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annan 05-10-2013 09:50 PM

low ACTH? mildly insufficient?
Help! I need help interpreting my ACTH Stim test results. I asked my doctor about these labs, and he literally put his head on the exam table and pretended he was sleeping. It was the oddest thing. History .. I've been very ill with Hashimoto's & Grave's disease for 7 years. My thyroid was radiated last year. We are finally digging into adrenal problems that could be contributing. Here are my test results:

ACTH, Serum 26.5 (7.2-63.3)

Cortisol, Baseline 18.9

Cortisol, 30m 27.9

Cortisol, 60m 29.0 (1.5x increase from baseline)

Baseline test was done at 9:30 AM, 30m was 10:10 AM. Baseline didn't quite double, but not low enough for primary adrenal insufficiency. What do you recommend in a case like this? Also, is my ACTH low? I read a healthy ACTH would be in the 40s.

Also, a saliva cortisol test is pending.

Kind regards ..

ladybud 05-11-2013 01:10 AM

Re: low ACTH? mildly insufficient?
Your serum cortisol on ACTH should double or more at 60 minutes. Usually, in primary adrenal insufficiency the ACTH is high, in attempt to stimulate the adrenals, similar to a high TSH in hypothyroidism. So I think you do have Addison's but it seems your pituitary may be sluggish as well in its ACTH production. I would want to get a full pituitary panel to look at the rest of the pituitary hormones, and treat you with cortisol for Addison's. You should be under the care of an endo, and your Drs reaction seems very strange indeed.

annan 05-11-2013 09:14 AM

Re: low ACTH? mildly insufficient?
For more info .. I was fasting for the baseline cortisol and ACTH. I ate food after the ACTH injection, so was not fasting for the 30m and 60m cortisol tests. I may have also been on .5 mg Ativan, which could have lowered the adrenal response?

My doctor did other adrenal-related tests, including Aldosterone, Plasma Renin, 21-Hydroxylase Ab (negative), 17-Hydroxypregneneolone, Chromogranin-A, and Metanephrines Plasma. He didn't have any concern about my adrenal health, but since I have been so sick and my ACTH Stim test wasn't picture-perfect, I wondered if this was worth looking into.

At this point I feel like any endo will have the same reaction as mine did. Unless you have obvious Addison's or Cushing's, they are uninterested in digging further. It seems one could be mildly adrenal insufficient but not sure if the ACTH Stim test would shed light on this. Saliva test pending. My primary doctor game me a 10-day px of Cortisol but it seems unnecessary unless I really know what I'm doing. I want to feel healed overall, not just a 10-day fix.

ladybud 05-11-2013 09:22 AM

Re: low ACTH? mildly insufficient?
I think the 10 day cortisol is a test to see if you feel better on it. I would try it and jot notes each day about your overall energy and stamina. I disagree that any endo will react the way yours did. What is the point of ordering tests if youre going to ignore abnormal results? Your stim test was abnormal, and the ativan or eating shouldn't have affected it. If you feel better on cortisol, I'm sure your PCP plans to continue it.

annan 05-11-2013 09:59 AM

Re: low ACTH? mildly insufficient?
Double entry .. sorry!

annan 05-11-2013 10:02 AM

Re: low ACTH? mildly insufficient?
Then perhaps then I'll get a second opinion from one of my former endos about the ACTH Stim test. I didn't fill the cortisol scrip from my primary MD .. he said I would feel better but that he wouldn't allow me on it for more than the 10 days .. he didn't want my adrenals to start depending on it and was worried about osteoperosis and diabetes with long-term use. In October 2011 I did a major steroid infusion therapy (10,000 mg IV for 3 days, then taper from 60mg orally to 0mg over 3 months). They were trying to jump start my immune system to see if I felt better, because no one can understand why I still can't function after so many years on thyroid hormone and trying so many different combinations of thyroid hormone. In the end, the steroid infusions didn't help. But I can't tell if the steroids made me feel better because during this time my Hashi's shifted to Grave's so I was all over the map with thyroid symptoms. It was the most hideous time of my life symptom-wise.

While my endo was taking his nap during my Question/Answer period about my lab results, at the end, I sighed and said, "What you've told me, and what every endocrinologist has told me, is 'I can get you in range. That is what I can do for you.'" (Meaning TSH.) I asked him, "Am I the only patient you have in TSH range who cannot function, or am I just an anomaly." He said that he had other patients like me, that I was not an anomaly. So I left his office. What else can he or any endo do for me, as long as they see my TSH in range and they rule out all other diseases they know about?

I am well versed on FT3, RT3, iron, adrenals, etc. etc. I am working on those angles as well, as I've never really gotten my iron in good range. But I just wanted to rule out any adrenal problem other than a little sluggishness or overactive perhaps.

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