ACTH Stimulation Test results interpretation

[SandCon14]

Not too long ago my doctor noticed that my AM cortisol was a little low (6.5 mcg/dl , range 7.0 - 25.0). He suggested the ACTH stim test. When they started the test, cortisol was higher (15.1 pg/mL, range 10.0 - 60.0) and it rose from 15.1 to 20.5 at 30 minutes, and 23.3 at one hour. My doctor said that everything looked great and nothing else was said.

I've been told though that the baseline cortisol level in most healthy people should double within an hour of the ACTH test, but mine only went up about 50%. Is this something I should discuss with my doctor?

[bri256]

What is the acth stim test?  how is that done?  

I was told my cortisol level was low about 6 weeks ago, but to get in with the endroconilogist has taken to an appointment in April.  Probably back normal by then, who knows??

[rumpled]

Have they done any antibody testing on the thyroid - or ultrasound?

It is wild that the doc is blowing off the tests... they find TSH to be the grail, yet, ignore it when it is off...

[SandCon14]

Yeah, I've had a few doctors say that I needed to "keep a watch on my thyroid" just in case, but when I ask about it they say it's "fine". Other doctors completely dismiss it, even at its highest point (like when it's in the upper 4's or around 5.0).

I think the only reason for the adrenal testing was because he was curious about whether or not that was the cause of my constant fatigue and muscle-related problems. When he noticed that my cortisol was low during the morning test, he probably assumed that was the cause and went for the stim test.

Don't get me wrong, I'm glad he was thorough enough to check the cortisol and stuff, but I'm not sure exactly why he disregarded the thyroid thing, especially since it's been consistently low since I've been feeling bad. Then again, I'm not doctor, so it's probably fine...

Thank you for your help, btw :)

[rumpled]

AI is a salt-wasting disease. So if you were off, sodium and potassium would be off, or at the low end of the range and potassium off as well - at either end of the range as well.

The *new* range (uh, about 5 years old?) is .3 to 3 for TSH and so you TSH sounds a bit low. Most people feel better on the other end of the range of TSH and on the upper ends of the T3 and T4.

It does not sound like your doc did a lot of adrenal testing but with normal sodium, not even sure why he did a stim test?

[SandCon14]

Hey, thanks for the response :)

My sodium was tested I believe, and it looked okay from what I remember. It was within range. Same with potassium. No antibodies, renin, aldosterone, DHEA though. Testosterone was checked and was on the low end (around 240), then was rechecked and came back at around 400. My thyroid was also checked, and my TSH been consistently around 3.00-4.00, although both T3 and T4 look good.

[rumpled]

We have endless discussions on this... some docs look for double the baseline, and some look for a *magic number* that we don't know but that they seem very satisfied with.

I don't know if the method differs by stim agent, or just the doctor pulling whatever out of you know what, but it just seems that some do it one way, others another and I don't know why and under what criteria.

How do your other tests look - sodium, potassium, etc. and did you have several sets of cortisol testing, and ACTH? antibodies? renin, aldosterone? DHEA sulfate? In other words, did you have a complete work up, or just one cortisol test and one stim test?