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my acth test results
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my acth test results

acth 18.7 pg/ml

baseline: 15.7 mcg/dl cortisol
30 min 16.7 mcg/dl cortisol
60 min 15.4 mcg/dl

my endo said my results were abnormal and i had to do the test one more time??
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Avatar_m_tn
this was done at 8 am so u know
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657231_tn?1390151580
You did not "stimulate" in other words, your adrenals did not step up and start working when they blasted them and tried to get them to work. By failing to stimulate, you passed the test for lousy adrenals.

Now you need to learn how to take steroids.  Are they putting you on hydrocortisone - twice daily, divided doses? Florinef? Talk about salt (you may need more)?
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Avatar_m_tn
no he says he wanted to redo the test to make sure, my 2nd test resuts should come back soon
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Avatar_m_tn
now not no,   my symptoms are fatigue, my vision isnt greatest now, palpitations , irregular heart beatss, rapid heart beat, cant lift much or i get lightheadead bad, sometimes pallor, diarhea (diarrhea) sometimes for a week then sometimes my symptoms go away for a day, i also sometimes get low sugar, when it all started i my vision would go black and come back, that dosent happen anymore
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Avatar_m_tn
this is my 4th doctor, my bills ran up to 60,000 dollars, i aint working so its hard, cause my job involves lifting alot, and bill collectors are pretty much sayin i need to pay it or im going to court
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Avatar_m_tn
would this indicate Hypopituitarism since my acth wAS AT A lower level, and my cortisol didnt stimulate much
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657231_tn?1390151580
You did not give the ranges at the lab for ACTH (they vary by lab). Hypopit would be that one or more pituitary hormones would be low - but without the ranges, cannot tell. Also, there are not any other tests.

But it shows very much that your adrenals do not function. That is easy to tell without the ranges as they did not change.
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Avatar_m_tn
range for acth was 7.6 to 63.3 it said on paper
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Avatar_m_tn
they have 2nd test resuls but he hasnt looked at them yet, i get real bad headaches when standing and they only go awy if i lay down for a while, plus my blood pressure at endocronogist was 67/50 a couple times they checked it
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657231_tn?1390151580
The low BP is from the low cortisol - hopefully they will put you on florinef too and are you taking salt? Do you know to get salt tablets?

I take salt tablets daily and my florinef (per doc) to keep my BP up. Salt food. I carry salt. Sea salt. Salt tabs. You are now allowed all the salt you need.

Salt is necessary - if you do not have enough - you can go into crisis - that is bad - you can die. Look up adrenal crisis - know symptoms. Get a kit together.
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Avatar_m_tn
from what i had read, that if your acth is low you dont have addisons
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Avatar_m_tn
why would my acth be in the lower end, when acth is low your cortisol should be high, an when acth is high then your cotisl levels would be low
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Avatar_f_tn
From all I've read, your basline ACTH of 18.7 isn't all that low and according to the "range" you gave, you weren't at the bottom or under "normal" for that lab. If your cortisol doesn't rise enough during your ACTH Stim test, that "usually" points to adrenal issues. From what I've read, you should have a raise in your cortisol level of "11" during the ACTH stim test and your test looks like your cortisol didn't raise that "11", so I have to agree with Rumple's opinions.

My baseline ACTH is usually less than "5" (range at my lab is 10 -60) and my baseline cortisol levels are consistantly low, usually less that "5", yet one of my 3 ACTH stim tests did raise my cortisol "11" units so the endo said that shows that my adrenals work IF my body was sending the ACTH hormones to my adrenals, which it's not. There's a thing called "isolated-ACTH deficiency".  It's "rare" so it's hard to diagnose.  It is caused by either your pituitary or hypothalamus.  There is another test called the "CRH stimulation" test that can determine if your pituitary or hypothalamus is the culprit for having low ACTH IF it is determined that you actually have low ACTH.

There are a lot of explainations in the Professional Merck Manual.  Here's the link:
http://www.merck.com/mmpe/sec12/ch153/ch153a.html
Hope it helps.
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657231_tn?1390151580
My ACTH is sky high, and I don't have Addison's... :)

Ask your doc if he considers you to be Addisonian or not if it means so much - and see if they ran other pituitary tests. Usually if one is off, others are as well.
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Avatar_m_tn
My second test.  

Cortisol baseline. 22.6

30 min.  25.6

60. Min.  26.0

He say their normal now.          Now I'm frustrated
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Avatar_m_tn
so my second results as u can see are different,  and from what i read it says In healthy individuals, the cortisol level should double from a baseline of 20-30 ug/dl within 60 minutes. For example, if the serum cortisol level was 25 ug/dl before the stimulation, it should reach at least 50 ug/dl.     it should double, so what do i do, it says im not healthy if this statement is right but my endo says my adrenals are fine since my baseline is over 20
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657231_tn?1390151580
I would say to take your tests to someone else and get another opinion.

Not stimulating or stimulating is the purpose of the test and it seems that you did not, hence the adrenals failed both times.
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Avatar_f_tn
This seems kind of odd.  Since your basline cortisol was so high, yet not over normal, just maybe your adrenals didn't stimulate more because you have other hormones that regulate things, too.  I mean to say that your basline was great if it was in the morning.  When it got artifically stimulated, maybe your HPA Axis is working well enough to say "Hey, I don't need this much at this time and so I'm not putting out any more cortisol." or maybe, your adrenals have been pumping out so much lately that they just couldn't produce anymore.  It also depend on which ACTH Stim test you got.  There are two that I know of.  There's a high dose and a low dose ACTH test.  From what I've read, the low dose test may be more accurate.  That being said, none of these tests ALONE are 100% conclusive for a diagnosis of a disease.  Plus, are you stressed out about all this medical stuff?  That can mess up the test results, too.  I know I'm not answering your question very well because I just don't know why your cortisol didn't rise.  Plus, most of the info I've read has said that the cortsol only needs to rise "11" units during the test, not double, so I'm not sure what to say about that.

