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Knickerbocker1 08-21-2012 05:39 PM

ACTH stim test results, confused.
I have been dealing with chronic fatigue and symptoms of low cortisol for a while. ( hypoglycemia, fatigue, intolerance to stress, blood pressure issues, anxiety, etc.)

I had an AM cortisol of 4.1 ug/dl and a low normal ACTH value prompting my endo to do the stim test.

I am thoroughly confused as the results seem to conflict my original cortisol test. I will note that I didn't sleep at all before the test, not even a minute, and was highly stressed out.

Baseline cortisol: 21.4 range: 2.3 -19.4 ug/dl
30 mins: 33.0
60 mins: 35.1

So are my adrenals ok? or did the fact that I didn't sleep and was running on pure adrenaline that day mean the test is invalid. Very confused.

ladybud 08-21-2012 07:24 PM

Re: ACTH stim test results, confused.
According to the usual interpretation, your results indicate adrenal insufficiency because the ACTH should get your cortisol up to at least double your baseline level at 60 min. and yours is less than that. The stress of the test may have caused your baseline to be higher than the previous baseline, which was low. That right there indicates a problem. I would take your results to a different endocrinologist if this one doesn't believe there is anything wrong. ???

Knickerbocker1 08-22-2012 05:26 PM

Re: ACTH stim test results, confused.
Thank you for the response. I have been finding a ton on conflicting info regarding test interpretation. I just read an article stating:

"Standard high-dose ACTH stimulation test — A serum cortisol value of 20 g/dL (550 nmol/L) or more at any time during the test, including before injection, is indicative of normal adrenal function [20].

*** Criteria that require a minimum increment in serum cortisol [4] are invalid [11], because patients who have a high basal serum cortisol concentration, due either to normal circadian rhythmicity or acute stress, may be nearly maximally stimulated and unable to increase cortisol secretion further. In addition, approximately 20 percent of normal subjects with high-normal basal serum cortisol concentration have little or no rise after ACTH. It is therefore important to obtain both baseline and post-ACTH samples for accurate assessment of adrenal function."***

According to that I would be 100% fine. I just don't know who/what to believe anymore.

Knickerbocker1 08-25-2012 08:18 PM

Re: ACTH stim test results, confused.
Anyone have any other insight? 400 views and only 1 reply ?

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