What I found was kind of disheartening as far as diagnosis goes. One of the tests they use to test adrenals is a cortrosyn (ACTH) stimulus test. ACTH-adrenocorticotropic Hormone is released by the pituitary to stimulate the adrenals which then release cortisol.
There are two types of adrenal insufficiency, one called primary which is Addison's disease--where your immune system attacks the the adrenal glands. Symptoms are muscosal hyperpigmentation, weight loss, and fatigue.
The second kind is secondary adrenal insufficiency, where the pituitary doesn't produce enough ACTH to stimulate the adrenals. If left untreated, the adrenals shrivel up and die, so it is important to treat.
Generally, people with primary adrenal insufficiency may have normal or high ACTH before the stim test, and the stim test will raise cortisol very little in the base value, after 30 min or after 60 mins, and the highest cortisol level will be below the normal range for cortisol.
In secondary insufficiency, the ACTH may be normal but usually low before the stim test. When they give you the cortrosyn to stimulate the adrenals, your base cortisol may be low, then at thirty and sixty minutes it will double, triple, quadruple, or even be 6 or 7 x higher than the base cortisol. This happens because the adrenals are starved for ACTH (cortrosyn) and go nuts when given cortrosyn. Generally the final cortisol level is at or above 28. This is the type of adrenal insufficiency I've been told is the one that can be caused by prednisone--since predisone effects the pituitary.
Apparently secondary adrenal insufficiency is drastically underdiagnosed and most endos and other doctors do not know how to properly diagnose it. It typically is not diagnosed until the adrenals are permanently damaged and secondary adrenal insufficiency has become primary insufficiency.
Its easy to understand why secondary adrenal insufficiency is not diagnosed since most WebMD, some test guidelines, and other physician resources give only information to diagnose primary insufficiency--stating that a ending cortisol of 28 or better indicates normal adrenal function. That may be true, but a closer look at the test results may clearly show problems with the pituitary and secondary adrenal insufficiency.
I have the actual physical signs of adrenal disease and symptoms and have been to four endos now and cannot get a proper diagnosis according to articles on secondary adrenal insufficiency. Since my polyendocrine disorder typically ends in Addison's disease and possible death, it is very upsetting.
Anyone with tiny black spots under the tongue that look like pencil dots, black spots on the arms--black not dark brown but more bluish black--or hyperpigmentation on the mucous membranes in other parts of the body should get properly checked for adrenal disease, though you may have it without these symptoms, because most deaths occurring from adrenal disease occur because doctors fail to diagnose and treat the condition early enough.
My source for this is Wikipedia--which in this case is well documented and includes several well researched documents. Hopefully you all have better luck with endos than I do.
Take care and thanks for asking. My ACTH was low, my stim test was base 4.7 (low), 27.1 (30 min.), 28.7 (60 min.)--clearly secondary adrenal insufficiency--actually almost 7 fold increase and characteristic low ACTH before stimulation. I have been like this for at least two years if not more.
If you feel tired or fall asleep alot where you have trouble waking up, fall asleep when you don't want to, you may ask for this test.
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