I can share from experience, in ANY case, you MUST have a 4 part cortisol measurement. Doctors will want to test A.M. blood only, or a 24 hr. Urine cortisol, but these are not as diagnostic as a 4 part, which is usually a saliva test, done at 7:00 a.m., noon, 5 p.m. and bedtime. We make the majority of cortisol in our bodies before 8 a.m., however I have seen test results where there is nothing in the morning and spikes at night. You can easily see from the test what your body is doing on a particular day.

You DON’T need a doctor to order this test, which runs about $120-$140. It can be ordered from http://www.canaryclub.org. They use the same labs as my doctor here in Houston; Diagnostechs and ZRT. And at the same time, they offer other tests such as hormones and thyroid measurements. They are extremely accurate, as I’ve had concurrent ones done at both labs and blood tests at my doctors with the same results.

If you suspect you have serious Adrenal Insufficiency, it’s prudent to see an Endocrinologist to have an ACTH Stimulation Test, which basically is just a morning shot that stimulates the adrenals to produce cortisol within a certain time frame, and if they don’t they can diagnose you with Adrenal Insufficiency. BUT, you CANNOT be on any form of oral hydrocortisone to have the test run and once you start the medication, it’s extremely hard to wean off to take the test.

Regarding your question about adrenal supplementation. If you take adrenal extracts, drops, herbs, etc. these do not cause the adrenals to become “lazy”, however, there are varying degrees of success with these therapies and they rely on the fact that the adrenals are healthy enough to ‘regenerate’, which mine were not. There are MANY people who have had good success with them.

If you have a baseline saliva cortisol done, it’s EASY to tell from subsequent tests whether the therapy is effective. I tried them for nearly 4 years and spent 1000’s of dollars on ACE (Adrenal Cortex Extract), Mil-Adregen, Licorice Root, Ashwaganda, Siberian Gensing, consultations with homeopaths at the Clymer Healing Research Center in Pennsylvania, but my adrenals continued to decline.

 

Plus, if your adrenals really ARE declining then you need to see a doctor for a morning blood baseline measurement of ALDOSTERONE, which is made in the adrenals and controls sodium/potassium ratios in the body. If you are having regular CBC (complete blood panels) and notice your potassium is very high, this can also be an indicator of declining adrenal function. Also, if you crave salt all the time, or your skin is changing pigment, becoming darker or yellow, this also a good diagnostic indicator.

 

Each person is different, however, the school of thought is that if you take more oral hydrocortisone than the body needs, it will begin to feedback to the adrenals and tell them to make less. Not taking more than what you need is called a ‘physiologic dose”. For most people, this can be 15-20 mgs. a day. But, I again stress, the ONLY way to tell is to monitor this with saliva or blood tests. If you see morning baseline cortisol measurements declining, you know for certain the adrenals are responding and making LESS.

Once you are totally dependant on hydrocortisone, then you are “technically” an Addison’s patients and being on complete hydrocortisone therapy is a slippery slope. In my case, I have to have syringes of Solu-Cortef (which is a liquid form) for emergencies, because in the event, say, of a car accident, or even vomiting the body cannot make the cortisol it needs and must have it some way if it cannot be ingested.

 

That being said; many people with Chronic Fatigue and Fibromyalgia find they greatly improve when their adrenals are addressed AND they find out whether their thyroid is working. There is an interesting web site: http://www.drrind.com that is pretty accurate in it’s instructions on body temperature testing to help diagnose adrenal/thyroid issues. But in short, if body temperatures are low and erratic, it usually indicates adrenal, if low and stable - thyroid. If your temps are really low, less than 97, it’s pretty certain you have some kind of hormonal issue.

IF you suspect you have adrenal problems AND thyroid problems concurrently, the adrenal problems have to be addressed before thyroid because you can run the risk of overstressing the adrenals. This happened to me and I became extremely ill when we tried to introduce first Armour Thyroid, then Synthroid. This is mentioned in the ‘contraindications’ section of both meds as well as in the Physician’s Desk Reference.

 

Have your TSH, FREE T4 and FREE T3 and a thyroid antibody panel done at your doctor’s office or again order it from http://www.canaryclub.org. It’s a blood spot test where you just prick your finger and deposit the blood drops on a special card,

 

The thyroid panels are more expensive than the cortisol panels, but for people whose doctors are uninformed or non-responsive it’s worth every penny. I again can’t stress enough, the FREE’s are the best indicator of true thyroid function, as Free T4 is the ‘storage’ hormone in the body and it converts to Free T3, which is the ‘active/energy’ portion. In my case My TSH is 1.4 (Excellent), Free T4 mid-range (OK), but I’m WAY below range on T3, which is why I have been having debilitating fatigue. Had my doc not tested this, we would not have known that I was not converting the storage to the active hormone. MOST doctor will not test the FREE’s without you badgering and insisting on it.

Here is a quote from an article on T3 from the National Institutes of Health--

 

'Decreased T3 function exerts widespread effects throughout the body. It can decrease serotonin and growth hormone levels and increase the number of adrenal hormone receptor sites. These effects may explain some of the symptoms observed in WTS (This is something called Wilson’s Syndrome). The dysregulation of neuroendocrine function may begin to explain such symptoms as alpha intrusion into slow wave sleep, decrease in blood flow to the brain, alterations in carbohydrate metabolism, fatigue, myalgia and arthralgia, depression and cognitive dysfunction.'

 

Don’t these symptoms sound familiar????  This is now the first time in 5 years I stand a chance at some real progress as we recently found an oral hydrocortisone I can tolerate and will begin T3 replacement therapy in the next few weeks.  Sorry this post is so long….but I have spent the last 5 years researching, studying, praying to understand the whole adrenal/thyroid component of this illness."

 

"You had asked www.fms-help.com/042008.htm if  anyone has a thought on whether Adrenal supplement weaken your own adrenals.    From all  I have read, specially  Standard Process website (a company respected by chiropractors and has been around for decades here in Wisconsin)  and also Wilson's book on adrenal, the answer seems to be that  the long term use of actual adrenal glandular  could do that,  but the salts  (minerals) made with complexing these adrenal components with mineral salts , a special process,  does not cause such a problem since  it only provides food and mineral to your own adrenal gland.  Also, a point to keep in mind ,  too much adrenaline in the blood equates with increased muscular pain since adrenaline tends to contract muscles, leading to pain."