Practitioner: I haven’t yet done the MasterCourse II in Thyroid & Adrenal Diagnostics but I want to better understand the HPA of that patient we discussed with significant sleep disorders. Waking blood? Saliva? Urine? Which one?
Rachel: Well, you’ve heard me say I am sure, that depends on the specific question you are trying to answer by way of this test result. For example, see this slide from MasterCourse II
which considers the best tests to answer qualitative questions about HPA behaviour and function (of course sometimes we just have quantitative ones like maximum or minimum output but I know you want to look beyond this)
Lastly, if I am running a <9am blood cortisol (which remains a good marker in most cases) then I always would add in DHEAs in the same sample which adds a WHOLE other layer of understanding: our capacity to weather the stress storm, to buffer the HPA activation or not! And if we’re collecting blood <9am why not include ACTH and then you can determine if there is a contribution from (mis)management…just saying…🤓
I have! And just recently a stark contrast between the results from 2 different methods of cortisol capture in the same patient illustrated just how likely this is. How do we ‘capture’ something so ‘dynamic’ and interpret anything of substance from a ‘static’ assessment technique? But rather than throw up our hands and throw out the whole attempt to measure cortisol, we can improve the rigor, reliability and real-world meaningfulness of our patients’ results by refining our timing of tests, choosing the medium wisely & manipulating test conditions to answer specific questions about their HPA function. Great desktop reference included!
You can purchase Cortisol – Have You Been Caught Out? here.