About my blood work.

[amr100]

Hi, I don't go to my doctor until Tuesday and I picked up the results early. I am on Hydrocortisone and I'm hoping to stop taking the medication but it depends on my blood work. To me it seems everything look good. One concern is the low normal ACTH but like i said it's still normal in the reference range. My ACTH is 10 Reference range is 6 - 50 my cortisol 14.1 Reference range is 4.0 - 22.0. What do you think?

[rumpled]

Hormones work in loops - so it is ACTH that tells the adrenals to release cortisol, then the pituitary senses the cortisol and shuts down the ACTH.

Hence there has to be both tests done, and you cannot test once, you have to test correctly AND you have to test at a diagnostic time of day (like 8am or midnight) so you have an idea of what the cortisol level should be.

If cortisol is high, it means the adrenals are not working and the issue is adrenal. If ACTH is low and cortisol is low - the issue is generally pituitary as the pituitary is not sending the signal. If the ACTH is low and cortisol normal - I would suspect lab error... IMHO. But you have to test several times. I know my ACTH was off all the time due to the lab - but most (as in 99%) of my docs were too stupid to know!

[amr100]

I don't know how it was done, it was so quick I didn't pay attention. I will next time. My ACTH is on the low side of normal if they chilled the tube and my cortisol levels are normal. Cortisol 14.1 Range 4.0 - 22.0 . Can my ACTH be low and cortisol be fine?

[rumpled]

How was the ACTH done? Was it in a chilled tube, and did the tech take it immediately and put it in a centrifuge? Or was it put in a bin? If binned, then the results are low due to lab handling.

Usually a single draw is not adequate to determine if your adrenals are working - you need a stim test.