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What Do These Lab Reports For Fatigue And Weight Gain Indicate?

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Posted on Thu, 15 Dec 2016
Question: I added back in our original thread because I have additional questions regarding your remarks.

I have had comprehensive blood work and the only marker that was out of range was bilirubin by a very small amount (1.4 mg/dl)

There has been a lot of emotional stress in my life over the past few years. Could this be adrenal fatigue? If so, what are the recommendations to resolve that?

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Hello,
I have had a number of test done because of some symptoms I have been having for the last 6- 12 months.
1) Fatigue and lower energy level
2) Weight gain ( about 10 pounds outside of the norm) 5'1 and I'm at 145lbs but usually 135lbs
3) Irritability
4) Headaches twice a month ( seem to match up with drops in estradiol and progesterone during my cycle)

Tried a 30 day SALIVA testing - (I can send full hormone profile from saliva)
Estradiol was low ( day 3 of cycle was .6 pg/mL)
Progesterone was low (day 21 was 235.2 pg/mL)
Cortisol ( 1 day & 7:00am test ) was 2.2 nM/L

Then proceeded with further BLOOD work:
Estradiol (3rd day of cycle) 25.9 pg/mL
Cortisol 6.3
Prolactin 8.3
TSH: 1.84

Not on any medications, not trying to get pregnant, no allergies, always have had a clean XXXXXXX of health.

Should I take any further action? An appointment with endocrinologist in my area is 3 months out.
Asked by Me , 4 days ago
Doctor's reply to your question above...
Brief Answer:
Hormone tests

Detailed Answer:
Sorry to learn about your bothersome symptoms.

I have reviewed the attached laboratory report. Such testing is not uniformly practised globally. It is not considered part of best practice ('standards of care') in Endocrinology. Expert guidelines by authoritative bodies does not endorse the use of these in practice because solid evidence for it's use is grossly lacking.

Regarding the blood tests for TSH and Cortisol, I will comment that the TSH and Prolactin are normal while the 8 am Cortisol is a tad low. This generally indicates the possibility of a condition called adrenal insufficiency. However one of the hallmarks of this problem is weight loss, while you are in fact gaining weight. Nonetheless, you are free to discuss this report with your doctor and consider proceeding with a test called ACTH stimulation test which can confirm or rule out this diagnosis.

Generally, as long as menstrual cycles are regular, one does not really need to check Estradiol, Progesterone and related hormones.
When I see someone like you in my practice, I typically order the following blood tests in addition to a detailed physical examination:

CBC (Complete Blood Count, also known as Hemogram; includes Hemoglobin, WBC and Platelet counts)
Electrolytes (Sodium and Potassium in particular)
HbA1c (Glycosylated Hemoglobin = your last 3 months' glucose average). Also known by other names such as GlycoHemoglobin or Glycated Hemoglobin or A1c
Liver function tests (SGOT , SGPT, Albumin, Bilirubin, Alkaline Phosphatase)
Kidney function tests (BUN, Creatinine)
TSH (checks your thyroid)
25 hydroxy Vitamin D levels (ideal range 40 to 60 ng/ml = 100 to 150 nmol/liter)

None of these tests require any fasting and can be done at any time of the day Correct diagnosis and treatment requires the opportunity to examine the patient so you must see an endocrinologist in-person. I understand you have an appointment although I am aware of the delays in scheduling with Endocrinologists.
doctor
Answered by Dr. Shehzad Topiwala (7 hours later)
Brief Answer:
Fatigue

Detailed Answer:
I am sorry to note the stress you are going through.

I have reviewed our previous discussion.

The mildly high bilirubin does not represent an immediate problem. However, please recheck it next month to make sure it is not showing an upward trend. Consulting a Gastro enterologist will help.

Regarding adrenal fatigue, this term has been created by non-experts and is misleading. There is no medical disease by this name. If one has a condition called adrenal insufficiency then fatigue is one of the symptoms. So it is important to rule out the possibility of this problem by means of appropriate testing as discussed previously:
ACTH stimulation test

ACTH STIMULATION TEST: PROTOCOL

THIS TEST IS PERFORMED TO RULE OUT A SERIOUS CONDITION CALLED ADRENAL INSUFFICIENCY.

