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Dr. Andrew Rynne

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Saliva tests show low cortisol. What would you prescribe?

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Dr. Shehzad Topiwala

Endocrinologist

Practicing since :2001

Answered : 1663 Questions

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Posted on Tue, 3 Dec 2013 in Thyroid Problem and Hormonal Problems
Question: My saliva tests show low cortisol all day long. My cortisol/DHEA-S ratio is 17.2. What would you prescribe. I have been diagnosed with severe adrenal exhaustion. I hear that allopathic endocrinologists do not agree with that diagnosis. I have also had hair mineral testing with the same diagnosis. How should I proceed. What would you prescribe.
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Answered by Dr. Shehzad Topiwala 8 hours later
Brief Answer: Lack of evidence Detailed Answer: You are correct in knowing that allopathic doctors are skeptical (putting it mildly) about this 'adrenal exhaustion' type of diagnosis. I have personally attended the endocrine fellowship module 1 of the A4M conference where they deliberate on this theme. I am far from convinced about the science presented there. If a a formally trained endocrinologist like myself were to diagnose adrenal insufficiency, there is a standard systematic approach to it. It involves an 8 am blood test for cortisol and based upon the results further tests like the 'ACTH stimulation' test may be deemed necessary. There is no role as of yet in performing a saliva test or DHEAS in the determination of adrenal insufficiency. It is only after rigorous clinical and lab testing to confirm the presence of adrenal insufficiency, I would proceed to treat a person with hydrocortisone tablets
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Shehzad Topiwala 11 hours later
Why is it that you don't believe adrenal glands can function somewhere between cushings and Addison's. You believe that the thyroid and pituitary glands can function at less than optimal levels. It seems strange that all of my symptoms fit the diagnosis. There is also literature that speaks to blood tests not being accurate. I am not trying to challenge your education and training. Just desperate for answers. I feel very ill. One of my doctors who is an MD had prescribed pregnenolone and DHEA rather than hc. What are your thoughts on that? Thanks.
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Answered by Dr. Shehzad Topiwala 13 hours later
Brief Answer: No comments Detailed Answer: I respect your thinking, and I acknowledge the role of complimentary and alternative medicine as well. For now, I am only going by the gold standard of hard science-backed therapies. But that does not mean that I believe that allopathy knows everything about the human body.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Shehzad Topiwala 10 hours later
Thank you. Do you think pregnenolone and DHEA could help? You did not answer that question. When I read the side effects of hc it scares me.
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Answered by Dr. Shehzad Topiwala 20 hours later
Brief Answer: No Detailed Answer: There is no evidence based guideline that I am aware of which recommends the use of pregnenolone and DHEA. So I do not use these.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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