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ACTH Stimulation Test
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ACTH Stimulation Test

I am in need of advice regarding adrenal insufficiency and test results. I have had FOUR ACTH stim tests done (2 done wrong, one lost for a month).  The endocrinologist did not trust the results from the third stim test, and thus, did a fourth.  The testing ensued due to cortisol levels of 0-8, DHEA 0, ACTH less than 5-10 at various test times.  Cortisol has never been above 10, except during the stimulation test and never exceeded 20 on the stimulation test.  I am now VERY frustrated because the endo says the stim test results are normal.  Help!  I need feedback on this...desperately want my life back.  I don't want to have adrenal insufficiency, but something is wrong and answers are better than not knowing and no treatment.

Here are the results from last two stim tests:

February '12:  16.2 (baseline), 16.5, 16.3

April '12: 8.3 (baseline), 16.7, 17.6

I suffer from abdominal pain, muscle fatigue and joint pain, headaches, and general fatigue...severe enough that I cannot even make it through the grocery store.
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For me, the number one symptom of adrenal fatigue is not being able to handle stress. When i hit severe adrenal fatigue this means i cannot handle ANY stress.  I had severe adrenal fatigue twice due to severe vitamin B12 deficiency and the second time due to hashitoxicosis flare up.

My white line (see below for Sergent's Adrenal White Line test) at it's worse spread over 2 inches and that took 18 months of stress free environment and B12 treatment for this sign to go away. My pupils always fluctuate in the light which is not doubt due to uncorrected hypothyroidism all these years but when i have severe adrenal fatigue my pupils go crazy and fluctuate every second or less (see Iris Contraction Test below). These three tests can show up issues that need no labs.

From the website - Adrenal Recovery Fatigue:

"Adrenal Function Tests You Can Do at Home

ADRENAL FUNCTION TEST #1-Postural Hypotension:

Postural hypotension (also known as orthostatic hypotension) is a drop in blood pressure that occurs upon rising from a horizontal position. It is commonly expressed as a feeling of dizziness or lightheadedness, a "head rush", or "standing up too fast".

To do this test, you will need a blood pressure cuff. Lie down and rest for 5 minutes. Take a blood pressure reading while still horizontal. Then, stand up and take another reading.

Normally, your blood pressure should rise 10-20 points. If it drops, particularly by 10 points or more, hypoadrenia is indicated. Generally, the bigger the drop, the greater the adrenal insufficiency.

It should also be mentioned that low blood pressure in general is also an indicator of exhausted adrenals when present in conjunction with the other symptoms of adrenal gland fatigue.

ADRENAL FUNCTION TEST #2-Iris Contraction Test

For this test you will need a weak flashlight or penlight, and a mirror. In a dark bathroom or closet, wait a minute for your eyes to adjust to the dark. This will allow your pupils to dilate (open) fully. Then, shine the flashlight into your eyes, and watch the reaction of your pupils for at least 30 seconds.

The light should cause your iris to contract, making your pupils (the dark spot in the center of your eye) smaller. Normally, they should stay that way, but if you have adrenal gland fatigue, the iris will be weak and will not be able to hold the contraction, it will either waver between contracted and relaxed, or will contract initially, but then open up after 10-30 seconds.

As with the postural hypotension test, the degree to which you "fail" this test is an indicator of the degree of adrenal insufficiency you are experiencing.

ADRENAL FUNCTION TEST #3-Sergent's Adrenal White Line

With your fingernail or the dull end of a spoon, draw a line across your belly. In moderate to severe cases of adrenal fatigue, the line will stay white, and even get wider over the course of time, while a "normal" reaction would be for the line to almost immediately turn red.

This test has historically been used to indicate severe adrenal fatigue and Addison's Disease, milder cases of adrenal fatigue may not exhibit this sign."
Your first test showed you had no response - and the second you barely made the double, but that can happen even if you are borderline.

I would get all your tests and find a better endo. ACTH tests are fussy at best (they probably were not lost but they degraded - if they are not spun right away, they can get lower just from sitting in the bin).

What are your sodium and potassium readings?
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