New Simple Method To Diagnose Adrenal Insufficiency To Improve The Health Of Those Affected
NEJM Evidence
A study into the use of an at-home test that uses saliva rather than blood to diagnose adrenal insufficiency, which has been developed by scientists at the University of Sheffield and tested in Sheffield endocrine patients at Sheffield Teaching Hospitals NHS Foundation Trust, is making a difference to the health of patients and could reduce time to diagnosis.
During the study, more than 200 patients attending Sheffield Teaching Hospitals NHS Foundation Trust’s Endocrine Unit were identified as being at risk of adrenal insufficiency due to long-term steroid use to treat other conditions. They were given swabs and a video showing them how to produce a saliva sample. The samples were taken in the morning at home, and the majority of patients reported they preferred this method to having to go to the hospital for a Short Synacthen Test .
Adrenal insufficiency is a common disorder of the adrenal glands, and occurs when the body is no longer able to make cortisol, a major hormone that helps the body overcome stress, infections and regulates body sugars, proteins and fats. This is particularly common in those who take oral steroids for other medical conditions as the body’s natural cortisol-making response shuts down while this function is temporarily taken over by the synthetic steroid.
More information:NEJM EvidenceJournal information:
How Do You Prepare For A Cortisol Test
It depends on the type of test youre taking and what your doctor tells you to do.
If youre getting a salivary test, dont eat, drink, or brush your teeth beforehand. If youre getting a blood test, its important to be well hydrated.
Try to relax and get some rest, as stress may affect your cortisol levels. Your doctor may ask you to avoid any strenuous physical activity the day before a cortisol test too.
The Adrenal Function Saliva Test Process
The adrenal fatigue test can be done right from your home or work place, the test kit contains a full set of instructions and all equipment required to provide your sample for testing.
This simple test only takes minutes to complete, this is done by taking 4 saliva samples over a 12 hour period, then your samples are placed in the provided return express postage bag which is sent to the laboratory for testing.
Test results are sent to one of our professional health practitioners within 7 business days for evaluation. Our practitioners contact you with the results and recommendations on any findings via email, mail or phone.
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Cortisol And Cortisone Measurements
Plasma cortisol
Plasma cortisol concentrations were determined in heparin plasma by an automated immunochemiluminescence assay . Patients enrolled in our study until November 2015 were measured by the cortisol I assay, whereas patients enrolled from November 2015 onwards were measured by the cortisol II assay.
Salivary cortisol and cortisone
Salivary samples were collected by chewing a cylindrical synthetic swab for approximately 1min. The patients were told not to eat or brush their teeth in a period of 30min before collection. Samples were centrifuged at 2682g for 10min, after which the synthetic swab was removed and collected saliva was stored at 20°C until further analysis.
Why Arent True Cortisol Awakening Response Tests Readily Available
A true CAR assessment requires salivary samples to be collected at the moment of waking, and twice more, at 30 minutes after waking and 60 minutes after waking.
The DUTCH PlusTM uses specialty, FDA-approved, and patented collection devices called SalivettesTM
SalivettesTM are specifically made for testing cortisol when timing needs to be precise and are used in nearly all of the published CAR studies.
The DUTCH PlusTM offers the most accurate salivary cortisol sampling with SalivetteTM collection and analysis
The DUTCH PlusTM offers an evaluation of the Cortisol Awakening Response by measuring salivary cortisol upon waking and then again 30 and 60 minutes later . Research has shown that this post-waking increase in cortisol is the best way to assess an individuals stress response and HPA-axis function.
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The Accuracy Of Cortisol Testing
As we discussed, cortisol is thought of as the primary stress hormone.
It makes sense then that you might have abnormalities in your cortisol level if you are under constant stress.
And while that may sound intuitive, it turns out to not really be true.
Despite a number of studies and tests, there have not been any that definitively prove a connection between cortisol and stress.
You can find some studies which show that stress is associated with lower cortisol and you can find others that it can also cause a dramatic rise in cortisol .
But you just dont find long-term studies that prove a precise connection between cortisol and stress.
Its undeniable that there is a connection between stress and cortisol, we just dont quite understand how it works yet.
Does this mean that all adrenal fatigue isnt real or that all cortisol tests are invalid?
Not by a long shot.
But it does mean that you should be aware of what you are testing for and have realistic expectations when you get tested.
Why does cortisol seem to fall short when comparing the stress you are under and how your body responds to that stress?
#1. Stress impacts other systems in your body.
The connection between stress and how it impacts cortisol is not as neat as it might sound.
It sounds intuitive that if your body is under stress that it will produce cortisol to combat the stress.
These concepts sound intuitive and they make sense.
But thats just not what we see.
These in turn may also interact with cortisol.
Saliva Adrenal Hormones Test For Adrenal Fatigue
When working with clients who suffer from various stages of adrenal fatigue or burnout, we start by performing adrenal and other tests to help with adrenal function assessment and determining optimal treatment options.
