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Should Hydrocortisone Do This To My Labs?

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I recently saw an endocrinologist about a history of high IGF-1. I was concerned I could be developing acromegaly. The endo's retest was at a good level (as seen below) but she has agreed to test me further with acromegaly specific test (OGTT GH suppression). So that's all great. Some of my other results are...wonky though and I was wondering what you all think since some of you know more than most doctors!

 

TSH is low but I'm on natural desiccated thyroid and would expect it to be suppressed.

 

I am taking a very low dose of hydrocortisone (20 mg cortef) and a low dose of florinef (0.1) so I am guessing it had an effect. My morning cortisol is quite high - could the meds throw it that high? My adenocorticotropic hormone is low, but I'm assuming that it's because the AM cortisol is so high.

 

My fasting glucose is hitting the prediabetes stage which is really freaking me out. My HbA1c is at prediabetic levels according to some labs too. Can cortisol do that? My fasting glucose was not great before going on cortef (5 and 5.6) but it has gone up some. My triglycerides are up to normal range for the first time ever, but they are not near high. My overall cholesterol is high but that's a pretty meaningless test as far as I know. My HDL is okay and my LDL is fine. I am overweight at about 170 at 5'8" but I genuinely am big boned and look good (minus stretch marks lol) in a bikini once I get into the 150lb range.

 

I am quite concerned about the cortisol and the glucose levels... any ideas?

 

Endo's Labs (reference ranges in parentheses):

  • Adenocorticotropic Hormone  =  1.6 pmol/L  (2.0-11.5)
  • IGF-1  =  265 ug/L  (76-277) In the past it was 401, 283, and 297
  • FSH  =  5 IU/L  (depending on cycle time it’s 1-33)
  • Prolactin  =  11 ug/L  (0-25)
  • LH  =  6 IU/L  (depending on cycle time it’s 1-76)
  • Ferritin  =  93 ug/L  (13-375)
  • Cortisol AM  =  892 nmol/L  (200-690)
  • TSH  =  0.04 mIU/L  (0.20-6.00)
  • Estimated Glomular Filtration Rate (GFR)  =  110 mL/min/1.7   (<60mL/min/1.73m2)
  • Alkaline Phosphatase  =  38 U/L   (30-115)
  • Cholesterol  =  5.35 mmol/L  (3.80-5.20)
  • Triglycerides  =  0.67 mmol/L  (0.60-2.30)
  • HDL  =  2.17 mmol/L  (>=0.91)
  • Total : HDL Ratio  =  2.5
  • LDL calculated  =  2.88 mmol/L  (2.00-3.40)
  • Creatinine  =  61 umol/L   (35-100)
  • Fasting Glucose  =  6.0 mmol/L  (3.3-6.0)
  • Hemoglobin A1c  =  5.8%  (4.3-6.1)
  • On the complete blood count, everything was normal except Eosinophils which was 0.8 (0-0.7)

One other thing to add is that I have been have very frequent bouts of what I interpret to be hypoglycemic attacks. It is happening up to a few times a day, at least once per day. I get jittery, cold sweats, find it difficult to focus my mind and my eyes, lack of coordination/dizziness, and a couple of times felt a bit faint. This usually happens after eating food and tends to get better if I eat again (sugary food, something like a pepperoni does not help) or haven't eaten for hours (like in morning). For example, I was a bit hungry and had a pepperoni stick about 20 minutes ago, and I am jittery and sweating a bit now - noticeable tremors to me.  Could that be too much cortisol or weird hypoglycemia or totally unrelated? If I was going diabetic, wouldn't it be hyperglycemia instead?

 

I've been doing reading but my mind doesn't focus well lately (for the past month really) and I'm not getting far.  And no, I haven't been glutened. I'm sure.  :) 

 

Thanks guys.

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Hey There, NVSMom!

 

Wow, I think I have yet to post an interesting and intelligent question yet on this forum.  Someone always beats me to it!

 

First, calm down.  I say that because I've been telling myself that for the past 24 hours!  I just got back my fasting glucose = 100 (range is 65-99) and my HbA1c is the same as yours:  5.8% and the range is <5.7%.  

 

I am not taking any drugs other than HRT (for bone growth, post menopausal) and Armour Thyroid (Hashi's).  