1 IT IS NOT NECESSARY TO FAST FOR THIS TEST

2 AT SHARP 8 AM IN THE MORNING, A BLOOD SAMPLE MUST BE DRAWN FOR

SERUM CORTISOL.

THIS SHOULD BE LABELLED AS THE 0 (ZERO) HOUR CORTISOL SAMPLE

3     THEN IMMEDIATELY AFTER THE ABOVE 0 HOUR BLOOD SAMPLE HAS BEEN TAKEN, INJECT SYNACTHEN 250 MCG IV SLOWLY OVER 10 SECONDS INTRA VENOUSLY (IV)


4     THEN EXACTLY 30 MINUTES AFTER THE INJECTION, DRAW ANOTHER BLOOD SAMPLE FOR

SERUM CORTISOL

THIS SHOULD BE LABELED AS THE 30 MINUTE CORTISOL SAMPLE

5     THEN ANOTHER 30 MINUTES LATER (WHICH WOULD BE A TOTAL OF 60 MINUTES AFTER THE ZERO HOUR SAMPLE/INJECTION), DRAW ANOTHER BLOOD SAMPLE FOR

SERUM CORTISOL

THIS SHOULD BE LABELED AS THE 60 MINUTE CORTISOL SAMPLE

6     IT IS VERY IMPORTANT TO ENSURE ACCURATE LABELS OF THE BLOOD SAMPLES AS
0 HOURS SERUM CORTISOL
30 MINUTES SERUM CORTISOL
60 MINUTES SERUM CORTISOL


Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Shehzad Topiwala

Endocrinologist

Practicing since :2001

Answered : 1663 Questions

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What Do These Lab Reports For Fatigue And Weight Gain Indicate?

Brief Answer: Fatigue Detailed Answer: I am sorry to note the stress you are going through. I have reviewed our previous discussion. The mildly high bilirubin does not represent an immediate problem. However, please recheck it next month to make sure it is not showing an upward trend. Consulting a Gastro enterologist will help. Regarding adrenal fatigue, this term has been created by non-experts and is misleading. There is no medical disease by this name. If one has a condition called adrenal insufficiency then fatigue is one of the symptoms. So it is important to rule out the possibility of this problem by means of appropriate testing as discussed previously: ACTH stimulation test ACTH STIMULATION TEST: PROTOCOL THIS TEST IS PERFORMED TO RULE OUT A SERIOUS CONDITION CALLED ADRENAL INSUFFICIENCY. 1 IT IS NOT NECESSARY TO FAST FOR THIS TEST 2 AT SHARP 8 AM IN THE MORNING, A BLOOD SAMPLE MUST BE DRAWN FOR SERUM CORTISOL. THIS SHOULD BE LABELLED AS THE 0 (ZERO) HOUR CORTISOL SAMPLE 3 THEN IMMEDIATELY AFTER THE ABOVE 0 HOUR BLOOD SAMPLE HAS BEEN TAKEN, INJECT SYNACTHEN 250 MCG IV SLOWLY OVER 10 SECONDS INTRA VENOUSLY (IV) 4 THEN EXACTLY 30 MINUTES AFTER THE INJECTION, DRAW ANOTHER BLOOD SAMPLE FOR SERUM CORTISOL THIS SHOULD BE LABELED AS THE 30 MINUTE CORTISOL SAMPLE 5 THEN ANOTHER 30 MINUTES LATER (WHICH WOULD BE A TOTAL OF 60 MINUTES AFTER THE ZERO HOUR SAMPLE/INJECTION), DRAW ANOTHER BLOOD SAMPLE FOR SERUM CORTISOL THIS SHOULD BE LABELED AS THE 60 MINUTE CORTISOL SAMPLE 6 IT IS VERY IMPORTANT TO ENSURE ACCURATE LABELS OF THE BLOOD SAMPLES AS 0 HOURS SERUM CORTISOL 30 MINUTES SERUM CORTISOL 60 MINUTES SERUM CORTISOL