View Full Version : Does Low DHEA-s Show "Normal" ACTH Stim not "Normal"

02-11-2008, 05:58 PM
Following an ACTH stim test where my new endo told me I was "normal", I had a DHEA-s test performed. The result seems to be quite low, especially for my age (41).

DHEA-s 40mcg/dL (32-240)
[taken on the 8th or 9th day of my cycle and at 8:30 AM]

I originally went to the endo to investigate further an serum ACTH of 11 (5-29) and a "low" morning cortisol of 15.

An ACTH stim was performed and the results were: AM cortisol = 14.5, 30 min = 31.7 and 60 min = 33.6.

Am I still looking at an undiganosed secondary AI, or is there something else going on here?

I am getting so tired of this endless search for an answer :(
[I am also hypthyroid but off my medication due to medication intolerance, mow week 5]

02-12-2008, 09:37 AM
The adrenal gland has several different layers, each performing different functions. So the cortisol feedback loop with ACTH and cortisol does not exactly impact the DHEA-S which is a precurser hormone for both estrogen and testosterone.
However, as you have found out, once one hormone goes, so do many. Often it is auto-immune.
You say you cannot take your thyroid meds... I found that by trying different brands, I was able to take mine and stay stable. I was allergic to either the color or the fillers in a brand. It is important to your heart and metabolism to keep your thyroid in balance. Were your antibodies checked?
Have you checked your vitamin D levels? I was super low and that made me feel awful. Take D3 to replace.

02-12-2008, 11:37 AM
Thanks, rumpled.

I have been on every thyroid med. The intolerance was really a "hyper" feeling about an hour after taking the thyroid med - lots of dizziness and other weird effects. It happened after I was on Armour for a few months - never did get above 60mg for more than a few weeks. So, I am suspecting the adrenals as there is really no other answer at the moment.

Yep, many of my hormones are out of kilter, according to my latest saliva test in Nov. Strangely, everything was low EXCEPT my progesterone, which for the time of my cycle was VERY high.

My antibodies were negative - tho the tests were given at my suggestion, some 5 months after I started t4 treatment. I have since retrested while off the meds and am waiting to see if there is any change.

I had a parathyroi test run recently as well, but seems to be mid range. I was concerned becasue my calcium is at a very low level, usually 8.6, but seems to flutuate at times up to 9.3. Weird. I read that blood caclium is usually carefuly regulated by the body and should not be either low or high, nor fluctuate grealty.

I have not had my vit d measured, but I expect I will look into this next. Is the Vit d and calcium related in terms of blood calcium

I have an upcoming appoinmt with a integrative medicine physician, so perhaps he will have some answers. I am soooo out of ideas. :(

02-12-2008, 01:01 PM
The symptom you describe was only attributable to the thyroid medication? That is very strange. If you were going to be hyper, as I have become at times on meds, I stayed hyper so to have it just be transient. Did your doctor check your free T4 and Free T4 or just TSH?

There are other calcium tests your doctor could order - such as an ionized calcium, and a 24 hour urine calcium. My PTH fluctuates so while doctors say it does not, well, hmm. Do get your D checked.

Low ACTH can be lab error. Was the test performed correctly - on ice, spun and frozen promptly?

02-12-2008, 05:52 PM
I am dizzy all the time, but it was more intense with thyroid meds. I was doing ok on T4 for a year. Went on Armour by transitioning. Was on Armour for a few months solo. It was the best ever! My mood was great, stamina better, and everyting was rosy - I could think clearly and felt like doing things. Then, I spend 4 -6 weeks reacting to Armour poorly, shaking, panicy, way overstimulated feeling. It was not transient in that it was present all the time during the "intolerance" period.

I kept cutting back, and then in depseration went back on T4 only. I was on 22 mcg/d for a short time. By late December, I would take the 22mcg, about an hour and a half later, felt energized, like rising from the dead, then another hour or so later, started shaking and feeling an extreme dizziness, my head was "buzzing", palpitations, panicy, and then a maybe 5 hours of feeling fatigued, a bit of confusiion thrown in. I felt simultaneously hypo and "hyper" I don't know how else to describe it.

I had a blood test done in December, since I could not tell whether I was really hypo and having anxiety etc, or hyper and over medicated.

The results were:

TSH 2.134 (.350-5.50
FT4 1.12 (.61-1.76)
FT3 3.0 (2.3-4.2)

No clinical signes of hyper....


As to the ACTH, I have no idea of how it was processed. I do know that I am on a medication (Seroquel 25 mg - super low dose), that lowers ACTH, but don't know if this is the cause (due to the low dose), if it is even genuinely low.

The lab "forgot" to draw the ACTH sample during my ACTH stim a few weeks ago. So, I have nothing to compare the earlier result from July to.:mad:

I will ask my endo about the calcium issue, and of course, my new dr later this week. There is something amiss I think.

Thanks for replying, as I need to figure out what is going on. I have been sick for more than 10 years, and only recently diagnosed as hypo. I am sure it has taken a toll on my body.

