I have a patient with a DUTCH first reading with low cortisol, low cortisone. Second reading was high cortisol, high cortisone after exercising. Third reading was within range. Fourth reading, cortisol was within range and high end of range cortisone. Her 24-hour cortisol and cortisone are above range, high end of range. This appears to be a result of the significantly elevated second reading, with a low first morning cortisol and significantly elevated second morning reading. What would be the best treatment strategy? She is being treated for hypothyroid, and we are currently doing an antimicrobial protocol.

Dr. Amy Nett: What are her symptoms, I think, would be my question? Let me try to summarize here. So, 24-hour cortisol and cortisone are above range, so she has fatigue in the morning. You’re saying her low—okay, so morning is low free cortisol and cortisone, and then—sorry. It’s so much easier to look at the graphs. Okay, 24-hour cortisol and cortisone are above range, high end of range respectively. Okay, so that’s free cortisol you mean. The free cortisol and cortisone are above range and high end of range respectively, and it’s mostly the second reading is significantly elevated. She has fatigue in the morning, but she has a high morning cortisol. You’re saying the overnight cortisol is low, because that waking cortisol, that is often the best representation of the overnight. Her third and fourth are kind of higher end of the range. This one is tricky because if she’s feeling fatigue, you could try adrenal glandulars. Chris has said he’s had success both with kind of low and high cortisol. I haven’t really used adrenal glandulars in patients with cortisol in the higher end, but you could certainly try. I would also talk to the patient about meditation, maybe just doing something such as Headspace just to try to normalize cortisol rhythm a little bit more. Adrenal glandulars might be your best bet. I mean, the other thing to think about is if it could improve morning energy levels just by sort of stabilizing cortisol overall a little bit more, so if she has high free cortisol, you could even do something such as maybe HPA Balance, I’m thinking. Let’s see. I don’t think you mentioned her metabolized cortisol. I think you’re just saying the free cortisol. So, if it’s high total cortisol is mostly what we’re dealing with, maybe do HPA Balance and phosphatidylserine just to sort of balance things out and see if that helps with fatigue and maybe try adrenal glandulars.