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-   -   low cortisol, low acth, almost quadrupled in stim? (http://www.healthboards.com/boards/addisons-disease/935587-low-cortisol-low-acth-almost-quadrupled-stim.html)

sharper22 01-16-2013 01:32 PM

low cortisol, low acth, almost quadrupled in stim?
 
My cortisol has been tested 4 times over the past 9 months - 10.9, 7.8, 12.9, 7.6.
?? In your opinions, are my cortisol and acth numbers normal, or should I pursue additional testing to rule out secondary AI??

In November after my first endocrinologist appointment she ordered a stim test and started me on 25mcg levothyroxine since my tsh was 3.13.

cortisol 7.6 (4.5-22.7)
ACTH 14 (10-60)
30 min cortisol 23.6
60 min cortisol 28.7

Last week (after 8 wks of meds) TSH was down to 1.3, but I still have all of the energy of an eggplant, plus heat and cold intolerance, low-ish body temp, etc. etc. Doc said that the cortisol and ACTH are in a good range, but my pcp said that cortisol should be at the very top of the range. I am 42 and as of 2 years ago was full of energy, balancing work, playing with the kids, lots of tennis, gardening and cooking. Now I am an unemployed couch potato due to my symptoms.

tfisher817 01-18-2013 12:43 AM

Re: low cortisol, low acth, almost quadrupled in stim?
 
I totally understand about the unemployed couch potato...I too was going along great in life and BAM i get a case of Mono and never recover. End results= Addison's.... But your test look normal to me did they do an actual ACTH level. that sometimes is how you can distinguish primary vs secondary. THE ACTH stim tests are more for primary and sometimes really don't tell us much if its not primary. Your thyroid as you know will cause the God awful fatigue and pretty much just an overall Blah to life...* i see your ACTH result now. It seems fine too....with secondary your ACTH will be lower usually meaning a pituitary issue have they set up MRIs?

sharper22 01-18-2013 11:21 AM

Re: low cortisol, low acth, almost quadrupled in stim?
 
My ACTH was 14 (range 10-60).
The only information I have found seems to indicate that the top 30% of the range is optimal.
I have read in 2 places now (unfortunately not sources that the endo will take seriously) that when you go from below 10 and more than triple in the stim test it indicates strongly secondary AI.

She refuses to consider anything that the thyroid. She switched my prescription from levothyroxine to armour this week, and said to check free t3, free t4 and tsh in 6 weeks. Her notes that the nurse read me over the phone say that at 6 weeks she wants me to decide if I like armour, levothyroxine, or no thyroid meds at all.
So she hasn't ordered any additional tests - no mri or anything blood tests to test pituitary function.
I guess I need to get all my dr. notes and labs and go endo hunting again. aarrgh.
It seems like I should be looking at secondary, but there aren't a lot of active SAI forums/posters that I can find to ask for advice. And Heaven knows I am not having much luck with the drs. Evidently I need to get sicker for the endos to look past the thyroid. :( Or I am considering crying and freaking out in the next appointment instead of trying to be calm and concise. Kidding. sorta. :dizzy:
Suzanne

tfisher817 01-20-2013 01:19 AM

Re: low cortisol, low acth, almost quadrupled in stim?
 
bless your heart. For some reason a lot of ENDOs want to ignore Adrenal issues unless its just right there staring them in the face and they cant ignore it. I don't know if they had a one day lesson on the adrenals and how VITAL they are in daily life or what but i have had two endos now since being diagnosed with addisons and i truly think i know more about the disease than they do and im an in no way saying they're all like that.....we just need to find them.


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