We currently have a patient on the go who has been using skin-lightening creams to excess and pitched up with a cortisol of 11 nmol/L
Synacthen test after withdrawal (purportedly) of topical applications, was uneventful, getting as high as 75 by 60 mins and achieved 130 at 24 hrs.
with best wishes
Richard
Richard Mainwaring-Burton
Consultant Biochemist
South London Healthcare Trust
Queen Elizabeth Hospital, Woolwich
Princess Royal Hospital, Farnborough
Queen Mary's Hospital, Sidcup
020-8836-5724
mob: 07831-739876
-----Original Message-----
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of EDWARD KEARNEY
Sent: 23 August 2012 12:04
To: [log in to unmask]
Subject: Re: CFS and low cortisol
Why use the 60 minute result in the interpretation. Is this not a
sub-optimal response and the 60 min sample is unnecessary?
>>> Mohammad Al-Jubouri <[log in to unmask]> 23/08/2012 11:43 >>>
Hi Caroline,
There is certainly a blunted response to SST suggesting disturbed
hypothalamic-pituitary-adrenal axis, which is not really surprising
given that patients with CF are sleepy and inactive most of the time,
therefore their HPA axis becomes sluggish and they may have disturbed
diurnal rhythm. This is a secondary phenomenon rather than the primary
cause of CF and therefore steroid therapy should not be given.
Best regards
Mohammad
Dr. M A Al-Jubouri, MB ChB, MSc, FRCP Edin, FRCPath
Consultant Chemical Pathologist
From: Caroline Addison <[log in to unmask]>
To: [log in to unmask]
Sent: Thursday, August 23, 2012 11:18 AM
Subject: CFS and low cortisol
Dear All,
Does anyone have any thoughts on the following case?
19 year old lady who has chronic fatigue syndrome. Approx. 1 year ago
she was found to have a low cortisol (48nmol/L) – she went on to have
a SST with the following results
Baseline cortisol 48 nmol/L, ACTH 15ng/L (ref range <47ng/L at 9am)
30min cortisol 447 nmol/L
60min cortisol 561 nmol/L
There is no clinical or biochemical evidence of hypoadrenalism (not
tanned, no postural hypotension, normal sodium and potassium)
MRI of the pituitary was normal as were other pituitary function tests.
She was discharged back to her GP on the basis that her low cortisol was
due to CFS and that cognitive behavioural therapy would be beneficial.
This lady recently had an episode of dizziness and presented at A&E at
a different hospital, where she was found to have a low cortisol (15
nmol/L) and was told that she should be on steroids.
Could this very low cortisol be due to CFS? Any thoughts or
suggestions?
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