Hence Im often asked questions about the best testing methods, especially the reasons why I use the saliva adrenal hormones test vs blood or urine testing.
To answer some of these questions I wrote this blog to provide you with an overview of the adrenal function testing options currently used.
Adrenal fatigue or the hypothalamus-pituitary-adrenal axis dysfunction is often called the 21st century syndrome being the consequence of the stress related to busyness of our daily lives, lack of sufficient sleep and perpetual juggling of tasks both at work and home.
These stresses accumulate over time and then manifest in many physiological and psychological imbalances that can lead to significant negative health effects, if experienced over a prolonged period of time.
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What Is Adrenal Insufficiency
Endocrinologists stress that adrenal fatigue isnt the same as the scientifically proven disease adrenal insufficiency, also known as Addisons disease. People diagnosed with adrenal fatigue dont have the same symptoms and dont meet the diagnostic criteria for Addisons.
There is a stage of adrenal disease prior to full-blown adrenal insufficiency that is subclinical, before the disease becomes serious enough to require treatment.
This pre-disease state may be what people are looking at when they suspect adrenal fatigue. However, calling this stage adrenal fatigue isnt medically accurate.
Some signs and symptoms of adrenal insufficiency include:
What Is Adrenal Fatigue
Adrenal fatigue is a common hormonal problem that our Naturopathic Doctors treat at the clinic. Adrenal fatigue feels just like it sounds it is often associated with exhaustion or burnout and it affects many people at some point in their lives.
But what exactly IS adrenal fatigue and how does it happen? First, its important to understand the two tiny glands that sit on top of the kidneys the adrenal glands. body respond to stress by releasing specific hormones the most well known of these is cortisol, also known as the stress hormone. The adrenal glands also secrete hormones such as DHEA-S, aldosterone and cortisol.
The term adrenal fatigue has come to mean an imbalance in levels or patterns of secretion of the stress hormone, cortisol. Patients with this condition do often experience fatigue, and may be suffering with symptoms of burnout or exhaustion. In a busy city like Toronto, our naturopathic doctors see plenty of cases of adrenal fatigue in our clinic! So lets take a look at what adrenal fatigue really is, and what can be done about it with naturopathic medicine.
In adrenal fatigue, a common myth is that the adrenal glands are burned out, and have lost their ability to make hormones. However, in the vast majority of cases of adrenal fatigue, the adrenal glands are still perfectly capable of producing hormones like cortisol, DHEA, and aldosterone.
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Is Adrenal Fatigue Real
Its also worth pointing out adrenal fatigue is somewhat controversial and is much more recognized in the alternative health realm than it is in allopathic medicine. As a result, official statistics on its prevalence remain somewhat elusive.
However,its well accepted in all types of medical practice that the heighteningdemands of modern-day life are causing average stress levels to go through theroof. This means its likely safe to surmise that adrenal fatigue is much morecommon than many people think and you may even be suffering from ityourself.
But, how can you know for sure?
Saliva Testing For Hormone Levels
Saliva testing based on checking on different hormones, to a large degree, gives you an indication of whether a problem exists.
They do not, however, give a clear indication as to what the problem is.
Only experienced clinicians can accurately determine the possible causes of the saliva testing results, and even then, mistakes can happen. This is largely because these tests only indicate the presence of a problem and do not show the root cause. There is also much variance in results.
You should not, therefore, view the results given by a computer as final. Rather, you should look at your results as a starting point to finding the root cause of an underlying issue.
These tests include:
Essentially, these saliva testing results give insight as to how your NEM is functioning at a given time. When under stress, a rise or decline in certain hormone levels would give a qualified healthcare professional insight into how your body is dealing with stress.
Please do remember stress is not only psychological in nature. Physiological issues, diet, lifestyle, and environmental factors could also cause stress and influence your NEM.
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Vitamins And Minerals For Adrenal Support
Deficiencies of a few particular vitamins and minerals are correlated with fatigue symptoms. Iron deficiency anemia can definitely cause fatigue . Consider supplementing with iron. However, excess iron can cause side effects, so ask your doctor to assess your iron and ferritin levels to make sure iron supplementation is right for you.
Using supplemental B vitamin complex has been shown to reduce stress and stress perception , and vitamin C may also improve your fatigue .
Nhs Adrenal Fatigue Test
There isnt a specific medical test for adrenal fatigue.
If your GP suspects you have an underlying condition or Addisons diseasea medical condition in which your adrenal glands are unable to produce the necessary hormonesthey may refer you to an endocrinologist.
An endocrinologist will run additional blood tests and an adrenocorticotropic stimulation test to measure adrenal hormone function . If youre diagnosed with Addisons disease, the treatment will require synthetic hormonal drugs to replace what the adrenal hormones would make under normal circumstances.
Thankfully, Addisons disease is rare. If you are experiencing symptoms of burn-out and exhaustion, its more likely you have a hormone imbalance due to adrenal dysfunction .
