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9403237 tn?1403570844

ACTH Test Results

Hiyo,

Baseline cortisol was 1.9 ug/dl
@ 30 minutes was 14.1 ug/dl and
@ one hour was 15.9 ug/dl

Is this consistent with a DX of secondary adrenal insurfficiency?

Thank you!
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9403237 tn?1403570844
Thank you for the help!
Helpful - 0
Avatar universal
Yeah... empty sella syndrome means the CSF is probably squishing your pituitary.

IF you had had a huge headache and visual issues, you could have had a pituitary apoplexy where the pituitary tumor actually exploded. It is pretty rare. In all my reading, I never heard of necrosis.

Your endo is not having you dose quite correctly. A normal person has the bulk of cortisol in the morning. Then the cortisol reduces thru the day. Getting a zap at the end of the day would interfere with sleep and er, put you in an abnormal cycle. Most people take their second dose between 2-4pm, not at night.

A total of 15mg is on the lowish side. You may also need other meds like florinef (fludrocortisone) or even just salt to help you feel better. It can help raise your blood pressure and make you have more energy and keep you out of crisis mode.

You should also be on the look out for low vitamin D, iron and other things - we typically need more support on the vitamins.

Know your sodium and potassium levels. You may need to add sodium. You may need other hormones as well. Get copies.
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9403237 tn?1403570844
I actually had the test done at the VA hospital (I know, how lucky...:) from an endocrinologist.  She said I had secondary adrenal insufficiency, BUT.....she is very, very flaky and doesn't appear very competent.  This is why I posed the question.  No, I was totally calm during the test, to answer your question.

My symptoms, having progressed over the last two years, are that I am extremely lathargic - sleeping 16-18 hours/day.  The endo placed me on 10mg of hydrocortisone in the am and 5 mg at night after my ACTH test results.  I have had absolutely no symptom relief.

Additionally, I had an MRI w/contrast of my brain about one year ago and the endo told me that I had "partial empty sella syndrome".......she explained that I basically had a void near my pituitary gland - I asked how did this get there and she replied that it most likely was a tumor at one time and now has disappeared.......I asked how - she stated, probably due to necrosis......After speaking with another doctor, they informed me that it would be almost impossible for a tumor to just "disappear" from your brain due to lack of blood flow.

I am scheduled to see the other one endo we have at this hospital (as I requested a change) on 7/1/14 and hope that they can provide me with a better treatment regimen and confirm the diagnosis.

Thanks for your help!
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Avatar universal
Hi Langdon,

I am no expert on adrenal insufficiency, but I have been chasing this disease for a lomg time.  So I will tell you what I know.  First we need to make sure were you got the test done did it correctly.  I had this problem with my first and second stim test.  They should have performed the test in a quiet room by yourself with an iv draw.  Also your test should habe started at 9 am. This part is negotiative since I have heard am is ok too.  You should also habe a baseline Acth result.  This helps with dx.  But I am assuming they did all this correctly your results indicate some type of addrenal insufficiency. Some one else chyme in on this please.

A base line cortisol of 1.9 is really low, but the response to the acth stimulation moved up ur cortisol level up 12 points but still did not make it past 20 on the last draw.  From what I understand, if it moves up more than 7 in the first 30 min. its not addrenal insufficiency but if cortisol does not move past 20 then you must see an endo.

So was there anything that occurred during this test that could have stressed you and raised your cortisol?  Also from what I have read when cortisol levels double or triple or more from base then it usually is a secondary insificiency; hypopituitarism.  So acth levels would be great.  If acth is low than this would indicate that.  

Also, what are your symptoms.  Have you had anyother lab work that was off?

Best wishes

Ivory
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