I was asked to comment on cortisols in a patient with an albumin of 10g/L
and an inadequate ACTH stimulation test. The patient has a severe
malnutrition secondary to coeliac disease and is now post partum 3 weeks.
Everything including her haptoglobin, clotting factors etc. are low so it
is a protein losing gastropathy (not just low albumin) i.e. all her binding
globulins are likely to be low. She also has abnormal LFT but her thyroid
scan looks like a thyroiditis so they are in keeping with the clinical
condition.
Does anyone have experience of it and does anyone know where free cortisols
can be measured and what a normal stimulation curve would look like for
free cortisol.
Thanks
Liz
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