Unfortunately, symptoms of dysfunction are not yet recognised by traditional GPsbut thats where Functional Medicine Practitioners come in. They will use adrenal testing to evaluate your stress response, recommend targeted nutritional supplements and address the root of your symptoms.
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What Information Does Testing Give You
I think the most important aspect of testing for any disease is to not only know that you have the condition but to also learn more about your condition.
If you are interested in diagnosing and managing adrenal fatigue, because you suspect you have it, the first question you want to be answered is whether or not its present.
Theres only one problem with this when it comes to your adrenals:
Theres no consensus regarding which cortisol test is the most accurate.
Thats problem #1.
You have to understand the limitations of each test and what type of information you are actually getting from that test.
If you are testing your serum cortisol, which is generally how I recommend that you start, you arent necessarily getting accurate information about how stress is impacting your body.
Other measures, including your blood pressure, heart rate, and other hormones, may actually be better indicators of this.
This same problem exists for both salivary and urinary cortisol, even those that may give you a better understanding of how concentrated certain cells are with cortisol.
They still dont give you the complete picture and may therefore be inaccurate.
But this isnt even the only issue.
Lets say you order a cortisol test and it comes back abnormal.
Now what?
Thats problem #2.
Once you have that information you better hope that the results you are getting are going to give you some idea of how or what you should be doing to fix the problem.
Adrenal Fatigue: Lets Talk About The Basics
Apparently, its not possible nowadays to have a discussion about a controversial topic without at least mentioning the other side of the argument.
And when it comes to adrenal fatigue, there is quite a bit of controversy .
The diagnosis of adrenal fatigue is not recognized by conventional doctors, but despite the fact that they dont recognize it as a credible medical condition there are a great many people who experience the symptoms associated with this condition.
It would be foolish to disregard the experience of hundreds of thousands of patients who experience the symptoms associated with the condition known as adrenal fatigue, but its also a good idea to maintain some degree of skepticism in any controversial topic.
What is not controversial about this condition is the fact that patients experience certain symptoms.
You can never deny the subjective symptoms that patients experience.
What you can deny, though, is that this condition results in some change or alteration to the stress hormone cortisol.
Cortisol, as many of you may know, is considered the stress hormone of your body.
During times of stress we know, from studying physiology, that cortisol is secreted and alters your physiologic state to allow your body to compensate for the stress.
Alternative providers believe that over time continued stress can cause disturbances to your cortisol level which can then be measured in various ways.
So we have somewhat of a standstill.
So whats the real story?
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Are Saliva Tests Reliable
Saliva tests are generally very good indicators of the levels of all the stress hormones in your body and saliva cortisol is actually covered by Plan B Medicare as well. The National Institute of Health and the World Health Organization recognizes saliva tests as being quite accurate. Plus, many insurance plans outside of Medicare cover this type of testing as well.
Saliva testing is often done by independent labs that do a wide variety of testing for doctors around the world. The advantage of the saliva test is that no refrigeration or special instructions are needed for the preservation of the saliva once it has been sealed in the test tubes. They are simply mailed to the lab for testing under normal conditions.
However, saliva tests are not the end-all, be-all when it comes to your physical condition. This is especially true if you have not suffered from a long-term event that would have caused the adrenal fatigue in the first place.
Remember that saliva testing should be considered the first step and not the final indication that you are indeed suffering from adrenal fatigue. While adrenal fatigue is relatively benign, the symptoms and the saliva test may cover you to a more serious condition that may be developing in your body. You should always double check the results with another test performed by a physician that will also scan for indications of anything that is more serious developing in your body.
First Stage: The Alarm
The first stage is an individual response to stress. Stressors can vary per person depending on the circumstances, as well as on a persons individual traits. For some people, an exam, a job interview, or the fact of going to the hospital is already stressing enough. Others are less prone to stress, so for them, for something to be a stressor it has to be more drastic than that.
To cope with stress, bodies generate a number of hormones. At this stage, lab testing can show elevated levels of DHEA, cortisol, insulin, norepinephrine, and adrenaline.
During this stage, people feel alarmed, may have trouble sleeping, or experience fatigue. Few people report symptoms like that in fact, few people believe them to be important. As a rule, people go through this stage more than once in a lifetime.
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The Most Comprehensive Way Of Measuring Adrenal Function Is Not A Blood Test
Due to the complexity of adrenal fatigue, traditional blood test are not the most accurate way to evaluate adrenal gland performance. There are several reasons for this.
#1- Steroid hormones in the bloodstream are 95-99% bound to carrier proteins, and in this form are unavailable to target tissues. Saliva testing measures the amount of hormone available to target tissues the bioavailable amount. For this reason, saliva testing better relates to specific symptoms of excess or deficiency and is a good option for monitoring hormone therapy.
#2 The other reason saliva outperforms blood testing is that the cortisol rhythm is unable to be measured in a single blood test.
