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Low Cortisol Level
A low cortisol level by itself does not mean a lot. You need to have
a stimulation test (cosyntropin test) to know whether the low
cortisol level is of signficance or not.
Those with low cortisol may respond normally to the stimulation
test. Then they are normal. However if they do not respond
normally to the stimulation test, then they are considered to have
A SIGNFICANT low cortisol level. At that time they should have
more tests to find out the reason for the low cortisol. Those
reasons may be in the brain (hypothalmus or pituitary) or may be
in the adrenal gland itself or may be because people take cortisol
pills (e.g. prednisone...)
To diagnose low serum cortisol (Addison's disease):
Serum cortisol taken at 8:00am < 5ug/dL [SI:140nmol/L] (some
authorities say < 3ug/dL [SI: 86nmol/L]) confirms the diagnosis. A
result of > 20ug/dL [SI: 550nmol/L] excludes the diagnosis in an
unstressed individual.
Between these values if the condition is still suspected a rapid
ACTH stimulation test should be performed. When impaired a long
ACTH stimulation test should be performed to differentiate primary
from secondary insufficiency.
A high plasma ACTH level with a low cortisol level confirms primary
adrenocortical insufficiency.
Addison's disease is a rare endocrine or hormonal disorder that
affects about 1 in 100,000 people. It occurs in all age groups and
afflicts men and women equally. The disease is characterized by
weight loss, muscle weakness, fatigue, low blood pressure, and
sometimes darkening of the skin in both exposed and nonexposed
parts of the body.
Addison's disease occurs when the adrenal glands do not produce
enough of the hormone cortisol and in some cases, the hormone
aldosterone. For this reason, the disease is sometimes called
chronic adrenal insufficiency, or hypocortisolism.
Aldosterone belongs to a class of hormones called
mineralocorticoids, also produced by the adrenal glands.
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