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Elevated ACTH, high-norm cortisol

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Old 01-21-2011, 09:40 AM   #1
Join Date: Jan 2011
Location: Phoenix
Posts: 3
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Elevated ACTH, high-norm cortisol

I'm a 36yo male and need help understanding the following:

Elevated ACTH (400% over top) 2 hours after waking. Blood test repeated several times (not lab error). Declines to high-norm later in the day. So I guess it's not a ACTH producing tumor because it has this rythm?

Declining ACTH/Cortisol ratio over several months (needing more ACTH to create cortisol).

High-normal AM cortisol (22), declines to normal during the day.

No hyperpigmentation.

Normal aldosterone levels.

Low testosterone.

Very elevated DHEA,s and DHEA (1000% over top reference). Goes much higher when taking testoserone gel. Up to 4000% over top.

Dehydration, can't sweat at all.


Low normal blood pressure 95/60. Sometimes 85/55. My "high normal" is 110/60.

Normal blood sugar, normal A1C.

Normal thyroid. I take levoxyl and selenium to keep TPO and TG Abs down to almost zero. TSH, FT3, FT4 all in the middle.

Everything else is normal.

CT of adrenals normal. MRI of pituitary normal. Catacholemines normal. Adrenal antibodies negative.

Endo says I don't have addison's because she would see hyperpigmentation. I
don't have any spots.

Seems I'm producing enough cortisol. but why would my body be wanting to create SO MUCH of it and only in the mornings?? to the point it is having to raise my ACTH so high. That's my main question. Why am I needing so much cortisol?

One endo said it is because my testosterone is low, and that by taking
testosterone, it would lower my cortisol.

But I have heard that taking testosterone can cause more stress on the adrenals.

Very confused.

I'm seeing a new doctor today. What kind of tests should he do (because I might have to ask for them)?

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Old 01-21-2011, 06:18 PM   #2
Join Date: Jan 2011
Location: Phoenix
Posts: 3
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Re: Elevated ACTH, high-norm cortisol

Update: My doctor ordered a morning ACTH blood test and 24 hour urine cortisol. Said I didn't need an ACTH stim test if my ACTH is already through the roof. I will do the test next week and report back the results here. Meanwhile if anyone cares to speculate?

Old 08-19-2011, 03:19 PM   #3
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Join Date: Aug 2011
Location: Boise, ID
Posts: 1
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Re: Elevated ACTH, high-norm cortisol

I had some similar tests. Turned out to be congenital adrenal hyperplasia. Get your docor to test 17 Hydroxyprogesterone. They screen newborns for it now, but didn't when you were born.

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