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Have fatigue, low BP, no periods. Undergone lab tests. Help me understand the test reports

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Practicing since : 2001
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Please explain my labs. I have fatigue, h/a's, low blood pressure, no menses, but not in menopause. RBC 4.39, WBC 2.9, Neut 41.1, Lymp 48.1, Abs. Neutrophils, 1.2, WBC-Abnormal Rare/occasional band forms are seen. No other immature forms or dysmorphic features are seen. Immunoglobulin A, Qn, Serum 74, Immunoglbulin M, Qn, Serum 344,
Posted Fri, 26 Apr 2013 in Thyroid Problem and Hormonal Problems
Answered by Dr. Shehzad Topiwala 18 hours later
Kindly send your entire hemogram report (Hemoglobin, hematocrit, blood counts with normal ranges etc) and CMP (complete metabolic panel which includes liver and kidney profiles and electrolytes). Although it is not in my specialty to interpret that, I am still interested in seeing the whole picture.

In light of your symptoms of headache and low blood pressure and fatigue, and the lab test results of cortisol and acth, it is important to rule out the possibility of adrenal insufficiency. First of all, I would recommend retesting the cortisol at 8 am in the morning. Values below 3.5 denote serious deficiency; values below 6 or so are also considered significantly low. Values above 15 to 18 are robust and good. None of these numerical cut offs are absolutely rigid. Everything requires corroboration with clinical examination.
So unless the CBG (Cortisol Binding Globulin, a blood test) is low, this cortisol value that you are reporting is concerning. However since it was done well after 8 am , it loses its importance and merits a repeat check at the right time. Now this is all assuming you are not on steroids like prednisone or equivalents like hydrocortisone or dexamethasone etc. Because if you are on agents like these then the blood cortisol results are misleading. In the meanwhile it will be beficial to get a hematologist's inputs on the blood count/immunoglobulin reports.

For more information on adrenal insufficiency, peruse WWW.WWWW.WW
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