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Question: I have not been feeling well here of late and wanted to see if someone could help me understand what is going on. First, I am 46 year old male. About 6'2" and weight 225 lbs. Six year ago I was diagnosed with hypoaldosternism (was having heart palpitations and very low standing blood pressure) and started taking .1 mg of florinef (generic). About 1 year into treatment .1mg was no longer enough to keep my standing bp from falling and getting dizzy. I was upped to .1mg 2x daily and increased my salt intake to 125% daily recommended. At this time I was averaging 64 oz of water (just tracked actual water intake not taking into account other sources). Here for the last year I have had to increase my florinef to .1mg 3X daily and averaging 80oz of water daily and still having issues with standing bp. I notice if I don't stick to a strict regimine of drinking frequently by bp goes low. Many time if I do any physical exertion at all I can feel my BP dropping and start getting light headed and will most of the time have to sit down to recover. I visited my family doctor and he had some tests run and referred me to an Endocrinologist. Sadly, getting into and Endo here takes about 4 - 6 months to get a visit. Here is the results of the blood work: Cortisol - 15.6 ug/dL Aldosterone - 4.4 ng/dL (did not stop taking Florinef prior to test) Sodium - 142 mmol/L Potassium - 4.0 mmol/L ACTH - 126 pg/mL Total Cholesterol - 114 mg/dL HDL - 30mg/dL LDL - 50 mg/dL I am no doctor but I do have some concerns that I would like to know about. First, since my ACTH is elevated, why is it still elevated if I am already taking .3mg Florinef daily, is it a response trying to get more cortisol production and that is what is also lacking? To me logic would dictate with high ACTH I would have high cortisol results versus mid range. Again, not self diagnosing just trying to figure something out while I wait 4 months for an appointment. Also, why is my cholesterol continually dropping over the last 5 years? I average around 130 and now and down to 114. An I eat ALOT of red meat (daily). Both my Sodium and Potassium at mid rage according tot eh test results. I am currently taking about 130% daily recommended, sometime up to 200% when my bp is very low. I actually take a teaspoon of salt and mix it with Gatorade to help. I am not sure what is going on with me
Symptoms:
Standing low blood pressure. Increased asthma issues. Frequent headaches.
Symptoms:
Standing low blood pressure. Increased asthma issues. Frequent headaches.
Brief Answer:
About low blood pressure and high ACTH:
Detailed Answer:
Hello and thank you for asking!
I have gone through your detailed concern carefully.
An elevated ACTH level is mainly suggestive of insufficient cortisol production by adrenal gland rather than low aldosterone.
A normal cortisol level does not exclude an adrenal insufficiency but a Synacthen stimulation test is needed.
Usually, low aldosterone production is associated with low cortisol production.
Probably this is the reason why you still have low blood pressure (despite taking 3 TB of fluorinef/ day). Hydrocortisone will probably be helpful but Synacthen stimulation test is needed to confirm it.
The tendency of the cortisol to get lower during these years is suggestive for a decreasing adrenal function.
I think your Endocrinologist will suggest the Synacthen test at the next appointment.
Hope the information will help. Feel free to ask further.
Kind regards,
Dr.Mirjeta
About low blood pressure and high ACTH:
Detailed Answer:
Hello and thank you for asking!
I have gone through your detailed concern carefully.
An elevated ACTH level is mainly suggestive of insufficient cortisol production by adrenal gland rather than low aldosterone.
A normal cortisol level does not exclude an adrenal insufficiency but a Synacthen stimulation test is needed.
Usually, low aldosterone production is associated with low cortisol production.
Probably this is the reason why you still have low blood pressure (despite taking 3 TB of fluorinef/ day). Hydrocortisone will probably be helpful but Synacthen stimulation test is needed to confirm it.
The tendency of the cortisol to get lower during these years is suggestive for a decreasing adrenal function.
I think your Endocrinologist will suggest the Synacthen test at the next appointment.
Hope the information will help. Feel free to ask further.
Kind regards,
Dr.Mirjeta
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
One part that I didn't see answered is about my cholesterol also dropping over the last 5 years. With it getting lower am I at some other risk for having too low of cholesterol?
Could this be related to adrenal function issues?
Is 114 getting too low? Is this something and Endo would be able to help with?
Could this be related to adrenal function issues?
Is 114 getting too low? Is this something and Endo would be able to help with?
Brief Answer:
About low cortisol level:
Detailed Answer:
Hi again,
Low adrenal function may be the cause of a low cholesterol level.
So, your endocrinologist will have it also into consideration as an indicator of adrenal insufficiency.
The levels are not as low as to be worrisome.
Kind regards,
Dr.Mirjeta
About low cortisol level:
Detailed Answer:
Hi again,
Low adrenal function may be the cause of a low cholesterol level.
So, your endocrinologist will have it also into consideration as an indicator of adrenal insufficiency.
The levels are not as low as to be worrisome.
Kind regards,
Dr.Mirjeta
Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.
Above answer was peer-reviewed by :
Dr. Raju A.T
Answered by
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