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AUDIO: Dr. Theodore Friedman - Demystifying Adrenal Fatigue And Adrenal Hormone Roles

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The way, in general,the endocrinologists and conventional doctors test their cortisol is first of all, they can either measure a morning cortisol, and if its very low, say less than five, they are pretty sure they have adrenal insufficiency and cortisol insufficiency. If their cortisol is pretty normal, let’s say it’s greater than 12, they are pretty likely not to have it, and then if it’s in gray zone between say 5 and 12, they may have cortisol, they may not make enough under stress-like circumstances. And I think that testing should only be done if somebody has the symptoms and sort of the etiology to have an adrenal problem or pituitary problem, but if you measure a cortisol in the morning that’s somewhere between 5 and 12, we do what’s called a cosyntropin test.

This test relies on the fact that ACTH is given, and ACTH stands for adrenocorticotrophic hormone, notice that word ”trophic” in it. So if you have low ACTH, either from a pituitary problem, your adrenals start atrophying. It takes a couple of weeks or maybe a month or so, but if you have a problem with your ACTH, your adrenals will atrophy and if you give ACTH, the adrenals will not respond. Similarly, if you have an adrenal problem itself, you give ACTH; they won’t respond either. So people do this cosyntropin test very frequently, and that’s usually the main test done to diagnose adrenal insufficiency in Western medicine.

In the more alternative doctors, what I have been seeing them doing is measuring salivary cortisols. The salivary cortisol assay is pretty good for picking up high cortisol at night, but I don’t think it’s that good for picking up low cortisol in the morning, and also the labs that do it vary dramatically. There is some conventional laboratories that do a very good job of it, but there’s a lot of companies that are Internet-based, that appeal directly to either patients or to alternative providers that measure it, and I have seen some of their data. Their assays are not reproducible. They measure one day, and it seems like it’s low; they measure the same patient, the same sample even, and the next day it’s high.

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