Urinary Hormone Metabolites Adrenal

Transcription

1 Test Name Result Range Urinary Androgens (μg/g Cr) DHEA (Urine) H Urinary Glucocorticoids (μg/g Cr) Total Cortisol (Urine) Total Cortisone (Urine) Cortisol/Cortisone (Urine) Tetrahydrocortisol (Urine) Tetrahydrocortisone (Urine) 1454 H Urinary Free Diurnal Cortisol (μg/g Cr) Free Cortisol (Urine) 6.99 L (1st Morning) Free Cortisol (Urine) L (2nd Morning) Free Cortisol (Urine) (Evening) Free Cortisol (Urine) (Night) Urinary Free Diurnal Cortisone (μg/g Cr) Free Cortisone (Urine) (1st Morning) Free Cortisone (Urine) (2nd Morning) Free Cortisone (Urine) (Evening) Free Cortisone (Urine) (Night) Urinary Creatinine (mg/ml) Creatinine (pooled) (Urine) Creatinine (Urine) (1st morning) Creatinine (Urine) (2nd morning) Creatinine (Urine) (Evening) Creatinine (Urine) (Night) <dl = Less than the detectable limit of the lab. N/A = Not applicable; 1 or more values used in this calculation is less than the detectable limit. Therapies None Indicated

2 Disclaimer: Graphs below represent hormone levels in testers not using hormone supplementation and are provided for informational purposes only. Please see comments for additional information if results are higher or lower than expected. Graph key ---High ---Avg ---Low

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4 2017 XX XX XXX U Sample Report Lab Comments ANDROGEN PRECURSOR DHEA(S) DHEA(S) is much higher than the reference ranges for a male. Although not listed as a supplement, this strongly suggests supplementation with DHEA. DHEA supplementation usually increases serum T levels % from baseline in women, but has little effect on the T level in men (Morales and Yen. J Clin Endocrinol Metab. 78: , 1994). Excessive DHEA supplementation can cause a transient suppression of adrenal cortisol synthesis, which generally recovers to normal level within 2-3 hr (Kroboth et al. J Clin Psychopharmacol 23: 96-99, 2003). This cortisol-suppressive effect of DHEA supplementation could exacerbate symptoms of low cortisol (eg. hypoglycemia and fatigue), particularly in individuals with adrenal fatigue and low cortisol. DHEA supplementation should always be used cautiously when cortisol levels are low or symptoms of hypoadrenia are present (e.g., morning fatigue, allergies, sugar and salt craving, chemical sensitivity, poor immune function, excessive stress). DHEA is commonly used as a supplement to raise androgen levels (A4, T, DHT). DHEA is converted to A4 by the enzyme 3 beta-hydroxysteroid dehydrogenase, and then to testosterone via 17-beta hydroxysteroid dehydrogenase, or to Epi-testosterone via 17-alpha hydroxysteroid dehydrogenase. A4 levels can also increase with testosterone supplementation as some T is able to back-convert to A4, but not to DHEA. A4 also converts to the weak estrogen, estrone (E1), via aromatase, and to the more potent estrogen, estradiol (E2) via 17-beta hydroxysteroid dehydrogenase. Adipose (fat) tissue contains more aromatase, the activity of which is further stimulated by high levels of the stress hormone cortisol. Thus, excessive adipose tissue in the waist (belly fat), in combination with excessive stressors that raise cortisol, can lead to disproportionate conversion of androgen precursors (DHEA and A4) to estrogens (E1 and E2) instead of androgens (T and DHT). High estrogens can lead to weight gain in the breasts and hips, and lead to prostate hypertrophy. Excessive conversion of estrogens to the more toxic 4-catechol estrogens, in the absence of adequate methylation pathways, can lead to increased risk for prostate cancer. URINARY FREE CORTISOL (UFC) The UFC is following a normal circadian rhythm, but levels tend to be low or lower than the median reference range throughout most of the day (exception evening cortisol normal). This suggests low adrenal reserves or use of medications that: either speed up cortisol turnover (e.g. thyroid medication or hyperthyrodism increases conversion of cortisol to cortisone) or lower its synthesis by the adrenal glands. Synthetic glucocorticoids such as prednisone or anti-inflammatory medications to treat allergies or asthma-none indicated have a negative feedback on the hypothalamic-pituitary-adrenal axis to lower pituitary ACTH synthesis and hence lower adrenal cortisol synthesis. Hormones such as testosterone, DHEA, and melatonin also have a suppressive effect on cortisol production by negative feedback to the hypothalamic-pituitary-adrenal axis. The UFC differs from the TOTAL CORTISOL in that the former measures only the unconjugated or free cortisol in urine, whereas the latter measure both free and conjugated cortisol. About half of the cortisol present in urine is measured as UFC. The first void is representative of the overnight production of cortisol and should be low if no stressors were occurring during the night, or early in the morning just before rising. The second void, which optimally is collected about 2 hours after waking, is representative of the awakening response and should be the highest level of the four collections. It is equivalent to a first morning saliva or blood cortisol measurement. Differences in the first and second morning samples are equivalent to a salivary Cortisol Awakening Response (CAR). If the adrenal glands are functioning normally, and stressors are minimal the second void should be significantly higher than the first void, but remain within the reference range. Excessive stressors that occur during the morning may cause the second cortisol measurement to rise above the reference range. If the adrenals are healthy and the stressor acute the cortisol should drop by the third and fourth measurement, but remain within normal reference range. If the stressor persists, the cortisol levels will usually remain above the reference range throughout the remainder of the day. However, if the adrenals are exhausted, or substrate (17-OH progesterone) and nutrients (e.g. Vitamins B5 and C) are unavailable for cortisol synthesis, a second morning cortisol may be high, normal, or low, but cortisol usually drops to low levels in the evening and night voids. When low cortisol is chronic this is usually co-associated with symptoms of low and/or high cortisol. In a normal individual without significant stressors, cortisol is highest in the morning shortly after awakening and steadily drops throughout the day, reaching the lowest level during sleep in the very early morning about 2 am. The first morning UFC value actually represents the nighttime rest phase, where cortisol values should be lower than second morning void several hours later. Assuming no medications are lowering adrenal cortisol synthesis, lower cortisol levels can be caused by by many different types of stressors such as emotional/psychological stress, sleep deprivation, low protein diet, nutrient deficiencies (particularly low vitamins C and B5), physical insults (surgery, injury, diseases, inflammatory conditions), chemical exposure, low cortisol precursors (pregnenolone, progesterone) or pathogenic infections (bacterial, viral, fungal). Adequate sleep and rest, gentle exercise, proper diet (adequate protein), natural progesterone, adrenal extracts, herbs, and nutritional supplements (vitamins C and B5) are some of the natural ways to help support adrenal function. For additional information about strategies for supporting adrenal health and reducing

5 stress(ors), the following books are worth reading: "Adrenal Fatigue", by James L. Wilson, N.D., D.C., Ph.D.; "The Cortisol Connection", by Shawn Talbott, Ph.D.; "The End of Stress As We Know It" by Bruce McEwen; "Awakening Athena" by Kenna Stephenson, MD.