2 doctors weighed in:

Always so cold, low blood pressure 77/42 sometimes. Low blood sugar. ACTH stimulation test ok. But sometimes low cortisol. Ideas?

2 doctors weighed in
Dr. Jesse Krakauer
Internal Medicine - Endocrinology
1 doctor agrees

In brief: Sounds adrenal

B"sd this is challenging - does sound like adrenal insufficiency - probably due to hypothalamic / pitiutary dsyfunction.
The options are extensive work up, or limited work up with a trial of glucocorticoids and possibly mineralcorticoid - fludrocortisone. Steroid therapy has its own significant side effects, so needs to be expertly managed, with frequent attempts to wean off the steroids.

In brief: Sounds adrenal

B"sd this is challenging - does sound like adrenal insufficiency - probably due to hypothalamic / pitiutary dsyfunction.
The options are extensive work up, or limited work up with a trial of glucocorticoids and possibly mineralcorticoid - fludrocortisone. Steroid therapy has its own significant side effects, so needs to be expertly managed, with frequent attempts to wean off the steroids.
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