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This cortisol level is normal, but assessing adrenal function can be difficult. In someone that has a low cortisol on most days may have an increase in cortisol on certain days related to acute illness or other physical or emotional stress. So, a single normal cortisol reading in someone with other findings that raise concern about adrenal insufficiency is not sufficient to exclude the diagnosis. There are a couple of options on how to proceed in someone with clinical suspicion of possible adrenal insufficiency. First, it would be fine to simply check cortisol levels on multiple days. It also would be reasonable to avoid testing on days with a greater amount of physical or emotional stress. The ultimate test that can be done if adrenal insufficiency is suspected would be an ACTH stimulation test, which measure the amount of increase in cortisol level in response to ACTH.
Yes, a TSH of 1.2 is perfect.
Of course, there are many different condition that can cause fatigue, and with associated muscle weakness and joint pain, the other major category that should be considered would be various inflammatory or autoimmune disorders. The initial evaluation would be generic tests for inflammation, such as a sed rate or C-reactive protein, and tests for the more common autoimmune disorders, such as an ANA and RF.
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