Type 1 short Synacthen test

its not anything to do with a pump. It's probably to exclude Addison's disease.

k9badger said:

Can anyone tell me what the above test is for in connection with T1. Could it be anything in preparation of going on a pump???

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You mentioned earlier that your wife had a bad hypo. It's possible the test is to rule out other hormonal problems that may have caused that hypo. The test checks the function of the adrenal glands.

@k9badger Addison's disease can affect diabetes control, as mentioned above, and the test you've asked about is to do with that. I don't know about thyroid issues affecting control but it would make sense if they did.

There are also things like coeliac disease that can cause hypos.

I would imagine her team are working through some tests to rule out these and other problems.

Another issue - hope you don't mind me mentioning it - is that some women find hormonal changes like the menopause can wreak havoc with control.

A short Synacthen test (don't know if there's a long one,) is also commonly used in a respiratory unit. It's all to do with long term steroid use, and it can predict how easily the adrenal glands will pick up endogenous glucocorticosteroid production.
Quite simple really - blood taken for levels, IM Synacthen given, bloods taken again at 30minutes and 60minutes post injection.

A synacthen test is a test to measure the function of the adrenal glands. It measures the adrenal response to a hormone. Adrenal glands are supposed to produce cortisone in response to the hormone, so the test measures how much cortisone is produced.

Addison's disease is when your adrenal glands don't produce enough/any steroids (which is the cortisone).

Like type 1 diabetes, Addison's is an autoimmune disease. If you've got one autoimmune disease, your more at risk of others.

Addison's causes hypoglycaemia because it's a lack of steroids, steroids are counter regulatory to insulin and keep blood sugar up.

@CarbsRok has type 1 and Addison's so may have more information on how Addison's presents and what to expect from the test.

Synacthen tests don't look for thyroxine. I'm not sure where that came from. But yes, changes in hormone levels can impact on insulin requirements and if you have you've had severe hypos or hypos that can't be explained on review it's a sensible first step of investigation to rule out some excess or insufficiency of hormone as a cause.

I had never heard of this particular test but wonder now having been on steroids continuously for years I have not had one.

Maybe as I'm never likely to come off steroids it is considered pointless.

JohnEGreen said:

I had never heard of this particular test but wonder now having been on steroids continuously for years I have not had one.

Maybe as I'm never likely to come off steroids it is considered pointless.

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I don't think the synacthen test has anything to do with taking steroids as a medication. It measures the cortisol steroids your adrenal glands make.

catapillar said:

I don't think the synacthen test has anything to do with taking steroids as a medication. It measures the cortisol steroids your adrenal glands make.

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When you have been taking steroids for a significant time at high doses as I have the Adrenal glands can stop producing Cortisol and don't always resume when you stop taking them leaving you with what is effectively Addison's disease.

JohnEGreen said:

When you have been taking steroids for a significant time at high doses as I have the Adrenal glands can stop producing Cortisol and don't always resume when you stop taking them leaving you with what is effectively Addison's disease.

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Well then I think you're right, if you're not coming off steroids then there's not a lot of point running the test. It would only be done for someone who was showing signs of cortisol insufficiency when coming off long term steroids - http://www.derbyhospitals.nhs.uk/easysiteweb/getresource.axd?assetid=12232

Further to this.

"
What is Secondary Adrenal Insufficiency

There are normally two adrenal glands, located one above each kidney. The adrenal glands are really two endocrine glands in one. The inner part produces epinephrine (also called adrenaline). The outer portion of the adrenal is called the cortex. It makes two important steroid hormones, cortisol and aldosterone.

Cortisol mobilizes nutrients, modifies the body’s response to inflammation, stimulates the liver to raise the blood sugar, and also helps to control the amount of water in the body.

Aldosterone regulates salt and water levels which affects blood volume and blood pressure.

Cortisol production is regulated by another hormone, adrenocorticotrophic hormone (ACTH), made in the pituitary gland, which is located just below the brain. In most individuals, aldosterone production is not dependent on ACTH.

Primary adrenal insufficiency, also known as Addison’s disease, is caused by the total or near total destruction of the adrenal glands and results in the severe deficiency of both cortisol and aldosterone.

Secondary adrenal insufficiency, in contrast, is due to the absence of the normal stimulation to the adrenal cortex from a lack of ACTH. This results in a partial or total deficiency of cortisol, but often a normal or near normal production of aldosterone.

What Causes Secondary Adrenal Insufficiency

The two major types of secondary adrenal insufficiency are diseases that cause a total absence of ACTH and those that cause a suppression of ACTH production. Since ACTH is made in the pituitary under the control of the part of the brain called the hypothalamus, diseases that destroy either the hypothalamus or pituitary can cause this lack of ACTH. Most common are pituitary tumors, craniopharyngiomas, surgery to remove a tumor, radiation therapy to the pituitary, cysts in the pituitary, and some inflammatory diseases.

The most common cause of suppression of ACTH is the use of glucocorticoid medications to treat a large variety of illnesses. Glucocorticoids are steroid hormones that act like cortisol. They include cortisone, hydrocortisone, prednisone, prednisolone, dexamethasone, as well as intravenous, intramuscular, inhaled and topical “steroids.” All of these medications have an effect on ACTH because the pituitary is producing this hormone in response to the body’s need for cortisol. When the cells in the pituitary recognize any of these drugs, they sense that there is cortisol present and therefore produce less ACTH. This ACTH suppression from glucocorticoid medication can be very temporary, prolonged, or permanent depending on the dose, potency and length of use of the medication. For example, a few days of prednisone will not produce a significant problem, but several weeks of prednisone at a dose of 10 mg will diminish the cortisol level and the ability to fight a stressful situation. Recovery of the pituitary-adrenal response after use of a suppressive dose for more than one month will take about one month. Generally, this one for one recovery time is typical up to about 9 to 12 months, when recovery will often take up to a year or may not occur at all."

http://www.nadf.us/adrenal-diseases/secondary-adrenal-insufficiency/

catapillar said:

Well then I think you're right, if you're not coming off steroids then there's not a lot of point running the test. It would only be done for someone who was showing signs of cortisol insufficiency when coming off long term steroids - http://www.derbyhospitals.nhs.uk/easysiteweb/getresource.axd?assetid=12232

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I have been engaged in an on going discussion with my neurologist as I would dearly like to stop taking them he has allowed me to now step down to 10 mg per day if there is a test to see if it would be safe for me to stop taking them or not I would like to be offered it.