Dr Apt. July 2nd. Advice Needed, Need med advice before tomorrow please

[ratdog]

Well I think I have told pretty much everything there is to tell about me already. Except maybe one. One month ago I had ct scan of brain and neck. Radiologist said pit. gland, thyroid gland and all appeared normal in size. Also ct scan of adrenals/kidneys were done and nothing odd was noted. Prednisone 5mg for 7 days took a lot of body aches/pains away, but gave me zero in energy and helped not one bit with depression. On the positive side, as I mentioned in my last post, it could have been a fluke, but I was able to have sex with my wife without viagra. The prednisone also made my free and total testosterone numbers on blood tests noticeably higher. When the new endo said stop the pred. for now, aches came back in about 2 or 3 days, and the bedroom fun died as well. I know those of you that have read all my posts know my fsh and luteinizing hormone blood tests were at ground zero, but lots of articles on the internet say if you are getting testosterone cyp. injections expect those numbers to be low. Also considering my ct of the brain showed no problems, would you say it was safe to say its my adrenals pooping out. my ACTH was 27, is that not produced by the pit. gland? Here are my questions, I really need my energy level to come back quick. I must go back to work ASAP. I sold a car yesterday to make 2 house payments. Thats house serious this is in terms of money. I still cannot walk up/down stairs without chest pain, and breathing problems. I could care less if I eat, but because of fluid retention I and not losing much weight. If my doc allows me to help make med choices, what will give me more energy, pred, or hydrocort.? Are either of those meds supposed to boost your energy, or just help with aches/pains? My time is running short.

[ratdog]

Just discovered one strange quirk about my labs. ACTH (PLASMA) was 27 on a range of 7-69 pg/ml. Many sites say if you have low cortisol, and the stim test doesnt make your cortisol jump, and mine did not, pre-injection was 8.4 and 1 hr later was 12.7, that my ATCH plasma should be really high, is that info true?

[NJO]

I saw a much better result depression-wise and in general with hydrocortisone. ACTH is usually high in untreated primary Addison's Disease. With secondary AI the ACTH is low...because it's not producing it and stimulating the adrenals to release cortisol.

[KimH]

I'm interested to see what your doc says about primary vs secondary AI. I am secondary, but my baseline ACTH was in the normal range. My doc said that, though in the normal range, my ACTH should have been higher given my low baseline cortisol. I had a normal pituitary MRI too. Your other pituitary hormones are low, but that could just be because you get testo shots. I'm very curious about what your doc will say.

[ratdog]

Appointment left me very confused. Starting me on 15mg hydrocort. at 8:00AM and 5mg at 4:00PM to see if I have improvement. He said my ACTH should have been very high, and was not. He also sais high blood pressure and addison's did not go together. When I asked about a phenochromatoma test he said that lab work already was done and ruled out. Setting me up for an MRA w/contrast to rule out renal artery stenosis. What next?

[KimH]

So did he conclude from your ACTH not being high that the problem is pituitary, or did he not decide?

[Wanda]

The dosing schedule they gave you will leave you feeling crappy mid day!!

I would split it 10mg early AM, 5mg at 11AM and 5mg at 3 or 4PM.

If you are planning to get up early and go to work, it would be helpful to take the first dose when you get up.

I take my first 10mg while still in bed, between 5 and 6AM. I am retired!

[Wanda]

Forgot to add....

There are people with addisons and high blood pressure.

[ratdog]

He did not rule out addisons, nor did he say I was primary or secondary. He mentioned the fact if I had addisons, I should have noticed more of an improvement after 7 days of 5mg of Prednisone. More than just some relief from joint pain. He sent me straight to the lab again, to have renin and aldosterone repeated, I really do not know why, they were just done last monday. The renin tested high and aldosterone ok. He added something to these tests, can't remember exactly what, maybe IG1? He repeated these tests because I did not take a diuretic all weekend, I hate the heart palps I get when I do take it. I had gained 7 pounds in one week and never get hungry, but my hands and feet were swollen. I think he is really concerned about a kidney problem. I am so depressed after todays visit. I was hoping for a simple, quick fix, and then back to work.
MRA of the kidneys will be next Monday. I really wish I felt better.

[NJO]

Taking the first dose at 8:00 am is not right...way too late. I take mine very early and then when you are out of bed it is already in your system. And I agree three doses is better. You need to mimic the natural rythmn of cortisol release.

And high BP does occur in those with Addison's...

[Joan]

Ratdog, I am sorry you are so depressed. You have good reason to be, though. I know how you feel and would like to help, but I cannot. The others are more knowledgeable than I. I take 30MG of HC, divided into 15 in the AM, 5 at noon and 10 in the afternoon at about four. Also, .1MG of fludrocort in the AM. I try to take the meds early, but sometimes it gets to be 8Am before I wake up! It is better earlier, though..... and then go back to bed if necessary. I do that sometimes, but if I go back to sleep then, I miss all the cool air outdoors ! Isn't this heat oppressive, though? We had 109 yesterday. TG for AC! Gotta go water early in the AM or it all dies......

Do you have a hobby?