02-13-2008, 10:46 AM
Armour, which is a fantastic med, has a very very high T3 component... and its ratio just may be a little too high for you. Your FT3 is right in the middle so you really did not need the armour T3. You happen to convert T4 quite well it seems... hence why you would feel all buzzy. Why not stay with an all T4 med or do a T4 and T3 with cytomel where you can control the amount of T3? Your TSH is at a level where I would feel awful. Plus, too it just takes a while to feel better on a dose. It once took me a year to find one. It was a bad year.

Bad lab... man, I hate it when the do crud like that... I actually bring ice to one lab when I have to do an ACTH as they are so dumb and I want my tubes kept cool. But ah the medication.. that factors in as well...

02-27-2008, 02:33 AM
Hi, i have a pituitary tumor (just found out)...why is it we just don't trust our endos??? maybe because they don't have to live in our bodies and tests don't always show what we are feeling (pooped)...from my very limited amount of time and initiation into this process, i understand totally your frustration...i was told by someone a healthy normal serum ACTH would be around 48-55 but, because Stim tests are done on us barely functioning people, the 'normal range' has been brought down low...mine was 9.7...a far cry from 48-55...my cortisol before the stim test was 2.3 (told it was a lab error)...During the stim test, a normal reaction would double the cortisol level which mine did...to 25...(half way there)
Primary Addisons will have high ACTH and almost no cortisol...secondary will have low on both... the problem with stim tests is ( something i argue with the endo every time i see her) that it can have a normal reaction but, ACTH levels might be too low and something that puts us over the edge, like illness, abnormal sress, can result in adrenal crisis....it's not a bad idea for people with low normal cortisol to carry an epi pen, a packet of salt, a packet of sugar, and some prednisone (think i jest????)....FYI keep looking for a GOOD ENDO who actually cracks a medical book on occasion....
As for thyroid...if you have low ACTH, your adrenals are probably stealing thyroxine (sp) and converting it...your body will convert estrogen, thyroid, testosterine, basically anything it can steal to make cortisol...so, people with adrenal problems can end up having borderline low thyroid, strange estrogen levels, ect...it's not possible to alter one thing or function without altering another thing, function which is another grip i have with conventional docs...READ about this stuff, cause it's likely your endo forgot it while building, buying that new house on your dollar...i have found that being more knowledgeable than your doc improves your rate of healthy functioning...and possibly survival...and keep searching for that enlightened souls with a medical degree...

02-27-2008, 11:34 AM
Wow chochmeh1, I am glad you posted and am interested in your situation.

Is your pituitary tumor affecting your ACTH? I am a newbie to this area and don't quite understand.

I am definately a reader, but have had trouble finding decent literature, more than the abstract...which are sometimes very tantalizing. I did, however, find some promising articles, but they seems to use nmol rather than pg/ml, so I have no way to understand them.

Have you found anything defiinitive, esp as regards a person's adrenal output when the are sick? I see the standard in lit and practice is focused on the adrenal level doubling, but I wonder what happens in healthy subjects, when they are either critically ill, or undergo an acht stim test.

Finally, I have heard the same about the ACHT as you have, with the ref reanges being artificially low. But, have not found anything to confirm what a realisitc range is in healthy subjects. I just wish more was available.

My endo never mentioned cortisol being produced from other hormones, but i have heard this as well. It made me wonder about my very high progesterone.....with low estrogens, testotersone and dhea.

What does your endo have to say about all this?:confused:

02-27-2008, 01:01 PM
I just had a saliva test done and the results are as follows:
I am a 38 year old woman.
DHEAS is a 14.1 which shows high for my age.
AM is 1.0 range is 3.7-9.5
Noon 3.0 range is 1.2-3.0
evening .8 range is .6-1.9
night .3 range is .4-1.0
The dr. put me on steroids 80 mg. of hydrocort however my legs started to swell and I had severe cramping he took me off and I am to start back with a lower dose.
I have an excessive thirst that I can not do away with, does anyone know what all this indicates?

02-27-2008, 02:45 PM
Lete me preface my reply by saying that I am new to all this. If I have read postings/advice on this and other boards (and sites) there is a caution about using too high a dose of HC if one is not clinically hypoadrenal, i.e. addisons or secondary adrenal insufficiency. From what I have read acedotally, there is some discussion about physiological vs pharmaceutic (or something to that effect) doses of HC. I believe that 20 (or maybe 30) mg of HC is the magic number, upper limit for physiological use of HC. It seems that persons with adrenal "fatigue" and not insufficiency are cautioned not to go above this mark, otherwise negative consequences can occur.

The one mentioned most often is permanent shutting down of the adrneal function. I don't know if it is true or not, as I have not pusued it in the medical literature. I would suspect as well, that a high dose of HC in any event would cause physical consequences that may be uncomfortable, or even harmful.

I would check to see what people are using as TOTAL REPLACEMENT DOSES for their addisons or secondary insufficiency. Certainly, one should not be taking an equal or greater dose than this if one has not been diagnosed with adrenal insufficiency.

Definately look around the web to see what the customary dose is (anecodatlly or otherwise) for adrenal fatigue. And also check like I said for what addisons etc sufferes take.

I hope someone with greater experience will have more suggestions for you. esp about your thirst and recent apparaent side-effects. :cool: