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NHS Cortisol Blood Test Versus 24 Hour Adrenal Salivary Index (ASI)

The NHS cortisol blood test is to see whether you have either Addison’s disease (too little cortisol) or Cushing’s Syndrome (too much cortisol) it DOES NOT SHOW ADRENALFATIGUE and neither does the NHS Short Synacthen Test. Unless you have either of those conditions, you will be told that you do not have an adrenal problem and your adrenal status will be ignored.

At the end, I have copied the information taken from the Patient Information Leaflet (PIL) under the heading Do Not Take This Medicine And Tell Your Doctor If”

Most of us already know what causes stress but what we dont know is why some people can handle it and others cant. Nor, until now, could we determine scientifically if stress really is affecting our health.

The ‘new’ salivary adrenal stress index (ASI) test enables people to do just that. Previously, adrenal hormones such as cortisol and DHEA, so important for our energy levels, had always been measured by a blood test taken once and once only at a random time of day, taking no account of the fact that the level of cortisol varies very considerably throughout the day. This is still the way it is done by the NHS and it accounts for the fact that sufferers of hypothyroid symptoms get little or no help from NHS endocrinologists even if they get to see one in the first place, which is often unlikely.

This 24 hour salivary adrenal test involves taking saliva samples four times daily, at 8.00a.m. at 12 noon, at 4.00p.m. and again at midnight, or just before you go to bed. The early morning cortisol level should be the highest of the day giving us a strong start and enabling us to meet the demands of the day. A healthy persons output of cortisol always follows the same curve, which can be plotted on a graph. It drops throughout the day until it falls to its lowest level by 11 p.m. or midnight, thus enabling us to sleep restfully throughout the night. Whenever the patients curve departs from the normal there is a problem. High night time cortisol means that the patient is finding it difficult to relax from the stress of the day and will have trouble going to sleep. This results in reduced REM sleep, a kind of sleep that is neither restful nor restorative, and which can produce depression and reduced energy levels the next day.

Another sufferer will have normal cortisol output in the afternoon and evening, but will have too high and too sudden a release of cortisol in the early morning. This will result in early morning wakening at around 5 or 6 a.m, or even 4 a.m. and an inability to go back to sleep.

Yet another sufferer will have high cortisol throughout the day.

Initially, DHEA levels may also be high in order to provide some compensation for this, but if stress becomes chronic the adrenals can no longer maintain the production of extra DHEA with the result that there will be an elevated Cortisol-to-DHEA ratio.

This ‘divergence’, as it is called, has been seen in many patients tests since the ASI test was first introduced, and it signifies an initial stage of adrenal exhaustion. It can have potentially very harmful effects on health including diminished immune function, reduced REM sleep, diminished skin regeneration and a catabolic state where tissue breakdown exceeds tissue repair and building, leading to muscle wasting, weight loss and bone loss (osteoporosis).

It’s not hard to see that this state is not far away from the start of even more significant adrenal fatigue.

Patients with this more significant adrenal fatigue will often have both a very low DHEA and low cortisol output throughout the day. Instead of having an 8 a.m. cortisol level of between 13 and 23, which is what gives a normal person get up and go to start the day, their morning level can be as low as 4, or even 2, and stays almost as low throughout the 24-hour period.

Someone with this low cortisol output will be in real trouble. If they still have a job they will be hanging on by their fingernails, needing to push themselves all day long and having no energy whatsoever left for looking after children or cooking meals or enjoying themselves socially. Many have had to stop working because of their chronic fatigue.

The ASI test is already seen by the small number of practitioners who use it as exceptionally helpful in assessing all patients with high stress or with chronic fatigue. Where practitioners using the test can be particularly helpful to their patients is in spotting when things are beginning to go wrong and thereby prevent any further deterioration. Its advantages over the standard blood cortisol test ordered by your endocrinologist or GP are obvious, and it should enable people, at last, to discover scientifically whether stress really is getting them down, and whether it is, or is not, a major reason for some of their health problems.

This article first appeared in InterAction, the journal of Action for ME.

Taken from the patient information leaflet inside your box of Levothyroxine.

you are suffering from a disease causing decreased production of all hormones produced by the pituitary gland (panhypopituitarism)

you are suffering from a disease causing decreased function of the adrenal gland

you are suffering from any disease of the heart such as chest pain or difficulty in breathing 9angina) or if you ever had a heart attack

you are suffering from increased sugar in blood (Diabetes mellitus) and/or being treated with tablets, or injections for the same

you are suffering from a disease in which an individual produces large amounts of dilute urine and feels thirsty 9diabetes)

you are an elderly person aged over 50 years

you are being treated with anticoagulant medicines (blood thinners)) such as Warfarin, antiepileptic medicines (medicines for seizures, such as phenytoin and carbamazapine; cardiac glycosides (e.g. (e.g. digoxin); antidepressant medicines or colostryamine

you are being treated with any medication that belongs to what is known as sympathomimetic drugs (e.g ephedrine) since they affect the work of the heart, lungs and many other organs

if female, and if you are pregnant or likely to become pregnant or taking a contraceptive pill. DISCUSS WITH YOUR DOCTOR OR PHARMACIST IF YOU ARE WORRIEDE ABOUT ANYTHING.



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Previous comments

Can you recommend a brand of saliva test so I can buy it?


Please can anyone recommend a lab in the UK that do the Adrenal Saliva Index Test or how I can get this test done on the NHS? I am on high doses of T3 but still have hypo symptoms after more than a year on T3 only. I have suffered a lot of stress in the past few years so need to see if my adrenals are to blame.


Is there any where in the UK to get this test done accurately?


Can anyone get a saliva test on the NHS does anyone know please?

Deborah Gray,