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Elevated ACTH, high-norm cortisol in the AM

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Old 08-11-2009, 04:13 PM   #1
Join Date: Aug 2009
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Question Elevated ACTH, high-norm cortisol in the AM

I tried posting this in the addison's disease section but I guess since this isn't addison's disease (yet?), no one responds there.

I'm a 33 year old male with hashimoto's thyroiditis. I've had several blood tests for ACTH, Cortisol and a number of other things. FT4, FT3 always in the middle range, RT3 is a little high, TPOAbs and the other hashi's antibody is always a little high but not too bad, etc. I've tried Armour in the past but did not do well on it.

My medications are Levoxyl 37.5 mcg (TSH drops to decimal range when this is increased), Aciphex 20mg and Toprolol XL 50mg.

My early morning ACTH is almost always elevated while my cortisol is always normal to high-normal (both checked in the same draws).

In the evening, both my ACTH and cortisol drop down to normal range.

I've had catecholamines tested (normal), a pituitary MRI (normal), several CT scans and imaging of my adrenals (normal), plus many other tests. If you can think of a test, I have probably had it done and I have the results on my computer (including enzymes, proteins, etc.).

My 24 hour urine cortisol was 5 (ref range 0 to 50). Repeated twice.

The only thing I do differently than most people, is I take my thyroid medication at night time. My endo said this won't affect anything.

Also my testosterone is low. Further, my DHEA and DHEAs are elevated and my IGF-1 is always high-norm (sometimes too high).

Prolactin, aldosterone, progesterone, estradiol and all the others are is normal range. Adrenal antibodies were negative.

Here is sample of early morning draws:


Here are a couple PM draws:

The ratio of ACTH vs Cortisol goes to NORMAL in the afternoon, but is way out of whack in the AM. My body wants more cortisol in the AM but has a difficult time producing it at that time.

TSH doesn't seem to affect my cortisol production much.

I have very little physical or mental stress.

Question #1: Factoring in the normal diurnal rhythm, why is it more difficult for my body to make cortisol in the AM vs afternoon (as evident by the ratios above)?

Question #2: Why is my body trying to produce TOO MUCH cortisol in the AM (sometimes over the top reference range), but only in the AM?

The endocrinologists here in Arizona DO NOT CARE about the elevated ACTH values. They say itís a normal response to stress (the only stress I have is dealing with uncaring doctors ).

I'm guessing that because the ACTH is not elevated all day long, this is not likely to be a lung cancer or anything like that.

Well, I'm going to try taking my thyroid medication in the morning instead of night time, then check the cortisol the next day. I think I tried this once and it didn't help.

Just two years ago before all of this I was in tip top shape, lifting weights for 2 hours daily, I was a power lifter. Now I look like a frail old man.

I think I have adrenal fatigue (although doctors don't beleive in this), but not quite yet addisions disease. I think it will lead to this eventually if it goes unsolved.

A few of my own thoughts....

Perhaps the T4-only thyroid medication at night time really does cause a problem?
My adrenals are trying to make more than just cortisol in the morning, like testosterone and other hormones, so it must work harder in the AM?
Perhaps I'm depressed and don't know it (depressed people have high AM ACTH and Cortisol)?
Perhaps my blood pressure dips too low at night (my pressure has gone down to 80/55 at night time once before), so maybe my adrenals kick in during my sleep?
Perhaps aliens abduct me in my sleep and beat me up?

Please, I need help to figure this out so I can give my adrenals a rest in the mornings.

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Old 08-11-2009, 05:49 PM   #2
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Re: Elevated ACTH, high-norm cortisol in the AM

Hi, that's an interesting post. I agree you seem to have adrenal fatigue and a saliva cortisol test would probably confirm it. It's also probably why you couldn't tolerate the natural thyroid hormones. It sounds like you might need some hydrocortisone to get the adrenals a rest and allow them to heal.

Last edited by moderator2; 08-12-2009 at 01:31 PM.

Old 08-11-2009, 07:21 PM   #3
Join Date: Aug 2009
Posts: 4
Re: Elevated ACTH, high-norm cortisol in the AM

I have tried perhaps 5 or 6 saliva tests from various places and most of the time I got very odd results like V shaped results, flat lines, etc. One result was convincing because it showed a normal diurnal pattern, just that my results were below the low reference range throughout the day.

Last edited by moderator2; 08-12-2009 at 01:31 PM.

Old 08-12-2009, 04:36 AM   #4
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javelina HB Userjavelina HB Userjavelina HB User
Re: Elevated ACTH, high-norm cortisol in the AM

Well, given your saliva results you are definitely adrenal fatigued big-time. You shouldn't be low range let alone below range.

Can you post your latest FT3, FT4, and RT3 here with the ranges? I'm pretty sure you are going to have to get your adrenals treated before you can continue with thyroid meds and you are probably pooling T3 now. That makes for one unhappy camper. Also have you tested you Vitamin D, B12, ferritin? They all need to be in the upper part of range and we tend to be deficient.

Last edited by moderator2; 08-12-2009 at 01:31 PM.

Old 08-12-2009, 11:55 PM   #5
Join Date: Aug 2009
Posts: 4
Re: Elevated ACTH, high-norm cortisol in the AM

TSH 1.09 (ref: 0.35 to 5.5)
FT4: 1.49 (ref 0.61 to 1.76)
FT3: 3.4 (ref: 2.3 to 4.2)
RT3: 279 (ref: 200 to 300)

Yes also checked 25-OH vitamin D, B12, ferritin, TIBC, etc. all normal to high normal.


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