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acth stim test and cortisol results advise please
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acth stim test and cortisol results advise please

My son had his acth stim test the other day.  The baseline acth was not taken on ice.  It was held at room temp for 30 minutes (74 degree room) - then put on ice and then sent to the lab.

The results:  27 acth (where normal goes up to 59 or something like that (from memory)

The test was highly stressful, the nurse tried, painfully, to get an iv in him while saying stressful things - for 10 minutes.

The baseline cortisol under extreme stress, where he was begging for it to end, crying, screaming - was 18.

One hour later, after stimulation, his cortisol was 26.

How does this look to you?

Thanks!
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657231_tn?1390151580
So, you had nurse nasty who did not even handle the tube correctly and spazzed out your son... so the doc has to see the tests and will not even know the circumstances...

ACTH would degrade so it was amazing it was even that high (my lab is 6-48) so he was fairly normal...

But he was supposed to be calm during the test after all they want the stim agent to work, not the nurse! But he did not double so that was good and he did not reach the 32 that some docs want but his cortisol was in a normal level to start (due in good part to the IV process I would bet)...

Make sure you tell the doc about the circumstances - it should not be a high enough jump but some docs...

And tell him that nurse should not give the test to children - ever!
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Avatar_m_tn
thanks so much rumpled, I really appreciate the info and advise! :)

I was wondering about if 18 to 26 at 60 minutes was substantial enough.

I seem to find conflicting answers about that.

Some say if you have a baseline of 18 you are good - well, that seems okay except if you are screaming and crying and at 18.

Others say the cortisol must double - well, we are certainly nowhere near doubling.

Other, as you mentioned, say that you have to be up to 32 or 34.

Gosh, if only it was more cut and dry!

The lab at the hospital tried to tell me that the acth test of baseline was fine sitting out at room temp for 1/2 hour - they said they talked to Mayo Clinic (the place where the blood ultimately went) and they said it was fine.

I wrote to Mayo - they told me 'the sample has been compromised but they will accept the sample' - not sure what that means...

Thanks again!
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Avatar_m_tn
This study states that having the acth at room temp 24 hours only affects it by 10 percent and that spinning it immediately is what preserves the sample.

Preanalytical Stability of Adrenocorticotropic Hormone Depends on Time to Centrifugation Rather than Temperature

My son's sample was spun at approximately 50 minutes, I wonder what this study means to his situation.  I cannot find any other studies outlining the stability of acth
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Avatar_m_tn
Impact of collection method and sample handling on measured levels of circulating ACTH


If you google that one you will see that they studied room temp collection etc. and found that the difference between standard protocol of collection and room temp is negligible... gosh, now I am wondering if his 27 is the real number, if so - what does that mean for him?
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657231_tn?1390151580
I am going by personal experience for the ACTH. It for sure changes. We covered it in another post. I know some docs want it done differently like that too.

Mayo looks like they say ok to use the test... the only good part of that is that your son is not put through the test again.

Hopefully your son will be treated.
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Avatar_m_tn
thanks rumpled, I am glad to know it from your personal experience.  The studies that I found seem strange to me because why on earth would there be such strict protocol and so much information about its instability if it was all so unnecessary.

Thanks again!  I really appreciate you!
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