Margaret McCartney: Does the GMC deserve its current powers?
>>>> the test they can order is still only the synacthen test and not the saliva test….
… and on top of that sadly very few of them know how to interpret either one correctly :doh: I agree – the world would be a better place (and the drain on the NHS less) if doctors could see it in their hearts to order both those tests when indicated, or even just open their minds, take off their blinkers and listen to the patients.
The synacthen test (SST) is actually an excellent diagnostic tool – when carried out AND interpreted correctly – and 100% reliable to diagnose or rule out primary Addison’s and Cushing’s. In addition it gives reliable pointers for hypothalamic or pituitary malfunction (secondary Addison’s), which should then get investigated further. Sadly, for reasons best known to the powers that are, part of the SST (the serum ACTH check, which would give a clear indication of hypothalamic/pituitary involvement) is nearly always omitted, and worse – in many cases the endos do not even follow the correct interpretation of the results, which are clearly laid out in the endocrine NHS handbook.
Equally, the salivary adrenal profile is an excellent tool to ascertain overall cortisol levels following the circadian rhythm; but it should never be assumed that a salivary profile and an SST tell you the same thing – they don’t. Even a flat lined salivary adrenal profile does not automatically suggest Addison’s.
A salivary profile tells you how much cortisol the body has at its disposal within a 24 hour period, nothing more. An SST tells you WHY. And the ‘why’ is not automatically down to weak adrenals because of hypothyroidism. It could equally be down to pituitary malfunction, non-thyroidal illness, even autism (autistic people have generally lowered cortisol levels, yet sporadic projectile ACTH output under stress – so cortisol levels could vary considerably) and probably a number of other reasons. But the point is – doctors should investigate and not deny that adrenal fatigue exists.
… ok – off my box now, frusty