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Does this Cortisol/ACTH lab result look normal
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Does this Cortisol/ACTH lab result look normal

Hi - I had a 60 minute ACTH test and here are the results:

Cortisol - (baseline) 5 - no range given

Cortisol 30 min post stim - 21 (range 18-47)

Cortisol 60 minutes post stim 24 (same range)

It did double.  I was just wondering if the baseline was rather low.  I don't know if it is good to be on the lower end post stim or not.  Very confusing.  No symptoms really.  Foggy thinking and fatigue but I think that might be my thyroid.  Am working with a (different) doctor right now because though my TSH is always on the low end of normal 0.5-0.8 or so), my Free t4 is scraping the bottom of the range (very bottom or right at cut off, like 0.7 /0.77(value 0.7-1.8)).  She started me on .25mcg synthroid about a week ago and I think I feel a little clearer if that makes sense.  
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1756321_tn?1377771734
The following is my basic guide on how to interpret your ACTH stimulation results that i have put together from reading various websites.

*Healthy adrenal function:

Cortisol levels should double from a normal base cortisol range within 60 minutes.  

*Primary adrenal insufficiency:

Cortisol does not double from the low base cortisol range within 60 minutes.  ACTH will be at the top of the range or above range.

*Secondary adrenal insufficiency:

Low base cortisol range can double, triple, quadruple within 60 minutes.  ACTH will usually be in the bottom half of the range to the very bottom, but not usually below the range.

*Mild primary adrenal insufficiency (low adrenal reserve):

A normal baseline cortisol range with a subnormal response to ACTH stimulation.

*Mild secondary adrenal insufficiency:

A low or low normal baseline cortisol range with a normal response to ACTH stimulation.

NOTE: If a person is unwell, the diagnosis of adrenal insufficiency cannot be excluded by a serum cortisol level.
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657231_tn?1390151580
Your doctor will probably read it as normal as you did at least double. Some want to meet a certain number and I think you beat that as well.

You can do okay on this test and still be borderline - if you still have low sodium and low cortisols overall, your adrenals may still be hanging in for now but maybe not for long, so hopefully your doctor will monitor you.
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Avatar_f_tn
The ACTH intact was 8.3 (range 7.2-63.3 pg/mL).  So a little lower in the range. What does everyone think about adrenal support supplements?  Do you think they help?
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Avatar_n_tn
your test looks normal.  I'd have a tendency to agree with you that it is more likely your thyroid----if you don't tolerate the dosage being raised--then would be a good time to check in to adding some cortisol support.

None of the thyroid tests are accurate, if you can talk your doctor into goin by symptoms rather than blood tests, you might have better luck in getting to feel better.

Your tests results show exactly why the tests are not accurate--if your TSH is at the low range, then suppossedly your T4 levels should be on the high end.   I tested the same way you did---with both my TSH and my T4 on the "low normal" end, instead of opposite each other.  I had low cortisol and low Acth, also.  i then had a stim test that gave me a diagnosis of secondary adrenal insufficiency---which was questioned by another doctor because i had  had steroid shots in my heels.        

I was on armour thyropid and hydrocortisone for about 2-2 1/2 years--but never felt any better.  i am presently on neither medication, but will be seeing a new doctor in 2 weeks.  Right now my cortisol looks ok, but he will start me on a lower end dose of NP thyroid, and slowly raise it over time---and watch to see if I need any cortisol as my metabolism raises.

Just something to think about, being on T4 alone is likely to keep you hypothyroid no matter what your blood test says----I think most people do better with some T3 added.  Also, there are two symptoms that will never clear up with synthetic thyroid medications---dry skin and water retention.  If you don't have a problem with either of these, i guess you'd be ok, but alot of people prefer to use natural thyroid medications---however, i have heard that sometimes there is too much T3 in the natural preparations for some people---I don't know if that's true---but i think it was rumpled that told me that---so maybe she'll jump back in here and clarify that one.
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