ACTH Stim question

I had an ACTH stim test today (started at 11:00). My endo says I have no adrenal issues, but I thought it was supposed to double if your adrenals are healthy.

10:50am CORTISOL 21.0 mcg/dl [5.0-25.0]

11:50am CORTISOL *30.6 mcg/dl [5.0-25.0]

[kevieb]

doesn't look like your endo even did your stim test right.

a stim test should be done while fasting, and as close to 8 am as possible.  acth should also be tested along with the cortisol for baseline levels.  after the stim agent is injected  they should do 2 draws approx 30 minutes apart. (my doc did 40 min apart).

a starting level of 21.0 would not even be considered an adrenal problem---at least i don't think so, however, cortisol is highest at approx 8 am.

a really low starting level will sometimes quadrupal.  some doc s look for a doubling of levels, some look for a level of ag least 20 or higher.

ask you doc why he did the test so late in the morning and what he wa looking for.

why did he run a stim test---was there something that made him think you might be having adrenal issues?

both my cortisol adn acth were low---somy endo ran the stim test.  i started at 2.4 and my first draw quadrupled to 9.6--but it started out really low.  my second draw was 11.3.  however, it was stated right on my test results that they were looking for a level of at least 20 or higher.

[Sunshine_67]

She dismissed my saliva tests saying they're unreliable, but according to them, my cortisol is low from 6am-10am and then goes up the rest of the day. So by doing the test at 11am, my cortisol was already rising. Had she done it first thing in the morning, she would have seen it was low. I asked her about the timing and she said it made no difference. She ran the Stim test because she doesn't go by saliva tests and kept saying the Stim test was the gold standard. I do have adrenal issues based on saliva tests, but since they're not at the extreme of Addison's or Cushings, she ignored them.

[kevieb]

she's full of crap about the timing.  the second endo office i went to told me the same thing.  I called the patient and family relations office--they were hospital affiliated and complained about the shoddy stim test they did and their refusal to test anythign else and said i did not want to pay for that test.  i was told i would be credited for anything to do with the test and that a medical revue was going to be done with this doc to see if he treated me correctly.   i haven't heard anything from them again---and i haven't even gotten a bill for my office visit co-pay.

you can look up the protocol for how a stim test is supposed to be done online.  if i can find it again i will send you a link.
what was your starting ACTH level---she needs to know that to do a stim test--also, they are supposed to do a 30 min draw and a 60 min draw.

[Sunshine_67]

She just posted the starting ACTH level yesterday and it was 27, but even the lab report said that sample was for 7am-10am and she started the test at 11:00. I told her my cortisol was only low in the morning and ever saliva test I've taken shows it rises around noon, so of course it would be higher after 7am. These endos are so by the book it's scary. They literally wait until someone is in a thyroid or adrenal coma before they treat them.

[Dina723]

I don't want to get your conversation off track, but what would you guys say to that test being carried out at 10:30 pm?  I was hospitalized so tbat's when they did it. Is that reliable?

[Dina723]

I don't want to get your conversation off track, but what would you guys say to that test being carried out at 10:30 pm?  I was hospitalized so tbat's when they did it. Is that reliable?

[kevieb]

dina--what were you hospitalized for?  ask your doc why they chose to do the test that late.  why were they doing the test?

sunshine--it doesn't sound like you have a cortisol problem as far as the amount of cortisol you produce--it sounds more like your natural rythm of producing it is off.

[Dina723]

At the time they were trying to determine why I suddenly became so ill. I had untreated hypothyroid found shortly before being admitted. so I think that made them think my adrenals might be connected to it. I still remain very ill. Even went to a prestigious hospital and they looked at the test and said it was fine. I said but it was done at night shouldn't it be done during the morning after fasting and not on any hormones?? And he said it doesn't matter. My left side where the adrenal would be is always sore, tender, and sometimes has a stabbing pain. And even with adequate thyroid hormones I am still sick. So I peruse the boards looking for any connections because I feel I have to do the leg work or no one else will. Sorry, frustrating!!

[rumpled]

You can also pass a stim test and still be sick - you can be borderline - and so the adrenals can still be functional for the time, but not for long so they need to look at the whole picture.

I agree about the test timing... time of day and delay in sample was not protocol. Sometimes they only do one draw but that is at 30min not 60. Do you have other tests like low sodium, wonky potassium etc etc?

[Dina723]

I will check my labs and I'm going to start a new post so this one can stay focused onSunshine:))) I'll title mine "ATCH time of day," so you can spot me. Thank you!!

[kevieb]

sunshine,  if you really feel like you may have a cortisol problem---and i agree completely with what rumpled said about being able to pass a stim test and still be borderline,  anyway, if you really want to get a more accurate picture, you can find the protocol on the internet for how a stim test should be done.  i hae had one endo follow it pretty strictly, and another that barely even followed it enough to call it a stim test.  i have also heard fasting, not fasting, time of day important, time of day not important.  i have a tendency to believe in the strict protocol---less room for error.  anyway, take the directions in to your doc and ask her if she would humour you and do the test again and follow the protocol exactly.  if she won't, and you don't have another endo, i think that an internist would probably know how to do the test right.     even in our little rural town in southern idaho they can do the test right.

dina--you have not started yur new post--so i am going to start it for you--i wanted to tell you something.