 

Your jittery symptoms?  I think your TSH is too low which is not good for someone like me who is trying to grow bone.  It would be better to be a .4 than an .04.  My TSH which I consider to be pretty low, but okay is 0.69.  When mine is down to .08 or lower I am jittery.  Sometimes if you hold your arms straight out, you can see your hands jitter!  My doc checks me that way.  Something to consider!

 

Back to the glucose.  I was freaked.  First of all, my doc ordered the Hemoglobin A1c by accident.  He had another patient window open and mentioned that my last A1c was high.  I told him that I never had that test.  That my Dad was just dxed with diabetes II this year but that he's very overweight.  I am in shape (exercise level well above the average female my age) and slender.  He realized that he was in another window, but I guess he decided to order the A1c blood test since I mentioned my Dad's diabetes.  I guess….

 

In the meantime, my modem crashed and I had to wait for our service provider to replace it (this morning).  So, I just had to pull all labs last night located in our old-fashioned filing cabinet.

 

My fasting blood glucose and random glucose levels have been anywhere from 59 to 136.  The two readings:  122 and 136 were when I was in ER for gallbladder attacks and I was not fasting.  The closest it's been to 100 (taken last week) has been in 1995 (92) and 2004 (96).   My last reading in 2012 (before celiac disease dx) was 73.  I felt better when I read this data (lesson to learn:  keep all copies of your lab tests…..)  Then I researched the HbA1c and found that it is not accurate when you have anemia and I have both Alpha Thalassemia and Iron Deficiency Anemia.  So, is my reading of 5.8% accurate?    I also ready that estrogen can impact glucose levels.  Am I possibly pre-diabetic?  

 

Chances are no.  I guessing (and I'd like input here) that I have been consuming way too much sugar.  I am a sugar fiend!  When I bake, I can eat 1/3 of the brownies in one sitting!  I can polish off 10 cookies at one time.  Yes, it's not good, but after I first bake them I gobble them up then I freeze them and then dole them out in small amounts.  I have always been like this.  I am super active and have never had a weight issue.  It remains steady despite my thyroid storms.  I can have a super high TSH but not gain weight (nor lose).  I do eat healthy -- geez, I had salmon and greens for breakfast, with fruit and coffee.  

 

Since going gluten-free I have increased my rice and corn consumption and have eaten way too many chips (though in moderation).  My carb levels are very high.  I have even started drinking soda when I'm at a restaurant and can't order anything safe or when I'm out and running errands and have forgotten to pack my emergency food (lessons still learning….).  I'm am allergic to nuts, milk and eggs, which really knocks some very diabetic friendly foods off my list…..

 

My cholesterol is super low now and historically, which I have attributed to celiac disease.  

 

Anyway, I hope this helps you.  I can't wait to see how others respond:

 

Has going gluten-free increased your fasting blood glucose or your Hemoglobin A1c?  

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+ am taking a very low dose of hydrocortisone (20 mg cortef) and a low dose of florinef (0.1) so I am guessing it had an effect. My morning cortisol is quite high - could the meds throw it that high? My adenocorticotropic hormone is low, but I'm assuming that it's because the AM cortisol is so high.+

 

Nicole.  Are you taking these meds to help your adrenal gland?  And if you are you need to fine out the natural rythem of ,your cortisol out put.  You have change times that you take these.  These meds attemp to mimic this natural rythem.  It increases quickly around 5 am then takes a dip after lunch and a moderate increase around dinner then tapers done the rest of the night. you want to help the rising levels and not let the lows go to low.  It is very conplicated.

 

Good luck

 

Colleen

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Hey There, NVSMom!

 

Wow, I think I have yet to post an interesting and intelligent question yet on this forum.  Someone always beats me to it!

 

First, calm down.  I say that because I've been telling myself that for the past 24 hours!  I just got back my fasting glucose = 100 (range is 65-99) and my HbA1c is the same as yours:  5.8% and the range is <5.7%.  

 

I am not taking any drugs other than HRT (for bone growth, post menopausal) and Armour Thyroid (Hashi's).  

 

Your jittery symptoms?  I think your TSH is too low which is not good for someone like me who is trying to grow bone.  It would be better to be a .4 than an .04.  My TSH which I consider to be pretty low, but okay is 0.69.  When mine is down to .08 or lower I am jittery.  Sometimes if you hold your arms straight out, you can see your hands jitter!  My doc checks me that way.  Something to consider!

