Dear Dr. Roach: I am inquiring about low cortisol. My son recently was told that his cortisol level is 0.39 and that it should be above 1.8. The result was from a saliva test. He has a very high pulse, low blood pressure, is somewhat fatigued and has a very poor appetite. 聽
He has an appointment to get a test done at the hospital next week. We were told that they will be giving him an IV with a synthetic cortisol treatment of some kind 鈥� a very minuscule amount. They will be checking his blood during this procedure. 聽
I was concerned after reading about this online, but was advised that it would be a very small amount and would be done only one time. Have you ever heard of this?
Anon.
Low cortisol, Addison鈥檚 disease, can be caused by an autoimmune destruction of the cells in the adrenal gland, which produce cortisol. Cortisol is critical for regulating many body functions, and it serves as one of the primary 鈥渟tress鈥� hormones, allowing your body to respond effectively to stress, such as illness or a physical threat. Addison鈥檚 also may be caused by destruction of the gland due to tuberculosis, which is rare now, or by deficiencies in the pituitary gland or higher centers in the brain. Cortisol levels are most commonly measured in the blood at 8 a.m. Saliva results may be useful, but there is less experience with using them.
The test your son likely is getting is an ACTH stimulation test, where he is given a synthetic form of adrenocorticotropic hormone, normally produced by the pituitary. The adrenal gland should respond by making larger amounts of cortisol. Other stimulation tests are necessary if the problem is suspected to be in the pituitary or in the hypothalamus. The ACTH 鈥渟tim鈥� test is commonly done, safe and very important. Addison鈥檚 disease is very dangerous if it isn鈥檛 recognized, and it is very easy to treat with replacement hormone. I have ordered many of these tests, and only a few were positive. The symptoms can be vague, but it鈥檚 so important not to miss the diagnosis. Your son鈥檚 symptoms certainly are consistent with Addison鈥檚, so he should proceed with testing. Please let me know the results.
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Dear Dr. Roach: I am a very active 81-year-old woman who is five feet, five inches tall and weighs 110 pounds. I play golf, work out two or three times per week, bicycle and walk. I am in good health and, until recently, had a flat abdomen. What would cause me, at this point, to have a protruding abdomen? In the morning my abdomen is fairly flat, but by evening it is quite pronounced. 聽聽 聽
D.E.B.
Your height and weight give you a BMI of 18.3, which is on the very low side of normal and borderline underweight, so I don鈥檛 think this is about being too heavy at all. I see two possibilities: The less likely is that there is fluid in your abdomen. This can come from liver disease, or from a cancer such as ovarian. But I doubt this, since enough fluid to be noticeable would make your weight go up significantly, and you probably would not be feeling entirely well. Still, it鈥檚 worth mentioning to your doctor, who usually can tell by exam but who might do an ultrasound to be sure.
The far more likely cause is that your abdominal muscles have gotten somewhat looser. These muscles need constant exercise to stay toned. Sit-ups or stomach 鈥渃runches鈥� are good exercises to keep your core muscles strong and tight.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
