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RE: [IPk] Pituitary and BG

On 11 Jun 2006 at 23:34, Jackie Jacombs wrote:

> Has Emily been tested for Addison's disease?  I dont know enough about
> what tests are required for this condition.

Hi Jackie, thanks for the links, there are some I haven't seen yet, 
I'll have a read. It's secondary Addison's I suspect rather than 
primary. Emily's hypothyroidism may be secondary (just going by the 
thyroid blood test results) which means that the problem could stem 
from the pituitary gland (or possibly the hypothalamus). 

What I've learnt so far is that hormones released by the pituitary 
gland control various other glands including the thyroid and 
adrenals. The pituitary releases Thyroid Stimulating Hormone (TSH) 
which 'tells' the thyroid to release thyroxine. A drop in thyroxine 
production caused by problems with the thyroid would cause the TSH to 
increase which would then cause the thyroid to produce more thyroxine 
until levels were back to normal. So the first sign of a problem 
would be an increased TSH with normal thyroxine levels. Eventually 
the thyroid cannot keep up and you would see low thyroxine levels 
along with the high TSH. 

In secondary hypothyroidism the TSH is reduced or not biologically 
active. The TSH level will stay low or normal despite thyroxine 
levels dropping. This is what seems to have happened to Emily and 
myself. Emily's TSH was 1.64 (normal range 0.35-3.5) and her 
Thyroxine (T4) was 7 (normal range 8-21). Her last T4 measurement 
from a couple of years ago was 10. The consultant says that T4 
usually only varies by +-1 so a drop of 3 is significant (my results 
were almost identical).

Secondary Addison's is similar, just with different hormones which 
seem to be harder to measure. Emily's consultant has offered to 
arrange a Synacthen Test for Addison's and and a TRH test to look for 
possible hypothalamic or pituitary hypothyroidism but, as you 
probably remember, Emily doesn't like needles (!) so I'm looking for 
more evidence either way to help us decide if the tests are really 

I get the impression that her consultant and GP think it's unlikely 
to be hypopituitarism, mainly because it's so rare (especially as 
it's both of us) and possibly because Emily's symptoms are relatively 
mild (but it's got to start somewhere, hasn't it?). That's why I dug 
out our old records and then noticed the big difference in basal 
rates in the afternoon/evening. It happened fairly gradually and I've 
been ill so probably not paying attention. I knew that it had dropped 
but hadn't realised by how much, plus the increase in hypos despite 
less insulin.

Thanks again for the links,
best wishes,
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