Where do you start when patients come into the office with symptoms of abnormal cortisol release patterns? At the Equip seminar in April, Dr. Lena Edwards was asked to describe the testing she does to help her patients. Time did not permit her to cover testing protocols, so we asked her to address the question for our members here on ARKProgram.com.
Question:
Dr. Edwards, What is your typical lab work up for patients who present with symptoms that could indicate abnormal cortisol release patterns?
Response:
“The most important question to answer when treating a patient with low cortisol is … WHY? The cause must always be sought. Yet, to put it simply, there is no protocol for which labs to do first. It is directly related to the patient and their symptoms. However, I have found that assessing all hormone levels is helpful at the initial visit.
“As we know, all hormones affect and are affected by each other. As such, we must know the status of all of them before we begin ‘muddying the waters’ with our treatments. The hormones can be tested with serum, blood spot, or saliva. While some physicians choose to do minimal testing, I like to have a baseline, plus I cover myself medicolegally.
“I typically begin with the following:
- IGF-1
- Free insulin
- TSH
- Free T3
- Free T4
- Thyroid antibodies
- Estradiol
- Estrone
- Progesterone
- DHEA-S
- Testosterone
- FSH (in women)
- LH
- ACTH
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- Cortisol (saliva is the best since it shows the pattern of release)
- Prolactin
- Cholesterol (VAP in appropriate patients)
- Pregnenolone
- SHBG
- Vitamin D
- Ferritin
- CRP
- CBC
- CMP
- HgA1C
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“Thereafter, the testing I order is directly related to the patient’s complaints and findings on initial testing. Ultimately, I assess patients for heavy metal toxicity, food allergies, intestinal dysbiosis, nutritional status, chronic underlying infections, etc. The process of assessing and treating these different parameters can take 6 to 12 months.”