very low am cortisol, normal ACTH stim

My husband has a microadenoma on his pituitary gland that, according to his Endo, isn't causing any problems.  We did do quite a bit of blood work and that hasn't answered my questions at all. It's only created more concern.  He has ALL the symptoms of Addison's Disease (headache, fatigue, muscle and joint pain, sweating and alteration of mood not to mention forgetfulness and confusion), and yet the ACTH stim test was normal.

His lab work was like this:   Aug 3  am cortisol was 2.7 (range 6.2-19.4).  Some endo's find this low level to immediatley be indicative of addison's.

                               Aug 17 - ACTH stim test at 10:30 am (not fasting)  cortisol was 8.7, ACTH was 17 (10-60 is range)
                                                                         11:13   cortisol was 20.1
                                                                      11:41   cortisol was 21.2

The Endo says there is nothing wrong with his endocrine system and referred us back to the PCP for headache treatment, but she never explained the Aug 3 am cortisol.

If not Addison's, then what?  I am sending copies of his blood work and MRI to another endo at a Univ Hospital for evaluation.  He is frustrated and visibly getting worse by the week, and I am  getting very worried that we're missing something.  All of these symptoms appeared after he was ejected from a vehicle, broke his back and hot the back of his head.  I know that a stressful incident can bring on adrenal insufficiency.

Any ideas?

[malthusian]

Hi

I have read that a lot of endos don't know how to properly interpret the Stim test. Try posting your q on 'real thyroid help' (google it) as there are a lot of people on there with pituitary problems.

[PlateletGal]

Do you have a copy of your husband's ACTH stimulation test results ? If so... what were his cortisol levels ?

There is primary adrenal insufficiency (Addison's) and secondary adrenal insufficiency. I've learned that some Endocrinologists do not diagnose secondary adrenal insufficiency, although our own government discusses this condition on their website:

http://endocrine.niddk.nih.gov/pubs/addison/addison.htm

[batina619]

I don't know about all that stuff but your husband has the same symptoms I had. My migraines had gotten so bad after fighting it for over 2 weeks that I ended up in the er and somewhere along the lines, they discovered I had a pituitary tumor (benign). It is said that tumors that start in the brain are typically benign. Im not experiencing any of the symptoms any longer. My mood is stablized, I don't feel any depression; I'm a little slow on the up-take but I think that will come back. It seems as though I have a peacefulness that I never had before. I had a lot of what I would call paranoid thoughts, unable to focus, seeing the negative side to everything to feeling calm. I could only hope that's permanent. I had posted earlier that one of the signs of pituitary tumor is your pee looks like water instead of yellow and you urinate alot. Also pressure in your head from the tumor even though your pituitary is the size of a dime can cause a lot of pain/headaches. I was told if you have a pituitary tumor, it needs to come out especially if you're showing symptoms. I hope this helps.

[batina619]

I found that my pain was mostly over my left eye even though it would go just about anywhere in my head, my primary point of pain was still over that left side. The neurologist kept telling me it was sleep apnea - which I do have; but I knew it was something else. I spoke with my cardiologist who got me hooked up with the right agency for my sleep apnea and even though that part of my life was finally straightened up - I still had the migraines. My migraines took on a new twist a year earlier when it started affecting my blood pressure and diabetes from the immense pain. Still, it took another year and another 3 week bout of migraines before I was so sick, I couldn't drive that I was taken to the er and I don't remember much after that until I woke up 4 days later. I still don't feel like I have the whole story. I am still having some headaches but I think when I get tired that's when it hits.

[rumpled]

You should see a neuro-endo at a pituitary center and get treated properly for your pituitary tumor. You need to get the testing to understand what type of tumor you have and then get it treated. Too many doctors just judge them by their size - and not by their effect.

If you go the brain/pituitary tumor forum, there are links in the health pages there that can help you.