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Dr. Brims
Dr. Brims, U.S. Licensed Physician
Category: Health
Satisfied Customers: 9139
Experience:  U.S. Licensed Physician, general surgery and internal medicine experience
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I have both hypothyroidism and adrenaline insufficiency. I

Resolved Question:

I have both hypothyroidism and adrenaline insufficiency. I also have a partially empty sella.
When the ACTH test was taken I was taking DHEA, and had only skipped my morning cortisone dose; in addition, I didn't fast. (This is what I was told to do.)
My cortisol, in the ACTH test, showed little response--I only got to 11.
Does it matter whether the poor adrenal response is due to a damaged adrenal gland or a problem with the pituatary? Would it be treated any differently? Is there some direct treatment for the pituatary?
Submitted: 1 year ago.
Category: Health
Expert:  Dr. Brims replied 1 year ago.

Dr Brims :

Hello, welcome to Justanswer, I will try to assist you with your medical question, and any medical information you seek

Dr Brims :

If your ACTH test did not get a good response then it means your pituitary gland is not the problem

Dr Brims :

They are treated differently

Dr Brims :

Are you there?

Customer:

Yes, I'm here. I wondered, however, if the fact I was already taking steroids and DHEA might have skewed the test results

Customer:

How would they be treated differently if the problem was the pituitary instead of the adrenal gland?

Dr Brims :

The fact that you are taking steroids would decrease the response from your adrenal glands

Dr Brims :

If it is your pituitary, they would likely have to replace more hormones than the adrenal gland

Customer:

So, as I suspected, that ACTH test wasn't a valid test because I was already taking the steroid

Customer:

Should I ask to have the test repeated?

Dr Brims :

That is correct,if you take a steroid long term it will cause adrenal suppression

Customer:

And what is the relationship between this and the hypothyroidism? Isn't it odd they developed at the same time if they did not both result from

Dr Brims :

What was the reason for the test?

Customer:

I hadn't been taking the steroid for a long time--just for a week.

Dr Brims :

ok

Customer:

The reason was to determine the reason for the extremely low a.m. cortisol level (1).

Dr Brims :

So you had not been diagnosed with adrenal insufficiency prior to the test?

Customer:

They were attempting to make the determination if this was a pituitary problem--particularly suspect because of the empty sella. But I think they blew it by not having me off the steroids and DHEA before administering the test.

Customer:

The adrenal sufficiency was first detected in a general blood test done in January--that was when the cortisol level was 1.

Dr Brims :

Okay, then they should likely repeat the test

Customer:

That is my view--at least if it will make any difference in the treatment. If the treatment will not change, I won't bother. Right now I am on Armour 60 (yes, I know the debate about synthroid; my doctor recommended Armour) and pregnisone 5 in the a.m. and 2.5 in the pm, as well as the DHEA. If they knew it was pituitary what would be added/removed?

Customer:

And what about the interaction of Calcium with these drugs? I have to take calcium because I had my parathyroids removed 8 years ago.

Customer:

are you still there?

Dr Brims :

If it is your pituitary gland it may affect more than your adrenal glands, it will have to be determined what other hormones are affected, if only your adrenals are affected from the pituitary insuficiency

Dr Brims :

then the treatment would be the same as pure adrenal insufficiency

Customer:

Couldn't the thyroid also be affected by the pituitary?

Dr Brims :

Yes, but if it was your TSH would be low

Customer:

I don't remember whether it was high or low --it was something bad--but whatever it was the doctor said it was hypothyroidism, requiring synthroid or armour thyroid.

Dr Brims :

It must have been high, if it was low and your TSH was also low they would have diagnosed you with pituitary insufficiency immediately

Customer:

I think what I really need is for them to redo the test and then for someone to patiently explain to me why they came to the diagnosis, and their present explanation of the cause of the disorders.

Dr Brims :

Okay

Customer:

It has been really frustrating. I live in Cleveland, with the Clinic but the Clinic doctors are notoriously obtuse and hurried--and this guy certainly was.

Dr Brims :

I am sorry to hear that

Customer:

I can retrieve the test results for you, if you think that would improve your answers.

Dr Brims :

The test results for your thyroid?

Customer:

I have the TSH test, the T3, T4 and ACTH tests available on-line from the Clinic.

Dr Brims :

Okay, what are the TSH, T3 and T4 results?

Customer:

This will take a minute.

Dr Brims :

ok

Customer:

T3 81 (94-170); Free T 3 2,8 (1.8-4.6); T4 5.5; FTI 5.1

Dr Brims :

Free T4 and TSH?

Customer:

I forgot to get the TSH. Be right back TSH 5.18

Customer:

Free T4 1.0

Dr Brims :

ok

Customer:

ACTH three readings; first 3; second 8; third 11. Notation on test says minimum normal is 18

Dr Brims :

TSH?

Customer:

TSH is 5.18 (It is in the earlier answer)

Dr Brims :

Okay, if your TSH is 5.18 your pituitary gland is fine

Dr Brims :

anterior pituitary

Customer:

Thank you. What is the TSH?

Dr Brims :

Thyroid stimulating hormone, it comes from the pituitary gland

Customer:

So, the problem with the thyroid is just from the thyroid and the problem with the adrenal is just from the adrenal and I just got lucky to have both of them screw up at once.

Dr Brims :

That is correct

Dr. Brims, U.S. Licensed Physician
Category: Health
Satisfied Customers: 9139
Experience: U.S. Licensed Physician, general surgery and internal medicine experience
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