Re: Need help understanding my ACTH stim test?
According to this article, http://jcem.endojournals.org/content/83/7/2350.full , its possible to pass the High Dose Stim Test and still have a HPA disfunction. You might want to bring this article to his Attention.
1) the baseline morning serum cortisol concentration has very limited predictive power in differentiating between normal and impaired HPA function; 2) the use of criteria based on incremental changes in serum cortisol from baseline leads to unacceptably high false positive and false negative rates; and 3) insulin hypoglycemia is still the best indicator of the integrity of the response of the HPA axis to stress.
This test is the golden standard. Once and done.
In contrast, in the conventional 250-μg ACTH stimulation test, plasma ACTH levels rise above 4500 pg/mL (23). Supraphysiological ACTH doses may cause falsely normal cortisol responses in mild forms of secondary adrenal insufficiency when the adrenal cortex is not yet atrophic (23, 25, 26, 27). The low dose (1 μg, iv) of ACTH may be adequate to provide physiological adrenocortical stimulation (10, 17, 24, 28, 29).