Part three of the HPA case studies, page 2, she says, “Inflammation also increases cortisol-to-cortisone ratio, so inflammation causes the body to convert cortisol to cortisone. If this is the case, how come on page 7 when the case study person has low free cortisol and metabolites, but high cortisone, why isn’t this thought to be the reason?

Dr. Amy Nett:  Inflammation can actually favor free cortisol over cortisone. Low free cortisol and high cortisone might actually suggest something like hyperthyroidism, estradiol, ketoconazole, it might just be quality sleep, magnolia, or scutellaria. So again, inflammation favors free cortisol over cortisone, but that low free cortisol and high cortisone, think about some of those other conditions that favor one over the other.

So then Justine says, “Just trying to get this all straight in my head. HPA-D case study, part five, page seven.” She says, oh right. Sorry. So Justine pointed out that if you go to this week’s course content, if you’re reading the transcripts, part five of the HPA-D case studies on page seven, at this time at the time of this recording, it’s a case study that shows a 55-year-old male who has very low cortisol both free, metabolized and bound, and then in the treatment it says to do a high cortisol treatment protocol. This was incorrect, we’re going to clarify that. That portion will be re-recorded and we’ll update the transcript accordingly. So Justine thank you very much for bringing that to our attention, really appreciating that. So that will be corrected and in part five, the 55-year-old male who has the very low cortisol and then we look at the hormone portion of it, the THD panel, this is a patient who does I believe, testosterone injections, the treatment should be a low cortisol with inflammation protocol. So thanks for catching that, Justine.

Okay, next case I’m just going to run through all of Justine’s because they’re all sort of focusing on cortisol, cortisone stuff. So case three in the case studies homework; so now we’re switching from the presentations to the homework study. So case three. Patient’s overweight, likely has early insulin resistance which contributes, so this is what the answer was. So it says she’s overweight and likely has early insulin resistance, which contributes to keeping free cortisol and free cortisone high relative to the low total cortisol production. But then in case four, it says total cortisol production is high, but free cortisol is low with a low cortisol to cortisone ratio. This is consistent with insulin resistance, overweight, or metabolic dysfunction.