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DR. EHTISHAM
DR. EHTISHAM, Doctor
Category: Medical
Satisfied Customers: 2202
Experience:  MBBS, FCPS
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Was wondering what these symptoms mean; morning cortisol 155

Customer Question

Was wondering what these symptoms mean;
morning cortisol 155
Vitamin D 39
Thyroid nodule and lung nodule
sweet smelling urine
joint and muscle issues
GFR 67
very tired
underactive thyroid
recurring mouth ulcers
neuropathy
sudden drops in blood pressure and palpitations
poor sleep
Submitted: 11 months ago.
Category: Medical
Expert:  DR. EHTISHAM replied 11 months ago.

Hello! My name is***** to JustAnswer. I'm reviewing your question now, and will post back with your reply momentarily.

Customer: replied 11 months ago.
Thank you. Whilst driving 4 years ago I lost sight in one eye. Blood sugar was 3 and Systolic bp was 210 Since then I have passed out several times especially when waking from sleep. BP suddenly drops
Expert:  DR. EHTISHAM replied 11 months ago.

Sorry to hear about your problem?

Since how long you have these symptoms?

What are your current medicines ?

What kind of neuropathy you have ?

What other investigations other than VIT D levels,cortisol and GF has been done ?

Regards

Customer: replied 11 months ago.
Thank you for your response. I am currently taking thyroxine and BP meds. Had a synachten 4 years ago and adrenals responded, had another this morning different doctor
Customer: replied 11 months ago.
I've had the symptoms for 7/8 years. Facial neuropathy and bog toes. Recurring yeast infections
Customer: replied 11 months ago.
When younger I was very thin always anaemic and low BP would faint when standing for long periods of time. When pregnant recurring bouts of low blood sugar
Customer: replied 11 months ago.
Now recurring episodes of dizziness at work even when sitting
Customer: replied 11 months ago.
extreme fatigue can't exercise as fingers swell and problems breathing
Expert:  DR. EHTISHAM replied 11 months ago.

What is the normal lab reference in your cortisol report ?

Regards

Customer: replied 11 months ago.
170-665 or thereabouts
Customer: replied 11 months ago.
I also had low sodium and high potassium 4 years ago
Expert:  DR. EHTISHAM replied 11 months ago.

Thanks for the information

Have your doctors did an MRI brain as well?

Regards

Customer: replied 11 months ago.
I was told the loss in eye sight was due to a migraine, I don't get migraines
Customer: replied 11 months ago.
apart from slow waves the MRI of the brain was fine
Customer: replied 11 months ago.
However the MRI was carried out 6 weeks post incident
Customer: replied 11 months ago.
Are you still there?
Expert:  DR. EHTISHAM replied 11 months ago.

Thanks for the information

Your symptoms does suggest a possibility of Addison disease as it can lead to low cortisol and blood glucose while high potassium and low sodium. An ACTH stimulation test will be helpful in diagnosis. Secondly some of your features points that there may be some autoimmune disease which is causing such symptoms. SLE is a possibility considering mouth ulcers,kidney and brain involvement and a work up for SLE will also be helpful. A CT scan of the abdomen to look for any mass or adenoma in adrenal will be further helpful. In autoimmune diseases like SLE due to impaired immunity the infection rates is generally high. So I would suggest that your doctor should work you up on these two possibilitis.

Good luck

Feel free to ask if any more question

If done Please leave a POSITIVE (3 – 5 stars, preferably 5) rating by clicking on the stars above, until you do I am not compensated for my time. You can continue to ask follow-up questions even after the POSITIVE rating

Regards

Customer: replied 11 months ago.
Thank you for your reply. If the ACTH test comes back fine, does this mean that recurring low cortisol as such is acceptable?
Customer: replied 11 months ago.
I have had episodes of sudden vomiting but I am finding it difficult to get to someone who can help me as they say my symptoms are so vague. I have been in hospital 3 times
Expert:  DR. EHTISHAM replied 11 months ago.

Yes if ACTH stimulation test is normal then it rules out adrenal insufficiency

Good luck

Feel free to ask if any more question

If done Please leave a POSITIVE (3 – 5 stars, preferably 5) rating by clicking on the stars above, until you do I am not compensated for my time. You can continue to ask follow-up questions even after the POSITIVE rating

Regards

Customer: replied 11 months ago.
what else would cause low cortisol?
Customer: replied 11 months ago.
Also what would cause the nodules or are these just normal occurrences?
Customer: replied 11 months ago.
I also can't tolerate the sunlight
Expert:  DR. EHTISHAM replied 11 months ago.

The nodules in the lung also need evaluation. A CT scan will be helpful. CT scan can tell if there are features suggestive of a tumor or its just a benign lesion but for confirmation biopsy is required.

Low cortisol can be due to pitutitary dysfunction, use of various drugs including steroids

Photosensitivity is also a feature seen in autoimmune diseases like SLE so a work up is required

Good luck

Feel free to ask if any more question

If done Please leave a POSITIVE (3 – 5 stars, preferably 5) rating by clicking on the stars above, until you do I am not compensated for my time. You can continue to ask follow-up questions even after the POSITIVE rating

Regards

Customer: replied 11 months ago.
I had a CT scan of the lungs and was told just to follow up in one year. I have never taken any drugs/steroids. I am finding it difficult to get my GP to take me seriously. Would an issue with the pituitary not have shown up on the brain MRI?
Customer: replied 11 months ago.
Also with a morning cortisol of 155 what level of response would I have to get with the synachten for me not to have addisons?
Customer: replied 11 months ago.
If my synachten test suggests adrenal insufficiency what follow up tests are needed?
Customer: replied 11 months ago.
I did have one antibody test done and it have a value of 1 (<5 was the value I think)
Expert:  DR. EHTISHAM replied 11 months ago.

