Addison's Disease Community
Adrenal insuffiency or Addisons?
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Addison’s disease, also known as Adrenal Insufficiency or Hypocortisolism, is an endocrine disease that occurs when the adrenal glands do not produce enough of the hormone cortisol and sometimes, aldosterone. Discuss topics including symptoms and treatments for Addison’s disease.

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Adrenal insuffiency or Addisons?

I am a fifty year old male and I am presently treating for heavy metal toxicity (mercury and lead), which I have been doing for some eight months. I believe the heavy metals wreaked havoc with my endocrine system.
I am finally starting to feel somewhat normal, after over one year of being thyroid deficient. My adrenals seem to have taken a hit, also, and it is my guess that they were the first to aile me, leading to my present thyroid issue.
My pcp has decided that I should undergo an ACTH stim test, and I agreed. My wife suggested that I get a low dose ACTH test, as it is less likely to cause side effects(?) and might be more accurate. Is this in fact true of the low dose test? I really feel like I am coming down the stretch on this long illness, so I want to be sure that I have the best information. That would be from you guys! Thanks in advance! My recent cortisol test was at 1.6 ug/dl, almost ten times lower than my measure in May of this year! Even if I were to adjust for my bedtime hours (going to bed early in the morning, getting up early afternoon), this seems very low.

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657231_tn?1390151580
I did not get enough sleep lately... *sigh* - either test can miss if you are borderline though...
"Abstract
OBJECTIVE:

We have shown previously that in contrast to the standard high-dose 250-microgram ACTH test, a low-dose 1-microgram ACTH stimulation test correctly identified all patients with pituitary disease who had impaired hypothalamo-pituitary-adrenal (HPA) function. In this study we further compared the performances of these two tests as screening procedures for possible HPA impairment.
DESIGN:

A comparison of the 1-microgram and the 250-microgram ACTH stimulation tests in healthy controls and in patients with pituitary disease whose HPA axis status was characterized formally by a gold standard test.
SUBJECTS:

A total of 89 subjects were investigated: 27 healthy normal controls, 43 patients with pituitary disease and normal HPA function, and 19 patients with various pituitary diseases and impaired HPA function.
MEASURES:

All 89 subjects underwent stimulation with 1 microgram ACTH; 80 also underwent the high-dose 250-microgram ACTH test. A receiver operating characteristic analysis (ROC) was performed to compare the tests.
RESULTS:

Using a stimulated cortisol > 500 nmol/l as the criterion for a normal response, the 1-microgram ACTH stimulation identified 18 of the 19 subjects with impaired HPA function (94.7% sensitivity with a likelihood ratio of 0.0588 for a negative test). In contrast, 15/16 passed the high-dose test (a 6.2% sensitivity with a likelihood ratio of 0.875 for a negative test). All normal controls, and 36/43 patients with preserved HPA function, passed the 1-microgram ACTH test (90% specificity). This degree of accuracy was unrivalled by the high dose test at all the cut-off levels considered.
CONCLUSIONS:

More sensitive and accurate, the low-dose 1-microgram ACTH test is as simple and safe as the standard 250-microgram test. We suggest it should replace it in screening for adrenal insufficiency."
2 Comments Post a Comment
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657231_tn?1390151580
I hope you have found a wonderful endocrinologist.

I was searching around pubmed and it seems that the low dose is not generally used - it can miss cases. I also know even the standard dose can miss too.

It is normal to worry about side effects - but some people actually feel better after the ACTH stim tests as it replaces a hormone that is not functioning! Most feel just flushed, or cold or whatever - and you are supposed to be monitored during the test.

Do you always go to bed during the day? If so, then your testing times should be adjusted as your diurnal or circadian rhythm has changed to adjust to that sleep schedule. It would or should change your cortisol levels and how it rises and falls. Cortisol does vary a LOT - and can have really low levels and be normal.
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657231_tn?1390151580
I did not get enough sleep lately... *sigh* - either test can miss if you are borderline though...
"Abstract
OBJECTIVE:

We have shown previously that in contrast to the standard high-dose 250-microgram ACTH test, a low-dose 1-microgram ACTH stimulation test correctly identified all patients with pituitary disease who had impaired hypothalamo-pituitary-adrenal (HPA) function. In this study we further compared the performances of these two tests as screening procedures for possible HPA impairment.
DESIGN:

A comparison of the 1-microgram and the 250-microgram ACTH stimulation tests in healthy controls and in patients with pituitary disease whose HPA axis status was characterized formally by a gold standard test.
SUBJECTS:

A total of 89 subjects were investigated: 27 healthy normal controls, 43 patients with pituitary disease and normal HPA function, and 19 patients with various pituitary diseases and impaired HPA function.
MEASURES:

All 89 subjects underwent stimulation with 1 microgram ACTH; 80 also underwent the high-dose 250-microgram ACTH test. A receiver operating characteristic analysis (ROC) was performed to compare the tests.
RESULTS:

Using a stimulated cortisol > 500 nmol/l as the criterion for a normal response, the 1-microgram ACTH stimulation identified 18 of the 19 subjects with impaired HPA function (94.7% sensitivity with a likelihood ratio of 0.0588 for a negative test). In contrast, 15/16 passed the high-dose test (a 6.2% sensitivity with a likelihood ratio of 0.875 for a negative test). All normal controls, and 36/43 patients with preserved HPA function, passed the 1-microgram ACTH test (90% specificity). This degree of accuracy was unrivalled by the high dose test at all the cut-off levels considered.
CONCLUSIONS:

More sensitive and accurate, the low-dose 1-microgram ACTH test is as simple and safe as the standard 250-microgram test. We suggest it should replace it in screening for adrenal insufficiency."
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