I am secretly hoping the local endo will see me again to explain my results as he had written a letter to my GP that he had not seen a problem in a urine sample I had given 3 weeks before my ACTH Stimulation test but would still do the ACTH Stim test as he said I verbally told him I had got a 199 nmol/l (scale up to 400+) cortisol reading from UCLH which he said warranted investigation. Apparently they usually ask for a urine sample of the day of the stim test. The local endo said there was not a sodium problem in that sample I gave which I think would rule out Addisons. Unfortunately the nurse never asked me to give a urine sample on the day of the ACTH Stim test.
A lot of factors can lead to anomalies in the ACTH stim test, such as some endos dont ask for fasting before the test (i.e. my local endo) whereas others say there needs to be fasting before the stim test. I had fasted for it but the senior nurse insisted on me having a cup of coffee (with sugar) and 3 digestive biscuits
as it said on the appointment letter that I gave her that I did not need to fast.
Unfortunately I am hoping having the coffee and biscuits (containing salt)
did not raise my cortisol to invalidate or skew the results (make them inaccurate). I had read caffeine and salt can raise cortisol. I cant believe I caved into having biscuits and coffee so easily after fasting especially to have this test. The nurse was forceful (gave me a stern stare when talking to me).
I had the short ACTH stim test where a smaller amount of ACTH hormone is injected compared to the one where they inject a greater amount of ACTH. Apparently the short ACTH stim test is more sensitive and more accurate for diagnosing primary adrenal insufficiency. I had asked the endo if he would be testing secondary adrenal insufficiency i.e low ACTH hormone in my pituitary but he said no.
I am really disappointed he did not do this. To do this they had to take ACTH reading the same time they took the baseline Cortisol. With the ACTH reading they can see if their is secondary adrenal insufficiency going on.
There are a number of rules which decide what is what with regards to diagnosis but unfortunately I don't think all the relevant blood markers were done. The table at the bottom of the link below kind of indicates what combination of markers lead to a particular diagnosis/disease state.
Agreed about Addison's usually affecting young people from what I have seen on youtube and on addisons forums.
I honestly cannot wait to find out my results.
When I last saw Dr Sri at UCLH Endochrinology (replacement for Dr Conway) he gave a blood test form to do a one off ACTH and Cortisol test (not ACTH Stim test btw) before my next UCLH endo appointment in August 2017, so have been thinking of getting that done before the local ACTH stim test results come out just in case I have to refer the local endo to the UCLH ACTH result.
I am feeling better in myself this week. I am signed off till mid week and have a couple of days leave but have to go back to work next week Monday. I have been given really hard work objectives (no training) and cracked under the strain over a week ago - feeling like I had a PTSD by the end of the working day, head hurting when trying to move its with lingering burning sensation getting worse as the day progressed. I had eaten at lunchtime. I felt like this for couple of days and glad I went to my GP who signed me off.
I dont feel in myself I handle stressful situations well unfortunately (and want to get to the root cause of the lightheadedness).
Hopefully the local endo will investigate things for me further.