Aa
A
A
Close
Avatar universal
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!
Cancel
6 Answers
Page 1 of 1
657231 tn?1453836403
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!
Comment
Cancel
Comment
Avatar universal
Comment
Comment
Submit Comment
Avatar universal
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!
Comment
Cancel
Comment
Avatar universal
Comment
Comment
Submit Comment
Avatar universal
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
Comment
Cancel
Comment
Avatar universal
Comment
Comment
Submit Comment
Avatar universal
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?
Comment
Cancel
Comment
Avatar universal
Comment
Comment
Submit Comment
657231 tn?1453836403
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.
Comment
Cancel
Comment
Avatar universal
Comment
Comment
Submit Comment
Avatar universal
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!
Comment
Cancel
Comment
Avatar universal
Comment
Comment
Submit Comment
Your Answer
Avatar universal
Answer
Know how to answer? Tap here to leave your answer...
Answer
Submit Answer
A
A
Recent Activity
5931836 tn?1466963790
Blank
ridey777 added the Heart Rhythm Tracker
Jun 26
5931836 tn?1466963790
Blank
ridey777 added the Anxiety/Panic Tracker
Jun 26
5931836 tn?1466963790
Blank
ridey777 added the Asthma Tracker
Jun 26
Adrenal Insufficiency Community Resources
RSS Expert Activity
233488 tn?1310696703
Blank
Marathon Running Done Over Many Yea...
05/15 by John C Hagan III, MD, FACS, FAAOBlank
233488 tn?1310696703
Blank
New Article on Multifocal IOL vs &q...
05/15 by John C Hagan III, MD, FACS, FAAOBlank
748543 tn?1463449675
Blank
TMJ/TMJ The Connection Between Teet...
01/15 by Hamidreza Nassery , DMD, FICOI, FAGD, FICCMOBlank