe it, and felt absolutely horrible for days.

Don't know if this is true, but I've read that patients with secondary AI sometimes feel better during the stim test (b/c their body is finally given the "go-ahead" to release cortisol) and primary people feel nothing or have an exacerbation of symptoms...

To piggy-back on what Dusty has said re: the low-dose/high-dose tests....because the dose is so much higher than what anyone's body would ever make, the 250mg test is actually considered "unsafe" for use in pediatric patients (can cause hemmorhage into the adrenals). It also can produce artificially high stim results because it's so "supraphysiologic". Even though I had very low morning cortisol numbers, I was able to stim to 15. At first this raised the question of PAI vs SAI. But, I am a small person (90 lbs) and had very profound reactions to each stim test, which indicated to the endo that the 250mg dose was just way too high for my body. Also found out later that my aldosterone/renin were wacky, etc, so that put the descrepancy to rest. But I honestly believe that I never recovered from the stress of those tests. I know they were necessary for my diagnosis, just wish I'd known enough then to request the 1mg test instead.

High cholesterol is a typical symptom of hypothyroidism. So it probably has nothing to do with how carefully you eat! Strangely enough, high beta carotene is another typical manifestation of hypo. That's why some patients look kind of orange in artificial light (the color isn't really altogether different from the bronzing that happens w/Addisons...). Iron-deficiency anemia happens frequently, too.

Hope you're on the mend soon, and that they get this adrenal stuff figured out. Certainly seems like there's some gray area there...be careful about dosing of thyroid meds with possible AI. The thyroid goes hypo to protect the body from going into crisis...so starting an untreated Addison's patient on Synthroid or increasing their amount of T4 can exacerbate symptoms.

Take care and keep us posted!
Leigh

[Idaho Dusty]

Leigh, I didn't know that the 250 was contraindicated for peds!  Scary!!  

I just found out that 250 mcg of ACTH is 1000 times what our bodies make normally.  Any doctor that can inject us with 1000X what our body makes and then reason that we've gotten our cortisol barely into the normal range and that makes us ok is not too bright!  Scary that so many of us were told we were normal under these circumstances...

:) Dusty

[Terca]

Wanted to give you guys an update and let you know more than ever I am so thankful for this forum and all the info that gets passed around! I had a lump on my thyroid which is how I found out about the hypothyroid and then met with an endocrinologist who mentioned my symptoms all matched addison's. I had surgery on Thursday, and still don't know the outcome of the pathology - they only took lump and half my thyroid, and the cells were atypical follicular, but have to wait 7-10 days to find out if it's follicular cancer or just follicular annoying. But, in the process, my blood pressure dropped to about 88 over 50 so they gave me cortisol in iV and magically I got less dizzy shaky and a bit more energy. She also found lymphocytic activity in my thyroid, showing some chronic thyroiditis and immune system involvement. SO, she confirmed me to have addison's, just maybe not 90% gone, but on my way. I only kept bringing up the possibility of it thanks to the info on this site, and wanted to say thanks. I see my endocrinologist in about 4 weeks, and plan on following up with some meds to help my stop feeling like I got hit by a bus the day before, every day before!

[ShannonD]

My thoughts are wilth you and will keep my fingers crossed for follicular "annoying"
Nice that you are getting some answers to questions.
Take great care,
ShannonD

[Idaho Dusty]

Lisa,

I hope you are on your way to feeling better and better!  Keep us posted on your progress.

:) Dusty

[Terca]

Hi all - just wanted to let you know that I so appreciate all the sharing and support this blog offers...
I definitely have lost my mind, physically I'm 4 weeks out of thyroid surgery and managed to get sick, so on top of the hypothyroid getting worse now that I have 60% less thyroid, I'm getting the tight chest, dizziness, short of breath stuff that I attribute to the adrenal gland stuff and low blood pressure. The joy of being "medically challenged" is that I'm getting told I have too many variables - the sickness, the adrenal glands, the hypothyroid levels, and no one wants to touch me, PCP says I know you're sick but could be thyroiditis as a result of the sinus infection, so don't want to give you prednisone, and the surgeon says the dizziness and stuff is adrenal and the endocrinologist says I "stimmed" pretty decently, so who cares that my cortisol is like 2 in the morning, I'm just in early severe adrenal insifficiency... I guess i'm venting... when I found out I had celiac disease 6 years ago I thought finally my health wouldn't be an issue and instead, I just keep adding words to my health record!
I'm done venting... thanks for "reading...." Lisa

[ashley]

Lisa,

So you're not being treated for either hypothyroidism or adrenal insufficiency right now? If that's the case, then you really need a new doctor. It is really difficult to find a good one - I know - I had to travel across the country to find one, but it was worth it. You need to be treated - your current doctors are not helping you if they won't treat you.

Wishing you better health soon!

ashley

[Idaho Dusty]

((((Lisa))))

Sorry you're so sick!  What kind of doctor removes part of your thyroid and then doesn't test or replace?  Were you given the 250 mcg stim test or 1 mcg?  Have you had an MRI with contrast?

I agree with Ashley, you need to find a new doctor and find one soon.  I always push Friedman in LA.  I've never seen him and have no financial interest.  I think he's a genius and I wouldn't hesitate to see him if my situation got slightly complicated.  I would find some way to afford him because he's a diagnostician and researcher who seems to get to the root of the problem.

What part of the country are you in?  If you're comfortable sharing that, maybe someone can suggest a doc they like in that area?  My mom is in the Denver area and uses Reese-Jones.  She really likes him.

Are you staying hydrated?  Getting enough salt?  Have you looked into L-Tyrosine for thyroid support?

Keep us posted.  You deserve to feel well!

:) Dusty

[ShannonD]

Lisa,  

So sorry to hear that you feel so bad!! I really do believe that if you are diagnosed and properly treated, that you would feel better if not normal.

Are you on medication now?
What happened to the endo that ran the original tests?
Did they have you on steroid for your surgery?  Did the keep you on a steroid after??

Certainly if you were borderline addison's before, there is a chance that the surgery put you over the edge.  Surgery is one of the specific things they mention that can uncover an addison's. Even if you are on meds, it could be that you need more HC because the recent stress on the body.

Sounds to me like your primary doc is plain confused.  So you need someone, endocrinologist, internist, someone who feels comfortable with this issue (addison's)

Let us know how you are.
Shannon

[Terca]

So, the trials and tribulations of Lisa continue... I saw my endocrinologist today, and since my TSH level is over 5 since the surgery with partial removal, today was my follow-up. he said my pathology from the surgery did prove I have Hashimoto's, so I get to add that to the list of auto immune "stuff" I have.. (celiac is there too)... so, he said that as far as my cortisol being around 2.5 in am- 3.0, and needing cortisol post-op, that I have partial adrenal failure. BUT, then he gave me Synthroid for my thyroid medicine and said that it could make me process what little cortisol I have at a faster rate, so I may end up doing the "technicolor yawn" (my polite way of saying puking), and have to call him. So, he remains confused and uncertain about what to do with partial failure. All I hope is that the Synthroid helps instead of hurts and my adrenals hold on for awhile longer. At least someone was wiling to do something- I ended up on verbal warning from my job because of my lack of consistent attendance, and the job is how I have my health insurance, so something has to give soon and I have to feel better soon... Thanks for reading my venting... Lisa