The endo I recently went to see told me my ACTH Stim test was "normal". I am a bit confused after what I have read on the web about secondary adrenal problems, especially that the ACTH stim is not necessarily able to determine if one has a secondary condition.

My understanding is that my ACTH is low at 11, although with the current range of 5-29, I presume and endo see this as "in range". I have seen on the web, studies which include ranges such as 9-52 or 10-60 pg/ml. So, I don't know how she can determine that everything is ok just based on the doubling of my cortisol.

The results were: AM = 14.5, 30 min = 31.7 and 60 min = 33.6.

Does anyone who has been through the diagnostic process of secondary AI have any advice? :confused:

Hi Sparkles! Sorry that no one has replied. I have been watching for an answer.
Where is Florida are you? I am in North Central Horse country. I am in the same boat as you. I find it ironic that my Endo recognized an a.m. cortisol of 7 was low when the lab lists 4-22 as normal. Yet, he fails to recognize that my ACTH of 7 is low with the lab listing 5-27 as normal. On my stim, my pre cortisol level was 5.8 but I stimmed to 20.2.
I have read numerous places that an ACTH less than 10 is diagnostic of Secondary. Of course that was when the normal range was listed as 10-60. I a have also read that secondaries have ACTH less than 20 and that most normal people have levels in the 30' and 40's. Still, because I more than doubled he pronounced me as normal and refused to do any further testing. I believe the ITT is suppose to be better at identifying secondaries.
I have been considering going to Shands for a second opinion.
~GGTS4U

Thanks for your reply.

Yep, I have read the same things. All I know is that the ACTH stim does not rule out secondary insufficiency, according to what I have read.

I will ask my endo about further testing. She was pretty good about doing the stim in the first place, and maybe she will be interested in further testing.

I see a dr in PA right now, as I was up to see my family and became very ill on my thyorid meds - which were discontinued for the time being. So, I found a Dr up here.

I hope you find some help at Shands. I was seeing an integrative medicine dr some time ago, but I was afraid to go the cortef route without proper testing. Unfortunately, it seems that conventional endocrinology is very much at odds with "alternative" medicine. I think, however, I did the right thing in at least getting the stim done before I make any decisions.

I just wish I knew if my likely seconday AI (unrecognized by conventional endos thus far), was permanent or temproary. It would be good to know. Incidentally, some of the articles I found which used the ranges 10-46 and 9-52 are European. I wonder if ours is the only range that is so low. ????

I see my endo in a few weeks, and maybe I can get this sorted out. :)

I know how you feel. I don't want to start meds if I don't need them. However, my endo won't do the ITT or any other tests. He won't even see me anymore.
Incidently, I have Premature Ovarian Failure and am now going thru tests for Pernicious Anemia (malabsorbtion of B12). All of these can be related.
I do believe that the ranges here in the US are flawed for alot of test. I have found that the B12 ranges here are the lowest also.
Let me know if you find any answers. Good luck.

It was my saliva test is what precipitated all this further investigation on my part becasue it showed lower cortisol, very low DHEA and low reproductive hormones.

Once I became intolerant of thyroid medication over the last two months, after I had such fantastic initial success with Armour, I knew I was in trouble.

Over the summer I had the ACTH which showed 11. Of course that endo never commented on it and I preume he considered it "normal". At least the new endo had enough sense to know that the literature suggests that mid range morning cortisol (say between 14-17) plus low normal ACTH warrents further investigation and give me the stim> I don't know that she is well-versed on diagnosing secondary AI. The lab "forgot" to get my ACTH this time round prior to my stim. I am still a bit perturbed by this!!!

In the meantime, I have decided that I am going to one of those online companies and order some labs for myself - including DHEA-S, and some of the sex hormones. I will show this endo and see what she says, and maybe the next endo (???:mad:) At least I will bolser my case.

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On the subject of autoimmune diseases, I found that I had signiifcant antigliadin ABs (IgA) - so I went gluten free in the hope that it would help my condition(s). My family has a number of autoimmune disease, including hypo, perncious anemia, PCOS and Crohns. Definately a connection. Good luck with your B12 diagnosis.