Q. Which tests should I do to check adrenal gland functions?

Answered by
Dr. Prakash H Muddegowda
and medically reviewed by Dr. Dr. Sneha Kannan
Published on Mar 07, 2016 and last reviewed on: Jun 01, 2019

Hi doctor,

I am a 27 year old man and a student of ecological solution. I do a little bit of sport. I eat a balanced diet. I have fatigue and headache when I do anaerobic exercise, and when I read a book. According to my doctor, my average blood pressure is 12.8 or 12.7. All my family members are in good health. My mother's sister has osteoporosis. Reading a book or something else gives me headache and fatigue, so I need to rest after reading something. When I need to read something I must drink a lot of water to be less tired, because if I do not drink a lot of water before reading I need to rest five times more than the usual. Because of this reason, I have stopped my schooling.

I got my standard blood test, TSH and lipid test done, I used to do running of one hour by weekend. I want to do home body building like push-up, but I cannot do it like I used to do before. I do not know why my anaerobic capacity has decreased a lot in the last three years. When I do some push-ups or another anaerobic exercise like 100 m speed running, I have really bad results; I take too much time to do this kind of exercise. I am abnormally getting breathless and my heart beats fast. I was not like that before six years, but my physical appearance has not changed. I must drink 1 liter of water 35 minutes before running, if I do not then I cannot even stand for ten minutes. If I drink a lot of water like 1 liter, 40 minutes before, I can do 70 push-ups at the first series, but If I drink only one or two glasses of water 10 minutes before, I cannot do 45 push-ups and my heart begin to beat hard and I am completely breathless and tired. After a running session of 40 minutes to one hour, immediately when I begin to do my legs muscles stretching even if I am completely relaxed and feel good, without any breathlessness also.

When I do my stretching my heart begins to beat very fast and hard and I begin to be breathless. Then I must wait and drink water and do my stretching very slowly. I have never felt this before, and I used to work at school with pleasure, read some books and do sport more easily. My wear has a strange smell after sport. It smells something like a rotten wood plank. It is a smooth bad odor not too much aggressive but really unusual.

The few doctors I have seen do not know what the source of the problem is, but we found that I do not have a good thermoregulation because I am cold and need a lot of clothes. It seems like I feel better when I am in vasodilation period like under the sun or in a hot place. So, I tried a supplement called Citrulline six months ago, to have more arginine in the body to have a better vasodilation. Indeed, I feel really less tired since I take the Citrulline. I feel like my muscle cells and other tissue are more supplied in something that I need in these cells. Citrulline helped a bit, but it did not resolve the problem. Hope you could help me. Thank you.

Dr. Prakash H Muddegowda

Geriatrics Hematology Pathology


Welcome to icliniq.com. All your clinical problems appear to be related to anaerobic respiration. Based on your query, my opinion is as follows:

For respiration, oxygen is most important - Anaerobic respiration mainly occurs because of reduced oxygen. You might require a lung function tests to evaluate for adequate oxygenation. If you are a smoker or exposed to pollution, dust or industrial exposure, it can get affected.

Anemia requires evaluation. Hope your hemoglobin level is within normal limits. Get a hemogram done. Anaerobic respiration leads on to lactic acid production. This lactic acid accumulation causes muscle pain and tiredness. Do get your lactic acid accumulation level in blood evaluated before and after the exercise. Lactic acid level requires correlation with possible muscle storage disorders or dystrophies compared to exercise; there may be increased lactic acid production.

Hydration would be washing of this lactic acid, which is possibly making you feel better. Meet a biochemist to get yourself tested for lactic acid increase and possible causes. Sweat glands can produce abnormal smell depending on diet. Look into your diet closely. Citrulline produces nitric oxide leading on to vasodilatation. It could be removing some amount of lactic acid or increasing oxygenation, but overall the main cause from lungs to blood and blood to muscle requires identification.

Get the tests for hemoglobin level, lung function tests along with oxygen saturation and serum lactic acid. If all are normal, then muscle glycogen storage disorders or muscle biopsy for any pathology maybe necessary.

Thank you doctor,

Can you tell me what test can I do to check all the adrenal glands functions? Thank you.

Dr. Prakash H Muddegowda

Geriatrics Hematology Pathology


Welcome back to icliniq.com.

Thanks for reverting back. I am not sure, how the adrenal functions evaluation is going to help you. However, as you have asked it, I am providing you the same.

Measurement of Metanephrine and VMA (vanillylmandelic acid) in urine specimens to evaluate for increased catecholamine. Measurement of serum concentration of aldosterone and renin by radioimmunoassay. For evaluation of abnormal cortisol metabolism, check for the below:

  1. Serum cortisol at 8 AM and 4 PM.
  2. Urine free cortisol.
  3. 17-hydroxycorticosteroids.
  4. 17-ketosteroids.
  5. 17-ketogenic steroids.
  6. Plasma ACTH (adrenocorticotropic hormone).

For borderline cases of hypocorticism, check for Metyrapone (Metapirone) inhibition, hypoglycemic stimulation and ACTH stimulation test. For hypercorticism, get low dose dexamethasone test and high dose dexamethasone suppression test. For enzymes evaluation in congenital adrenal hyperplasia, check for 21-hydroxylase, 11-hydroxylase and 17-hydroxylase. Further ultrasound abdomen, CT scan, FNAC (fine needle aspiration cytology) and biopsy along with immunohistochemistry can also be done for structural evaluation and confirmation.

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