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Adrenal Insufficiency??????
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Adrenal Insufficiency??????

My daughter, Sarah, is still in the hospital.  She has had three Random Cortisol tests before 8am in the last week.  They ranged from 1 to 1.3.....Way below normal!!!!  She had a Blood Cortisol Stim Test before 8am.  Her baseline was 1.  At 30 min. it went to 22.5 and at 60 min. to 32.3.  The dr. said her adrenals make cortisol. Yes, we know that.  My question to him, always, is, "Why does it take the synthetic hormone in the stim test to make her adrenals respond and make cortisol?  Finally, they gave her 4mg. of Decadron and the next day 2mg.  She started feeling better.  Then 2 days later, she started going backwards again.  The Dr. put her on .25 of Decadron daily.  She had her 3rd dose last night.  She's feeling a little better.
Why does it take giving her the synthetic hormone during the stim test for her adrenals to finally make good levels of cortisol.  Any insight is greatly appreciated!!!!

Thanks,
lori
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657231_tn?1421251398
It may be - and this is just a guess - source? It could be her adrenals are working but her source is pituitary and so the adrenals are just not being signaled? What are her ACTH levels? With pituitary source you would have low ACTH and low cortisol (the pituitary would not signal the adrenals and thus both would not be working). In adrenal source, the ACTH tends to be higher and that is where people get tan - the pituitary tries hard to signal signal signal while the adrenals just won't get the message.

Just an idea... the treatment in the end is the same. But perhaps the doc needs to look er, up?
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Hi, when her ACTH was checked back on Sept. 26th, it was 8.  My husband and I met wit her Internist today and he thinks it's either pituitary or hypothalamus bc her Adrenals do make Cortisol when given synthetic ACTH.  He wants to do further testing but not while she's in an acute state.  For the past 4 days, she was on .25 of decadron.  Tonight they're increasing it to .5 bc she's not getting better, she's actually going backwards since getting the IV Decadron on Fri. and Sat.
Is 8 for ACTH considered low or normal?

Thanks,
lori
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657231_tn?1421251398
Well that means - if done in a chilled tube and spun immediately - that her pituitary is not a happy camper. In my lab - that is low end but not abnormal yet I think it is 6-43 - every lab differs. I only know the range as I laugh as I keep hitting 3648.

ACTH though is a fussy test - so if the tech binned the tube, it can just degrade down there.

They can test the hypothalamus too - that test is CRH. It may have to go to a special lab - it is not a typical test. It is a frozen (aka) fussy test too.

I am on dex (decadron) too - it takes a while to kick in and lasts a long time. What time is she taking it? I take mine at bedtime so I have it for the next day.
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She takes hers at bedtime, too.  The Hosp that she's at doesn't have the means to check her CRH. They want to send her to a bigger Hosp for that.  The National Institute for Health ACTH range is 9-52 if I remember correctly.  It makes sense that its her pituitary bc once she's given synthetic ACTH, her Adrenals make cortisol and puts her cortisol levels in the normal range.
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I hope she gets a decent doc and gets the right dose that works for her.
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