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  • Looking for adrenal fatigue experts

    I recently had my a.m. cortisol checked and it was *way* high (43.8 with a reference range of 6.2-19.4). Then had a 24 hour urine cortisol test and ended up exactly in the middle of the reference range, so Dr. says there's nothing to worry about.

    However, I went back in my lab history and had a high a.m. cortisol test 3 years ago with another Dr. (33.2 with a reference range up to 21) and was right in the middle of the reference range for my 24 hour cortisol test then, too.

    I'm wondering if I have adrenal fatigue, because my cortisol must dip way down during the day to end up within average range after such high a.m. readings. I've tried to research that, but have found conflicting information about whether cortisol *ever* gets high with adrenal fatigue, or if it just stays too low all the time.

    I'd love to find some info that will tell me if I'm on the right track or not. Just for info, I'm hypothyroid and, despite my numbers being within normal ranges, still feel most of the symptoms. I'm still arguing with my Dr. to increase my meds.

  • #2
    "Doctors tend to recommend a one-time blood test, or an ACTH STIMULATION test, or a 24 hour urine test, but patients have found none to be ade*quate or complete measures to discern sluggish adrenals. The ACTH STIM will tell you how much stimulation your adrenals are getting, but not how much cortisol they are producing. Granted, the ACTH can be valuable if there is suspicion of a pituitary dys*function. But we have noted that most patients with adrenal fatigue have healthy ACTH stimulation.
    A blood test will only discern cortisol at one time of the day, failing to tell you what goes on at other times. A urine test simply gives you an average of a 24 hour period, and that masks being high one time, and low another, which are important clues to sluggish adrenals.
    Instead, we have relied on the 24 hour adrenal saliva test, which tests your cortisol levels at four key times in a 24 hour day and allows you to view your daily cyclic adre*nal function."
    - from

    There are differing stages of adrenal fatigue and in the adaptive stage, your cortisol can be high. However, I'd suggest different testing than what you had. You need a 24 hour ASI saliva cortisol test (4 samples taken) to determine your real cortisol pattern:

    You can order this test yourself (although you might want one that also tests DHEA levels):


    • #3
      +1 to hazyjane's post. I have had the saliva test and your levels are supposed to start high in the morning, level off in the afternoon, and then drop a little more at night time. This all makes sense because you need the energy to get out of bed and get your day started and then taper down during the day so you can get to sleep at night. My results were the opposite of the norm. Very low in the morning and higher at night. I was having a lot of trouble getting out of bed. I started taking a supplement recommended by my doctor at the time but it was not cost effective. I now take a couple of amino acids (L-Tyrosine and L-Glutamine) to help with managing my energy. The L-Tyrosine has had a dramatic effect on energy and mood, I ran out for a few days about two weeks ago and I really started feeling sluggish again. If you're willing to share what meds to which you are referring (something for the hyperthyroid)? Anyway I'm no expert, just speaking from personal experience.


      • #4
        Thanks so much for the responses!

        My doc did end up testing DHEA, along with free testosterone. Both were within normal range (DHEA was 82 w/ a ref range of 60-230 and free testosterone was .13 w/ a ref range of .1-1.1). The only thing that came up abnormal was SHBG at 264 w/a ref range of 38.2-111. In my research it seems that SHBG can be artificially elevated with birth control pills, which I am currently on.

        Is the 24 hour saliva test something that my doctor can order? I'd rather do that than have to pay out of pocket.

        As for the hypothyroid, I currently take 12.5mcg of levothyronine (T4) and 2.5mcg of generic cytomel (T3) once a day. I basically take 1/2 of the smallest dose possible for each.


        • #5
          Your doc can order a 24-hour saliva adrenal test for you from ZRT labs. Is that something they would be open to doing? Some docs don't believe in saliva tests.
          I remember reading that SHBG can be elevated due to hypothyroidism.

          Have you checked out Dr. Kharrazian's thyroid book yet? It's light-years ahead of everything else as far as info and treatment options go (plus a great section on adrenal health):