Hi, I have a question, I was sent for the cortisol test, am/pm plus the acth test and a cortisol urine test, anyway I am not sure whats going on, the doc told me that they woudl inject me something, however when i asked the lab, they looked at me like I was crazy, the girl did not know what she was doing and was confused, since she says she has never done this kind of test before, I am worried that she didnt do it right, I mean she called 3 different people to ask, anyway she drew 2 tunes of blood and took a urine specimen, is this how this test is done? is the acth test the same as the cortisol am/pm? I have to go back there in an hour to get the other blood drawn but I am just praying that she did this right. by the way I had the test done at 10.30am, and teh next one will be at 3.00 pm, not sure how many hours in between I should have had them done, Oh well let me know what you guys think since I am lost.

Ugh.

Sometimes I'm not sure what doctors are thinking when they send you to a lab with a request for a test like that without consulting the lab workers first.

If you were supposed to have an ACTH stimulation test (which is the standard test for adrenal function) then there has been some confusion. Did you get a blood draw, wait quietly an hour at the lab, then have another draw? If yes, then you are probably okay. If no, then read on:

Usually, they draw a baseline cortisol level. Then they give you an IV or IM injection of ACTH (250mcg). They wait 1 hour and draw a second blood cortisol level. In the best circumstance, they place an IV catheter-so they aren't sticking you with needles multiple times and they make you lay down and stay still-this helps give the most accurate cortisol result-without stress being as much of a factor.

If your doctor wants an AM and PM blood draw of cortisol-it shouldn't be done on the same day as the ACTH stimulation test, because the stim test will alter your otherwise natural rhythms.

Sounds like you might have to let your doctor know what happened today so he/she can talk to the lab people first before you try again.

Good Luck and keep us posted!
Sadie

By the way...usually a cortisol urine test is performed over a 24 hour period (you collect everything for 24 hours at home), not on a single sample of urine. I'm not sure what test your doc wanted for you, so I can't say if it was done correctly or not. Be sure to let your doctor know that they collected just a single sample of urine.

sadie

Hi sadie, and thx for responding
I did not get any kind of injections, she pretty much took the 2 tubes of blood and said that, the acth test and cortisol are the same, that since the doctor just wrote acth, that is not an acth stimulation test, aghh, I am more confused now, I mean what a mess, and with the urine she only took a sample while i was there, so I am not sure if it was done right, I dont know why they have people that dont knwo what there doing in places like this, I mean these tests are so important, and the worst part is that she argued wth me because i mentioned to her that the doc had told me that they weregoing to give me an injection, and she looked at me like I was nuts.... aghh anyway i called my doc and there supposed to call me back soon but I guess i will go have the cortisol test done, she says I shouldnt go because if they dont inject me anything the cortisone level will be the same?? meanwhile I am trying to tell her that the am/pm cortisol test and the acth are 2 different test, aghhhhh

Ok I have a question, I called a few labs and asked about teh acth stim test and they do the injection part of it, now with the cortisol test would that be enough to know if I have an adrenal problem? or is this acth test more accurate, I am about to give up on getting it done, the girl at the lab says she did the acth plasma, in any case let me know what you think, if not I will justw ait for the results of this test and see what happens next, meanwhile i will find out where I can get the acth stim test done.

Ok I have a question, I called a few labs and asked about teh acth stim test and they do the injection part of it, now with the cortisol test would that be enough to know if I have an adrenal problem? or is this acth test more accurate, I am about to give up on getting it done, the girl at the lab says she did the acth plasma, in any case let me know what you think, if not I will justw ait for the results of this test and see what happens next, meanwhile i will find out where I can get the acth stim test done.

They draw the ACTH before they begin the test, because this helps determine if the adrenal insufficiency is primary or secondary. If the ACTH is very high--meaning your pituitary is sending signals to your adrenal glands to make cortisol and they aren't!--then that's primary adrenal insufficiency. If the ACTH is very low (like mine) then the pituitary is not sending signals to the adrenal glands to make cortisol, and that's secondary adrenal insufficiency.

Clear as mud?

But what Sadie Mae said. Sounds like your test may need to be repeated by a more competent lab.... A lot of endocrinologists do their testing right in their offices nowadays. And, FWIW, I've never had a urine test with my stim testing, and I've had it twice....

Good luck to you!

~Deb

I should clarify that the ACTH level is only part of the criteria a doctor will use to determine the difference between primary and secondary adrenal insufficiency. And I'm not a doctor. Just a patient with secondary.... :)