Sorry.  I KNOW how frustating this is for you.  We've all had to fight for a long time to get answers and just getting cortisol tests don't always answer those questions.  Do you have other "signs and symptoms"?  I've got a little energy left so I'll bounce around the forums here and see if you've written about them.  If you haven't, maybe you could tell us how you're feeling and what started your cortisol quest?
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Avatar_m_tn
symptoms i have had, pallor, palpatations, bad pounding headaches which i never got before, irregular heart beat, flutters, diarrehea, nausea bad, ive had recorded low blood pressure around 65/50 , upper back pain, pain in hands, wrist, arms, shocks in abdomen, dizzyness, tingling in feet...other symptoms i just dont remember, its been 10 months and the first symptom i ever got was blurry vision
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Avatar_m_tn
also they did test my sodiom and pottasium levels at the time of test

which were:

sodium 139 [135-149]

potassium 3.5 [3.5-5.5]
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Avatar_m_tn
so monday i have a appointment with doctor, just my general doctor...so its my last ditch effort to convince her maybe we need to investigate more....is there any other test i should ask for? other then the acth test
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Avatar_f_tn
OOPS.  I guess you did write some of your symptoms down.  Hey, it's early in the day for me :) Okay, now I have a few questions....

Are you on any meds, either prescribed or supplements or recreational, including alcohol intake?
Have you had a brain MRI or CAT scan to check out your pituitary gland to make sure it looks okay?
How's your liver function?
How are your electrolyes?
Have you had any other hormones tested and what were their results (Growth hormones, sex hormones, thyroid hormones, etc)?
Have you had an hs-CRP?  This measures inflammation.  If it's really high (over 8 or 10, depending on the lab) then that can point to a possible autoimmune disease.
Have you had changes in your libido? (can be caused by several hormone issues).
Do you have chronic pain (joints, muscles, etc)?
What kind of diet do you have?  Do you crave sugar, salt, fat?  What type of food helps you feel better?
What are your sleep habits?  Do you practice good sleep hygeine?  Do you have sleep apnea?  Do you work swing shifts?  Do you travel to different time zones a lot?

The list could go on, but all these things matter.  There's so many things to evaluate when you are trying to pinpoint a disease or syndrome.... Especially when your symptoms aren't present 100% of the time.  Trust me, I know.  After years of intermtitent symptoms, they finally became constant and then my PCP was able to get closer to my diagnosis, despite the Endo doc.
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Avatar_f_tn
We must be typing at the same time.  You and I have quite a few of the same sypmtoms... They did a brain MRI on me and it showed that I have "Empty Sella syndrome" and a "bent pituitary stalk".  According to my PCP, this showed that my pituitary may not be working at 100%.  It also explained why my problems at the time were intermittent.  I sure whould suggest you talk to your doc about getting a Brain CT or MRI to make sure that there is nothing structurally wrong with your pituitary gland.  Pituitary problems deffinitely can effect your vision and all your other issues.
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Avatar_m_tn
my electrolytes are fine when hosptial tested them a couple times

they did do a mri long time ago but were lookin for brain tumor

and i did have ultrasound of heart and a chest xray to

i have a hard time trusting this hospital,  

the meds i am taking are zoloft and kolonopin, but symptoms started before taking them and havent gone away

my eating habits before this happen were not great i did alot of lifting and lived on alot of sugar snacks like gummy worms bears and candy cause i never got many breaks at work, and ate fast food mostly too..and drank tons of water, so my eating habits were not great then...so then i was thinking maybe i was flushing out too much sodium and stuff, but my eating habits are good now and i feel mostly the same, could that have sparked a chain reaction of problems and what could that be...i know when i lift for a period of hr, i get dizzy and palpatations...its been 10 months and i feel hopeless, especialy without insurance, and god knows that , theres no help for me out there that i can find
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657231_tn?1390151580
They should test your hormones - just testing one is not thorough. Renin, aldosterone, dhea sulfate, cortisol, and pituitary hormones at a minimum.
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Avatar_m_tn
My symptoms sometimes go away for days.   Mornings usually the worst
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Avatar_f_tn
Well, I've reaserched a lot, and haven't come up with much.  Like Rumpled and I have said, ALL hormones should be checked.  Also, with more pain in the mornings, that may point to some sort of autoimmune problem if it's found that you don't have an endocrine problem?   RA symptoms are usually worse in the morning, etc.  Could be a million things.  Can you pinpoint ANYTHING that you may have done differently on the few days BEFORE and/or DURING the times when your symptoms went away?  Maybe something you ate or maybe you were someplace other than normal where you weren't exposd to something in your everyday environment that may be "toxic" to you?  Everything matters when you can't find out what's wrong.  It's taken me several years to finally pinpoint my problems, and I had to go through a process of writing EVERYTHING (and I mean EVERYTHING) down to maybe find a pattern of worsening and/or bettering of my syptoms (symptoms).  Besides my blood tests that were abnormal (yet okay by 3 endo's and NOT okay by 3 internists), it helped me and them by knowing my symptoms weren't caused by any particular food, environment, or cleaning product, sleep pattern, drug, etc.  Ask your doctor and see if that may help him/her with figuring out why you are so sick.  I wish I could offer more help....
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Avatar_m_tn
It sounds crazy before all this.  My job was a lot of lifting and I ate mostly candy and fast food.  I stopped drinking pop and drank tons of water.  Then everything started like a chain reaction.    I eat more healthy now.  But no change
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Avatar_m_tn
Also tingling and numbness in hands and feet
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