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    Old 12-02-2016, 05:41 PM   #1
    fatiguedincalif
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    help interpreting ACTH stimulation test

    Hi, I am a 49 year old female suffering from fatigue and other symptoms for 30 years. My symptoms wax and wane and this last year I have been feeling quite poorly. My main symptoms are fatigue, brain fog, difficulty sleeping and excessive urination, especially at night. During the last year my primary care physician has ruled out thyroid disorder, diabetes and sleep apnea. My 8 am cortisol level was 6.4 (reference range 4-22).
    Because my cortisol was low-normal my PCP ordered an ACTH stimulation test. The results were:

    12 noon 5.2 ug/dL
    30 min post injection 16.6 ug/dL
    1 hour post injection 19.7 ug/dL

    I understand that my cortisol more than doubled, which rules Addison's out. However, my understanding is that the 30 min level of 16.6 is low; it should be 18 or higher according to the Cleveland Clinic website. My PCP said that my final level of 19.7 is borderline so she is sending my results to endocrinology for their input.

    I believe that I may have secondary adrenal insufficiency. Any thoughts or inputs? Thank you in advance.

     
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    Old 12-06-2016, 06:54 PM   #2
    fatiguedincalif
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    Re: help interpreting ACTH stimulation test

    Update: According to my PCP my results are borderline. She has prescribed 15 mg of Cortef daily for 1 month. If I feel better on hydrocortisone then that is diagnostic for adrenal insufficiency. If I do not feel better in a few weeks then I am supposed to stop the medication (due to fears of it causing diabetes) and then it will be assumed that I do not have adrenal insuffiency.
    My concern is that 15 mg of Cortef might be too low a dose; I understand that most prescriptions start at 20 mg.

     
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    Old 01-18-2017, 10:37 AM   #3
    Dragonfly Wings
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    Re: help interpreting ACTH stimulation test

    Good Morning fatiguedincalif, How are you going now? Did your diagnosis come through? It is strange they would trial you on medication for just a month and use that as diagnostics without doing any further testing.

    I hope things have improved for you!
    K.

     
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    Old 01-30-2017, 07:54 PM   #4
    Diefen
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    Re: help interpreting ACTH stimulation test

    Has your skin darkened? For primary addison's, dark skin is a common side effect pre-diagnosis. This is b/c ACTH some times darkens the skin, and if your adrenals aren't producing cortisol your body is cranking out ACTH non-stop.

    So while this isn't definitive, if your skin noticeably darkened then I don't think you have secondary addison's. But since you are borderline, unchanged skin tone doesn't really rule out primary.

    Last edited by Diefen; 02-08-2017 at 02:45 PM.

     
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