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High ACTH, normal cortisol, stress during test


My 10 month baby had a blood test for ACTH and cortisol. The result came back that ACTH is 5 times normal (57 while normal range is 0-10) and cortisol is normal. She has no clinical symptoms aside from dark skin, however her dark skin has been fading slowly. Her face is actually a few shades lighter than her legs now.

During the blood test, she was poked numerous times with a needle, and held down so hard that blood spots have appeared on her skin. She was also crying non stop for about 20 minutes.

Could stress during the test cause such a high level of ACTH, or does stress only cause a small fluctuation?

How likely can this be Addisions, given such a lack of symptoms?

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