ACTH test results

[bjlake3692]

Can some explain the purpose and what they are looking at when they run a one hour STIM test?

My husbands results were 19 at the start of the test, injection was given, an hour later his results were 9

Everything I read says that if the levels do not respond (increase) that is an indicator that the problem is in the adrenals.  Yet all the doctors keep saying his results were normal and nothing to worry about, and refuse to rerun any other test.  They say that since the 19 was within range there is no issue

My guestion is if they are only concerned that the first number is within normal and don't care about what happens to the 2nd number why do they even bother to do the injection and retest

My husband might need surgery and this scares me if the adrenals are not functioning.  He has been battling hypothyroidism (TSH is currently 44) since he had thyroid surgery 10yrs ago.

[rumpled]

Then he did not have a dynamic MRI - that shows the smaller lesions.
I hope the docs keep testing him or do you have an option of a neuro-endo? It takes a lot of doc shopping sometimes... I had to as well.

[bjlake3692]

I just checked with my husband, he said they put him in the MRI machine for a while, brought him out and gave him an injection, and then put him back in the MRI machine

[bjlake3692]

We do have an AM cortisol test schedule for Janurary....will that be helpful.  As for the MRI I do know it was w and w/o contrast but nothing about pituitary was noted on the report.

[rumpled]

Dang... that sounds like me and my pit tumor - only I had Cushing's! But they just kept saying oh it is your thyroid... blah blah blah...

I cannot tell you need ACTH or the CRH results to know primary or secondary. ACTH will be high for primary, low for secondary. The Pit will be trying extra hard to signal the adrenals and the adrenals not listening - so it will be high if the adrenals are at fault. The ACTH will be low if the pit is not even sending out the signal so the adrenals will not even get it.

Did they do a pituitary MRI? Dynamic - do contrast while in the machine? Weird that he went in for that purpose and nothing was said.

He probably is just on the verge - but the normal at the start of the test... ah... the docs are just number crunchers... and fail to see that we have to live it.

[bjlake3692]

Unforunately, I have been through tons of doctors with my husband because of the TSH issue (had thyroid surgery 10yrs ago due to Graves) and not being able to get it regulated.  I have shown each doctor a copy of the STIM test and they just "roll their eyes" and tell me there is nothing to worry about...the test was fine and the symptoms are all thyroid related"

Do you know with those type of results would that be suggestive of primary or secondary adrenal failure.

He had an MRI done last week to look at the pituitary gland, but when we got the reports back it didn't say anything about the pituitary (did note a cerebral aneursym).  So I'm not sure if they didn't check it or if it just isn't on the report because no issues were noted.

[rumpled]

The purpose, is as you say, is to determine if the adrenals are functioning. Some doc run a two part test - ACTH and CRH - so then you determine the source of the issue as well.

So 19... that is normal (absent ranges) and if he dropped, yes, technically, he should have failed the test. He did not respond to the stim. They are going by the normal baseline.

Is his endo a regular endo, or neuro-endo? Can you consult a pituitary center? His TSH is way too high - as you know...