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  • Seeking opinions on ACTH stim test results

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    Old 04-29-2013, 10:10 AM   #1
    anonymous345's Avatar
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    Seeking opinions on ACTH stim test results

    I recently had an ACTH stim test because my endo suspected that I might have adrenal insufficiency.

    History: Type 1 diabetic for 30 years, hypothyroid (hashimoto's) since early 90's. All under good control. Labs were just drawn and everything is in range.

    Symptoms: Fatigue/exhaustion, aching joints/muscles, tingling/numbness in feet and hands, constipation, dizzy/lightheaded/blackout upon standing or stretching, recurrent yeast infections. General feeling of being "ill." Have had symptoms since my pre-teen years, but doctors usually won't take them seriously. Seems to be getting worse in the last 3-5 years.

    During extreme stress (physical and emotional,) I also get depression and anxiety. Anytime I am sick with a stomach bug that involves vomiting, I get severely dehydrated and require IV fluids and sometimes hospitalization. Recently I was also diagnosed with other inflammation-related issues including rosacea, food allergies, and seasonal allergies.

    First she did the blood tests. These were performed at about 6pm:
    ATCH bld was 7 (range is 8-42)
    Cortisol bld was 2.3 (pm range is .9-15.8)

    She said that my Cortisol level was a little low and that we should do the ACTH stim test.

    I had this one performed about a week later in the morning around 9am:
    Cortisol Basal: 7 (am range is 3.4 to 26.9)
    Cortisol 30 min: 19.9
    Cortisol 60 min: 25.2

    The notes on the results say, "A peak value of at least 18 ug/dL is a normal response to cortrosyn stimulation."

    So I guess they are saying the results are in range. I have been reading about secondary AI on this forum, though, and thought these results could possibly indicate that. I also read that secondary AI is less common in patients with other autoimmune diseases (usually we get primary AI,) but I found a small study that found correlation between autoimmune disease and secondary AI.

    Also, potassium and sodium levels are in range. Blood pressure runs just slightly low -- 110/70 or so.

    No comments from the doctor (yet.)

    Your thoughts? Any advice on how to proceed?

    Thank you.

    Last edited by anonymous345; 04-29-2013 at 10:20 AM.

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    Old 04-29-2013, 12:11 PM   #2
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    Re: Seeking opinions on ACTH stim test results

    I think your stim test results indicate a possible secondary Addison's- which is due to pituitary insufficiency of ACTH. Your baseline ACTH, which comes from pituitary gland in brain, is low. When given ACTH, your adrenal glands respond normally. So the adrenals themselves are ok, but the pituitary is not producing sufficient ACTH to stimulate the adrenals adequately, hence the low cortisol. A pituitary blood panel should be done next to see if other pituitary hormones are off balance. ACTH can be supplemented by medication, but it is important to know the status of your other pituitary hormones.

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