Morning cortisol results

[BlackInk]

Hello

My GP tested my serum morning cortisol levels. The result came back as 305, marked abnormal, but my GP has commented 'No action required'. No normal range is given in the lab results, but isn't this on the low side?

I've been suffering with a range of symptoms (stomach trouble, exhaustion, twitching, weightloss, joint pain, brain fog...).

Does anyone know whether a result of 305 would be considered normal?

I've had a positive ANA in the past and persistent low/borderline ferritin, folate and B12.

Many Thanks
BI

It's not abnormal.
When you say morning, what time?
It should be around 400-500 at 8am it then decreases after that.

Are they wondering if you have Addison's disease?

If so that's not diagnosed on a one off test, so as asked above what times was that taken at?

Thank you both, the blood test was done just before 9am. I also gave a 24 hour urine sample but results not in yet. I

I’m taking oral HRT which I think can artificially raise cortisol results?

You're supposed to stop any hormone replacement for 6 weeks before a cortisol test.

There is no normal range because cortisol works on a supply and demand basis. (Much the same as insulin)
So at midnight it can be as low as 35 but if you're ill or injured it can be as high as 1000.

The test to actually diagnose Addison's is called the short synacthen test.
They take a baseline test and also should take an ACTH sample too.
They then inject with synthetic ACTH and test again after 30 and 60 minutes.

Cortisol should double after 30 minutes and then rise again after 60 minutes.

With a result of 300 it's likely your adrenals are working to a degree and it's highly possible you'd pass an sst. And then you're discharged and back to square one.

You could try pushing for another morning cortisol test but this time stop the hrt for six weeks first.

Did they also test your electrolytes? Primary Addison's causes low sodium and high potassium.

I was diagnosed with a U&E blood test and then had an sst just to confirm diagnoses.

So my 24 hour urine results came back at 40nmol/d and marked normal, no normal range given. Does that alongside the morning cortisol reading rule out cortisol issues?
Thank you!

It's on the low side but I'm not sure why you've had that test. It's typically used to diagnose cushings disease. (The opposite of Addison's).

Both results are not quite optimal but until/unless they get much worse you're unlikely to get very far with an endo. At least with Addison's as a cause of your symptoms

The big symptoms are low blood pressure - mine got as low as 60/30, salt craving - to the extent of drinking the brine from an olive jar and hyperpigmentation - lots of people commenting on how brown you are and how healthy you look.

These are all symptoms of primary adrenal insufficiency - the adrenals not working.

It's a possibility that the problem is with your pituitary gland not asking for cortisol.

Either way I suspect they will see your results as not yet bad enough to show anything on further tests.
It's a bit crap because that's how you feel and no one seems to be taking you seriously.

I've known of teenage girls present with all the classic symptoms but the doctors only see weight loss and vomiting and diagnose an eating disorder.

If it is Addison's the only thing you can do from here is wait to get worse and then ask to be tested again.

I hope you find answers soon

Thank you @JimMaxwellantheshippingforcast

I've got a huge list of symptoms and funny things going on, gradually building up/worsening over the past few years. Symptoms point to something autoimmune, but GP says not fitting obviously with anything. My mum had benign tumours on her pituitary and adrenal glands, and a cousin has adrenal insufficiency (also lots of T1 diabetes in the family), so I guess that's why they tested cortisol.

GP said that if the results were borderline I could stop HRT and retest in a couple of months, but I can't find ranges anywhere online to ascertain whether they are borderline or not.

I have all the early symptoms of Addison's listed on the NHS website, and some of the later symptoms (my blood pressure is usually 90/70 but they always just say nice and low) - in fact all of them except actual vomiting and obvious pigmentation changes. I have noticed in the last year or so that I tan VERY easily (never burn) and get lots of comments about my tan - but not sure that's the same as Addison's pigmentation.

My symptoms and test results also suggest something like Lupus but GP isn't keen to refer me. I guess I just have to wait and see if I get worse, which is a depressing thought!

Thanks again :)

If it were me, and stopping hrt wasn't going to give me horrendous symptoms I'd stop and retest the cortisol.

I understand why your doctor is saying it's borderline but the range is so wide it's difficult to put numbers on it. It's only at 8am can they say with relative certainty it should be between 400 and 500. That's the reason that morning test is time critical.

A couple of examples

A person with normally functioning adrenals has a level of 35 at around midnight.

Major surgery can see levels of between 1000 and 1200

There have been observations of levels of more than 3000 in people with critical covid. Although this is very much an anomaly.

A result less than 100 at 8am is usually an instant diagnosis.

The deterioration can take years (sorry).
My blood pressure was always around 100/60 when I was pregnant with my eldest. I was diagnosed when he was 6.

I first noticed the hyperpigmentation around 3 years before diagnosis. It started with scars rather than a general tan.

It's good that they have Addison's in the back of their mind because it's less likely to be missed.

Sorry I couldn't be any more help

Thank you. I don't necessarily think that I have Addison's, I just want to get to the bottom of why I feel so rubbish all the time. It seems that almost every test I have comes back borderline. I'll see what the GP says when he calls me...