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Dear Dr. Roach: My son recently was told that his cortisol level is 0.39 and that it should be above 1.8. The result was from a saliva test. He has a very high pulse, low blood pressure, is somewhat fatigued and has a very poor appetite.

He has an appointment to get a test done at the hospital next week. We were told that they will be giving him an IV with a synthetic cortisol treatment of some kind -- a very minuscule amount. They will be checking his blood during this procedure.

I was concerned after reading about this online, but was advised that it would be a very small amount and would be done only one time. Have you ever heard of this? — Anon.

ANSWER: Low cortisol, Addison’s disease, can be caused by an autoimmune destruction of the cells in the adrenal gland, which produce cortisol. Cortisol is critical for regulating many body functions, and it serves as one of the primary “stress” hormones, allowing your body to respond effectively to stress, such as illness or a physical threat. Addison’s also may be caused by destruction of the gland due to tuberculosis, which is rare now, or by deficiencies in the pituitary gland or higher centers in the brain. Cortisol levels are most commonly measured in the blood at 8 a.m. Saliva results may be useful, but there is less experience with using them.

The test your son likely is getting is an ACTH stimulation test, where he is given a synthetic form of adrenocorticotropic hormone, normally produced by the pituitary. The adrenal gland should respond by making larger amounts of cortisol. Other stimulation tests are necessary if the problem is suspected to be in the pituitary or in the hypothalamus. The ACTH “stim” test is commonly done, safe and very important. Addison’s disease is very dangerous if it isn’t recognized, and it is very easy to treat with replacement hormone. I have ordered many of these tests, and only a few were positive. The symptoms can be vague, but it’s so important not to miss the diagnosis. Your son’s symptoms certainly are consistent with Addison’s, so he should proceed with testing. Please let me know the results.

Email questions to ToYourGoodHealth@med.cornell.edu.

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