Ved nærmere ettertanke...

Egentlig ville jeg trodd at den S-cortisol-verdien min skulle vært OVER referanseområdet da jeg tok den - jeg var SUPERstresset! Ikke så rart, heller - etter å ha dratt både meg selv og sønnen min ut av sengen en time tidligere enn normalt, kranglet med ham om alt fra tannpuss til påkledning og spising, dratt både ham og meg på sykkel hjemmefra til legekontoret, og så forsøke å holde en trett og gretten treåring i ånde både på venterommet og MENS jeg tok blodprøven...

Ellers ser jeg jo at de som kan noe om binyreproblemer (altså 'slitne binyrer'/lav binyrebarkreserve) i sammenheng med hypo sier at blodprøver som regel ikke avslører noe (unntatt kanskje ACTH-respons-testen).

I natt, mens jeg satt og skrev på sykehistorien min, fant jeg til slutt fram til en artikkel som jeg bare har sett referert fra tidligere, nemlig denne:

"Adrenal Problems (Replacement Cortisone Therapy)"

Klipper og limer litt fra den:

Sitat:
(...)we are concerned with the mild form of deficiency, where the patient may be well, until subjected to stress and/or illness. Then, many of the symptoms may appear with prostration and collapse; or there may be level of insufficiency present all the time, with varying degrees of weakness, muscle and joint pains, and general ill health.

So what do we look for in the way of symptoms? It is rarely clear cut, because the deficiency is so often part of another illness, and may therefore have something of the symptoms of both. We are particularly concerned with thyroid deficiency, which, if of longstanding, or fairly severe in degree, is most often associated with adrenal insufficiency, as well as a direct result of the stress on the system low thyroid function will cause.

The patient will complain of weakness and episodes of prostration, frequently feeling quite unwell without being able to pinpoint the cause. Episodes of dizziness, sometimes cold sweats, caused by the blood sugar becoming abnormally low, are not uncommon. Often, an odd internal shivering is described. Aches and pains of a rheumatic nature are other frequent complaints. The patient often complains of the cold, and is likely to be cold to the touch. The subject does not feel well, and may look ill, with dark rings under the eyes, and a general pallor. There are likely to be digestive problems, with excessive wind and bloating, and bowel disturbances. The menstrual cycle may be disturbed, or absent and libido low. Depression and anxiety may also be a feature.

(...)

Low thyroid function has some of these features, and it may be difficult to distinguish one from the other; In fact it should not be necessary because, as I pointed out above, as the two are often together, so too must the treatment overlap and be designed to relieve both.

The complications of treating hypothyroid or underactive thyroid patients, is that their consequent poor adrenal reserve may become suddenly obvious, as soon as the thyroid is treated. The thyroid supplementation may, at worst, precipitate the adrenal problem; but what usually happens, is that the thyroid replacement may either not apparently work at all, or the patient may have thyroid over dosage symptoms on quite a low level of replacement. Hence, where low adrenal reserve is suspected, it is possibly dangerous, and certainly ill advised, to treat the patient without supplementation of the adrenals, in the manner explained further below.

If a high index of suspicion of adrenal insufficiency is raised by the history given by the patient, then what are the signs the doctor looks for to establish the diagnosis? Actually, it is sometimes difficult where the problem is not particularly severe; but there are some pointers. The blood pressure is usually quite low, often very strikingly so. The difference between the lying, (or sitting) blood pressure, and the standing one, may be very important. Normally, it rises when the patient stands. In low adrenal reserve, it either does not change at all, or lowers further. The pupil reflex is slow, or unstable, or even reversed, to bright light. Reflexes may be abnormal, especially the Achilles reflex -- in the heel. The heart sound is characteristically altered.

It is satisfactory to confirm the clinical impression by blood tests; but these sometimes are unhelpful. The level of cortisone in the blood may be measured, but it is widely variable. However, DHEA, mentioned above, is quite a good indicator of adrenal cortex function. The urinary excretion of adrenal hormones is an excellent indicator -- but the practical problems, (it has to be over 24 hours), and the expense of really good laboratory analysis, tend to limit this test to hospital in-patients.

It is, in our view, perfectly practical and reasonable, to establish the diagnosis on clinical grounds, and because the therapy given is of very low -- physiological -- doses, there is no possible risk to the patient, however long it is needed. In a very large number of cases, the adrenal insufficiency may right itself over two or three months, making further supplementation unnecessary.

Og når jeg ser nærmere på prøveresultatene mine, ser jeg jo at jeg har DHEA helt på nederste grense i referanseområdet...

Er ærlig talt litt lei meg for at jeg ikke fikk resept på hydrokortison i dag (heller...). Men jeg har jo kremen min, da!

Og forresten:
En ting til angående de binyreprøvene mine; burde jeg ikke vært testet for 21-OH-antistoffer...? Det er jo det den heter, den testen som viser antistoffer ved Addison's. Jeg har trodd at det var en av prøvene som ble tatt, men det ser jeg jo nå at det ikke er.