 

Back to the glucose.  I was freaked.  First of all, my doc ordered the Hemoglobin A1c by accident.  He had another patient window open and mentioned that my last A1c was high.  I told him that I never had that test.  That my Dad was just dxed with diabetes II this year but that he's very overweight.  I am in shape (exercise level well above the average female my age) and slender.  He realized that he was in another window, but I guess he decided to order the A1c blood test since I mentioned my Dad's diabetes.  I guess….

 

In the meantime, my modem crashed and I had to wait for our service provider to replace it (this morning).  So, I just had to pull all labs last night located in our old-fashioned filing cabinet.

 

My fasting blood glucose and random glucose levels have been anywhere from 59 to 136.  The two readings:  122 and 136 were when I was in ER for gallbladder attacks and I was not fasting.  The closest it's been to 100 (taken last week) has been in 1995 (92) and 2004 (96).   My last reading in 2012 (before celiac disease dx) was 73.  I felt better when I read this data (lesson to learn:  keep all copies of your lab tests…..)  Then I researched the HbA1c and found that it is not accurate when you have anemia and I have both Alpha Thalassemia and Iron Deficiency Anemia.  So, is my reading of 5.8% accurate?    I also ready that estrogen can impact glucose levels.  Am I possibly pre-diabetic?  

 

Chances are no.  I guessing (and I'd like input here) that I have been consuming way too much sugar.  I am a sugar fiend!  When I bake, I can eat 1/3 of the brownies in one sitting!  I can polish off 10 cookies at one time.  Yes, it's not good, but after I first bake them I gobble them up then I freeze them and then dole them out in small amounts.  I have always been like this.  I am super active and have never had a weight issue.  It remains steady despite my thyroid storms.  I can have a super high TSH but not gain weight (nor lose).  I do eat healthy -- geez, I had salmon and greens for breakfast, with fruit and coffee.  

 

Since going gluten-free I have increased my rice and corn consumption and have eaten way too many chips (though in moderation).  My carb levels are very high.  I have even started drinking soda when I'm at a restaurant and can't order anything safe or when I'm out and running errands and have forgotten to pack my emergency food (lessons still learning….).  I'm am allergic to nuts, milk and eggs, which really knocks some very diabetic friendly foods off my list…..

 

My cholesterol is super low now and historically, which I have attributed to celiac disease.  

 

Anyway, I hope this helps you.  I can't wait to see how others respond:

 

Has going gluten-free increased your fasting blood glucose or your Hemoglobin A1c?  

 

Wow, our blood are pretty close aren't they!? I think you are ahead of me so far in the research. My search words just aren't giving me much that could cause high fasting glucose beyond cortisol or diabetes or too much growth hormone (acromegaly) which is the concern that brought me to the endo. This article gets into it a bit: http://www.idf.org/sites/default/files/attachments/article_61_en.pdf

 

Growth hormone is secreted by the pituitary gland, a tiny organ in the centre of the human head just beneath the brain.This hormone has major effects on glucose metabolism – the opposite to those of insulin. It increases glucose concentrations in the blood and decreases the body's sensitivity to insulin, thus opposing the normal action of insulin. GH concentrations are up to 2-3 times higher in people with diabetes compared to people without the condition.The excessive GH secretion may be partly responsible for the 'dawn phenomenon' – a rise of blood glucose concentrations in the early morning before waking from sleep. .....While excess GH secretion causes diabetes in up to 40% of people with tumours which over-produce GH (a condition called acromegaly), a lack of GH also has a detrimental effect on sensitivity to insulin...

 

I definitely have been consuming way more sugar than normal over all of December and into January. I was drinking soda a few times a wee (pop is my vice) but I'm on the wagon again.  LOL I am sure that could have thrown my HbA1c up higher but my last one last spring was still a 5.6. I have never had HbA1c or fasting glucose checked before I went gluten-free so I have no idea how it compares to then. I'm not anemic at all, and haven't been for 20 years (again I am a lucky celiac) so that won't be an issue for me, although I can see where it would affect yours!

 

I doubt that my jitters are thyroid related but it could be possible. I have had jitters off and on for the past 10+years (even when I was quite hyo) it's just that now I am jittery most of the time - any time I hold a fork or book it is pretty noticeable.

