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  • Elevated ACTH and high-norm cortisol?

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    Old 08-10-2009, 07:58 PM   #1
    ACTH
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    Elevated ACTH and high-norm cortisol?

    I'm editing this post to make it clearer in hopes to elicit a response.

    I'm a 33 year old male with hashimoto's thyroiditis. I've had several blood tests for ACTH, Cortisol and a number of other things.

    My medications are Levoxyl 37.5 mcg, Aciphex 20mg and Toprolol XL 50mg.

    My early morning ACTH is almost always elevated while my cortisol is always normal to high-normal (both checked in the same draws).

    In the evening, both my ACTH and cortisol drop down to normal range.

    I've had catecholamines tested (normal), a pituitary MRI (normal), several CT scans and imaging of my adrenals (normal), plus many other tests. If you can think of a test, I have probably had it done and I have the results on my computer (including enzymes, proteins, etc.).

    My 24 hour urine cortisol was 5 (ref range 0 to 50). Repeated twice.


    The only thing I do differently than most people, is I take my thyroid medication at night time. My endo said this won't affect anything.

    Also my testosterone is low. Further, my DHEA and DHEAs are elevated and my IGF-1 is always high-norm (sometimes too high).

    Prolactin, aldosterone, progesterone, estradiol and all the others are is normal range. Adrenal antibodies were negative.

    Here is sample of early morning draws:

    TSH......ACTH.......CORTISOL
    6.8.......116.......24.2
    6.3.......80.......20.1
    3.7.......51.......13.3
    2.8.......68.......16.8
    3.7.......108.......21.9

    Here are a couple PM draws:
    TSH.......ACTH.......CORTISOL
    6.8........26.......7.5
    1.56.......29.......7.9

    The ratio of ACTH vs Cortisol goes to NORMAL in the afternoon, but is way out of whack in the AM. My body wants more cortisol in the AM but has a difficult time producing it at that time.

    TSH doesn't seem to affect my cortisol production much.

    I have very little physical or mental stress.


    Question #1: Factoring in the normal diurnal rhythm, why is it more difficult for my body to make cortisol in the AM vs afternoon (as evident by the ratios above)?

    Question #2: Why is my body trying to produce TOO MUCH cortisol in the AM (sometimes over the top reference range), but only in the AM?


    The endocrinologists here in Arizona DO NOT CARE about the elevated ACTH values. They say it’s a normal response to stress (the only stress I have is dealing with uncaring doctors).

    I'm guessing that because the ACTH is not elevated all day long, this is not likely to be a lung cancer or anything like that.


    Well, I'm going to try taking my thyroid medication in the morning instead of night time, then check the cortisol the next day. I think I tried this once and it didn't help.

    Just two years ago before all of this I was in tip top shape, lifting weights for 2 hours daily, I was a power lifter. Now I look like a frail old man.

    I think I have adrenal fatigue (although doctors don't beleive in this), but not quite yet addisions disease. I think it will lead to this eventually if it goes unsolved.

    A few of my own thoughts....

    Perhaps the T4-only thyroid medication at night time really does cause a problem?
    My adrenals are trying to make more than just cortisol in the morning, like testosterone and other hormones, so it must work harder in the AM?
    Perhaps I'm depressed and don't know it (depressed people have high AM ACTH and Cortisol)?
    Perhaps my blood pressure dips too low at night (my pressure has gone down to 80/55 at night time once before), so maybe my adrenals kick in during my sleep?
    Perhaps aliens abduct me in my sleep and beat me up?


    Please, I need help to figure this out so I can give my adrenals a rest in the mornings.

    Last edited by ACTH; 08-11-2009 at 04:04 PM.

     
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