That's good if there was nothing of concern on CT scan . MRI is usually a very sensitive test and detects such mass lesions of pituitary .

If adrenal insufficiency is detected than you will need to get it treated with steroid replacement therapy.

Your symptoms should improve if replacement is adequate . Your symptoms should improve and your metabolic profile should normalize.

Good luck

Feel free to ask if any more question

If done Please leave a POSITIVE (3 – 5 stars, preferably 5) rating by clicking on the stars above, until you do I am not compensated for my time. You can continue to ask follow-up questions even after the POSITIVE rating

Regards

Customer: replied 11 months ago.
In Ireland it seems you need to have zero cortisol to be treated. Can you suggest levels post synachten my cortisol would have to rise to to have this diagnosis? Also what are the tests for SLE?
Customer: replied 11 months ago.
My GP is very obsesses with stress and MH issues, I myself am a psychologist and have explained that this is not a MH issue
Customer: replied 11 months ago.
can low cortisol interfere with my metabolism and how?
Expert:  DR. EHTISHAM replied 11 months ago.

An increase in baseline cortisol value of 7mcg/dl or more and value must rise to 20mcg/dl or more in 30 and 60 minutes sample.

For SLE you need a screening test called ANA as it is positive test in 90-95 cases. Further more specific but less specific test include ENA profile and anti-dsDNA levels.

Good luck

Feel free to ask if any more question

If done Please leave a POSITIVE (3 – 5 stars, preferably 5) rating by clicking on the stars above, until you do I am not compensated for my time. You can continue to ask follow-up questions even after the POSITIVE rating

Regards

Expert:  DR. EHTISHAM replied 11 months ago.

Cortisol is main hormone involved in glucose metabolism and in the stressful conditions to fight with stressful conditions

Good luck

Feel free to ask if any more question

If done Please leave a POSITIVE (3 – 5 stars, preferably 5) rating by clicking on the stars above, until you do I am not compensated for my time. You can continue to ask follow-up questions even after the POSITIVE rating

Regards

Customer: replied 11 months ago.
Given my symptoms ( my BP fluctuates between 120 to 170 systolic also) do you have a hunch as to what the issue is?
Expert:  DR. EHTISHAM replied 11 months ago.

As I mentioned Addison and an autoimmune disease sould be my first thought in such a case

Good luck

Feel free to ask if any more question

If done Please leave a POSITIVE (3 – 5 stars, preferably 5) rating by clicking on the stars above, until you do I am not compensated for my time. You can continue to ask follow-up questions even after the POSITIVE rating

Regards

Customer: replied 11 months ago.
Thank you so much you have been very helpful and your advice has been much appreciated.
Expert:  DR. EHTISHAM replied 11 months ago.

My pleasure

Good luck

Feel free to ask if any more question

If done Please leave a POSITIVE (3 – 5 stars, preferably 5) rating by clicking on the stars above, until you do I am not compensated for my time. You can continue to ask follow-up questions even after the POSITIVE rating

Regards

Expert:  DR. EHTISHAM replied 11 months ago.

Are you there ?

Any more question ?

If done Please leave a POSITIVE (3 – 5 stars, preferably 5) rating by clicking on the stars above, until you do I am not compensated for my time. You can continue to ask follow-up questions even after the POSITIVE rating

Regards

Customer: replied 11 months ago.
I am here.
Expert:  DR. EHTISHAM replied 11 months ago.

anything else to ask ?

If done Please leave a POSITIVE (3 – 5 stars, preferably 5) rating by clicking on the stars above, until you do I am not compensated for my time. You can continue to ask follow-up questions even after the POSITIVE rating

Regards

Customer: replied 11 months ago.
Which specialist treats autoimmune disorders?
Expert:  DR. EHTISHAM replied 11 months ago.

SLE and most other autoimmune diseases are treated by Rheumatologist. It depends which organ is most effected as some autoimmune diseases are treated by neurologist like MS

Good luck

Feel free to ask if any more question

If done Please leave a POSITIVE (3 – 5 stars, preferably 5) rating by clicking on the stars above, until you do I am not compensated for my time. You can continue to ask follow-up questions even after the POSITIVE rating

Regards

Customer: replied 11 months ago.
Thank you. Good bye for now
Expert:  DR. EHTISHAM replied 11 months ago.

You are welcome

Good luck

Feel free to ask if any more question

If done Please leave a POSITIVE (3 – 5 stars, preferably 5) rating by clicking on the stars above, until you do I am not compensated for my time. You can continue to ask follow-up questions even after the POSITIVE rating

Regards

Expert:  DR. EHTISHAM replied 11 months ago.

Please leave a POSITIVE (3 – 5 stars, preferably 5) rating by clicking on the stars above, until you do I am not compensated for my time. You can continue to ask follow-up questions even after the POSITIVE rating

Regards

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