 

I just don't know about being hyper...My TSH has been as low as 0.01 but as long as my free T3 in above the halfway point of the normal range, and not dancing around the upper limit either, I feel pretty good. I did go hyper once when I first began NDT, and my dose was too high. At the time my TSH was 0.11 (still below range) but my free T3 exceeded the range by a bit. I felt pretty weird, and my heart felt like it was going harder than normal. It really does feel different than this. This almost feels more like my postural hyoptension does when I would go to stand up and get light headed (partially what the hydrocortisone treats). It also does seem affected by food and coffee which was never the case with thyroid symptoms before - I think I'll start keeping a food and symptom journal again so I can be more sure of what is going on. Like a lot of people, I tend to see what I recognize and ignore other information. I will keep that in mind and ask the doctor check my free T3 next time.

 

As for bone density, I am a lucky celiac. I had a bone densiometry (sp?) done in the spring, and my bones are denser than average so I am less likely to develop osteoporosis in the future.

 

My cholesterol is very odd. I usually have too low triglycerides and low LDL and normal HDL. In the past I have had high lipoprotein a, but I don't know if that would affect that cholesterol number... I have no idea how they even came up with that when all my numbers seem fine.Hmm.

 

Thanks for all the ideas. I appreciate it!   :)

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+ am taking a very low dose of hydrocortisone (20 mg cortef) and a low dose of florinef (0.1) so I am guessing it had an effect. My morning cortisol is quite high - could the meds throw it that high? My adenocorticotropic hormone is low, but I'm assuming that it's because the AM cortisol is so high.+

 

Nicole.  Are you taking these meds to help your adrenal gland?  And if you are you need to fine out the natural rythem of ,your cortisol out put.  You have change times that you take these.  These meds attemp to mimic this natural rythem.  It increases quickly around 5 am then takes a dip after lunch and a moderate increase around dinner then tapers done the rest of the night. you want to help the rising levels and not let the lows go to low.  It is very conplicated.

 

Good luck

 

Colleen

 

 

I usually take my cortisol around 7am with food (it's hard on the stomach), and I did take it on the day of the test - about two hours before it. I am guessing that my meds threw my cortisol results off, but I am mainly concerned that taking cortisol is messing with my blood glucose levels. If it is, I'll get off them as soon as I can talk with my other doctor and taper it off.

 
I take a single dose pill and I asked my doctor if I should spread it out and he said no. I'll have to do some reading on that. Thanks!  :)

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I usually take my cortisol around 7am with food (it's hard on the stomach), and I did take it on the day of the test - about two hours before it. I am guessing that my meds threw my cortisol results off, but I am mainly concerned that taking cortisol is messing with my blood glucose levels. If it is, I'll get off them as soon as I can talk with my other doctor and taper it off.

 
I take a single dose pill and I asked my doctor if I should spread it out and he said no. I'll have to do some reading on that. Thanks!   :)

 

Yes, if it is not needed long term, taper off.  We know they are not good for us long term anyway.  And I do think you probably shouldn't have taken it before the test because the test will reflect the level with the help.  

 

http://www.livestrong.com/article/419079-cortisol-blood-glucose/

 

Stressful Conditions

In stressful situations, cortisol's role is to provide glucose to the body through utilization of protein stores. This quick delivery of glucose prepares your body for the fight or flight mechanism. When the body is in a persistent stressful state, cortisol is constantly obtaining glucose. This constant flow of glucose leads to high blood sugar levels.

Another Effect of Cortisol

Cortisol obtains quick glucose for the body to use in times of stress. At the same time, cortisol also reduces the effects of insulin. Therefore, not only are blood glucose levels high, insulin is unable to perform its regular function of maintaining normal glucose levels, according to "Today's Dietitian." The pancreas continues to release insulin, but the cells are resistant to insulin. However, the pancreas continues to secrete insulin in response to high glucose levels, which puts extra stress on the pancreas.

Its amazing what one med can do to other parts of the body.
 
Colleen

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Thanks Colleen. I think you are probably right that cortisol might have played a role in my higher fasting glucose.It may not be the sole cause, but it's definitely a good guess that it had some effect.

 

I'll get in touch with my doctor and discuss his plan for me. I don't know how long term he is thinking of having me on that so I need to know more.

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