I got my results back from my stim test. It was done at 8:30 am and I was fasting. ACTH was given intermusclarly (sp?)

cortisol baseline 20.2 ref 3.1-22.4
30 min cortisol 31.3
60 min cortisol 39.8


Didn't quite double, but close. What do you all think? I think that I do not have secondary adrenal failure since my ACTH must have been high enough to get it up to 20.2 on my baseline ...right? Thanks for any help.

P.S. I was on progesterone at the time of this test. I didn't take it that morning, but did the night before. What effect if any does this have on the result?

I'm new here and have just been diagnosed with adrenal insufficiency. I had a test drawn for something else inthe hospital lab prior to the Cortorsyn challenge test done in the doctor's office, but I don't have the results of that yet. I think it was for ACTH. I do have the results of the Cortrosyn challenge test, which I flunked.

Cortisol, baseline (AM) -- 2.4
30 min post -- 10.5
60 min post -- 13.1

I don't know what this all means yet with regard to primary or secondary adrenal insufficiency, but I'm hoping the Cortef will restore my health. I've lost forty pounds the past year and have become quite ill. It's been a long, long road to a diagnosis. One doctor accused me of trying to starve myself. Another doctor told me to stop going to doctors and go out and have some fun. Jerks...

~Deb

Thanks, Chris. Will do.

Hi PunyDeb,
Your tests suggests to me that you may have the pituitary issue (secondary). Luckily your doc sees this. Most docs would say that you more than tripled so you are ok.

You should ask for other pituitary hormones to betested (LH, FSH, GH, TSH, prolactin) and also get thyroid tests (free T3 and free T4, antibodies). If pituitary tests shows problems, you need to get an MRI to check for a tumor. 1% of people don't have a tumor(MRI shows nothing), but may have been caused from head injury.

Good luck and please keep us updated,
Chris

I now also have my ACTH result, which was drawn the same morning as and prior to the stim test. It was 8. The reference range given for ACTH drawn between 7 and 10 AM, which mine was, is 0-46. So, apparently, that was normal. I have no idea what this means. Normal ACTH with cortisol deficiency...

My pituitary MRI was pretty normal. No tumors. I've changed endocrinologists, since the other one refused to test me for adrenal insufficiency even after I asked *twice*. He only did it after my primary care doc drew a random serum cortisol of 1 and faxed the report to him.

Anyway, my FSH, LH, and prolactin levels are normal as well. We're still waiting for the IGF-1, but the new endo expects it to come back fine, too.

So what, according to the new endo, is the most likely cause of my secondary adrenal insufficiency? My asthma inahler!!!!!!! Color me furious!

When I was put on the Flovent inhaler years ago, I was assured it wasn't absorbed systemically as long as I rinsed my mouth, which I did. Then the FDA started issuing warnings about adrenal suppression after that.

What I want to know is why none of my doctors--including my FORMER endocrinologist!--who all had a complete list of my meds, and who all knew I was suffering from unexplained weight loss and fatigue, never thought of this....

Argh!

Thanks, Chris.

Hi Punydeb,

We were told the exact opposite from what you were told about the inhaler. My son began to show symptoms of adrenal insufficiency shortly after beginning his asthma inhaler and when we discovered (3+yrs. later) that he had secondary adrenal insufficiency (with normal MRI and other normal hormone levels), I was sure it had to be caused by the inhaler. However, we have now had 2 endocrinologists and 2 pulmonologists at 2 separate major university hospitals tell us that there is "no way possible" that the inhalers could have caused this disease, b/c the dosage was way too low. Both endocrinologists were very willing to entertain the idea that the inhaler caused it, but after their own research, and after tapering him from the inhaler very slowly, and even tapering him from Cortef after being on it less than a month, his adrenals never kicked in. In fact, both the endos and the pulmonologists said that the inhalers most likely masked the symptoms of the disease initially.

I will say that I did extensive research on inhalers and secondary insufficiency and could not come up with a single study that linked the two things, unless you were using a seriously high dose from the inhaler (Andrew never had). I admit to still being skeptical, but I have now reached an acceptance. Whether or not the inhaler caused the insufficiency, he has the disease, and we must live with it and go from there.

Hi Punydeb,

We were told the exact opposite from what you were told about the inhaler.

Isn't this annoying? ::sigh::

So they call your son's condition idiopathic secondary adrenal insufficiency? Hmm... I guess time will tell if that's what they end up calling mine. Thank you for sharing this. Is the inhaler in question Flovent...?

All best...

~Deb

Originally the endo. called it idiopathic secondary adrenal insufficiency, but since then have settled on a diagnosis of "isolated ACTH deficiency." Still idiopathic in my book - the only head injuries that Andrew has had (other than typical toddler type bumps) didn't occur until AFTER he was diagnosed!

And yes, he was on Flovent 44mcg - 2 puffs/twice/day - well under the level that they say can suppress the adrenals. Who knows though?? I only know that I tend to react strongly to small doses of medication, and I always have the weird side effects too, and so I will always wonder if that's what happened to Andrew. My daughter (Andrew's twin) also suffers from asthma, and as soon as he was diagnosed, I weaned her from the inhaler as well, even though she showed no signs of adrenal suppression. I just tell *everyone*who is told to put their child on inhalers to be sure those inhalers are the last resort.

Isolated ACTH deficiency? Interesting.

I used the 220 mcg strength of Flovent twice a day for years. ::sigh::

My oldest daughter was using Flovent, too, at a lower dose than me. She's weaning off it now after what she's watched me go through. She's 22.

Good luck to your son! I'll let you know if my adrenal glands ever decide to work again now that I'm off the Flovent.

~Deb