High ACTH, Low Cortisol, Low GH, Normal TSH test

[amaliz]

I have been struggling with panic disorder for 7 years.  No medicine has seemed to make a dent in my anxiety levels.  My doctors and I are now exploring other areas, one of which is my hormone levels.  My thyroid appears to be normal.  I had a blood test which showed my ACTH at 122, morning Cortisol on the high end at 21.2.  My GH level is 0, which technically can be "normal," but I wonder if it should be normal for me.  Our next step was a 24 hour urine which showed my cortisol level at 5 ug/L and 6 ug/24 hr.  My symptoms include anxiety, low blood pressure, lightheadedness, overweight dispite exercise and smaller food portions, thin skin with stretch marks from my rapid unexplained weight gain that I thought it might be due to the antidepressants I was having to take, extreme fatigue, weakness, inability to keep up with others when exercising (I feel like I should be so much stronger and have more endurance than I do.  I get lightheaded and vision gets grey and blurry if I accidently over do it).  I am seeing my doctor again in 3 weeks, but would love another view or opinion.   Thank you.

[Mark Lupo, M.D.]

The 24 hour urine cortisol levels are normal - this suggests against Cushings.

The serum ACTH and Cortisol are both somewhat high - this may be simply due to stress, however would suggest an Endocrine consult to evaluate for any pituitary or adrenal disease.