You have empty sella... so there is no seeing what is going on there.
How is your IGF-1 and other hormones? Your cortisol is probably borderline now - and your endo is eh... well, if I was you, I would not take cortef if I had good numbers but on the other hand, make sure she/he is willing to monitor you carefully so that if things change you can get it. What is your normal ACTH readings? Are they done properly - chilled tubes - spun immediately? If not, they are low due to lab error, not you.
But I bet that other hormones are off - and that can make you feel like crud.
I have low cortisol and my thyroid uptake of meds is fine - I have no adrenals. I have no thyroid either.
here are some recent numbers
ACTH Plasma 10 pg/mL
IGF-1 420 ng/mL
Cortisol AM 3.6 mcg/dL
Total Test 462 ng/dL
but my cortisol shot up to 27 mcg/dL when they did the ACTH stimulation test....I dont know is that low is borderline, isnt that way looow? most people I have seen labs on that are healthuy are in upper 10's (18-20)....endo doesnt know whats causing the IGF-1 to go so high, did glucose tolerance test and was very good, no issues there....she thinks is the testosterone injections (200mg/1cc) week.....
i asked her to do a comprehensive hormone blood check and she says not necesary...geez......am just completely lost here....going nutz
You did not post ranges, and every lab differs so it is very hard to tell what is where.
If your IGF-1 is high - that is indicative of acromegaly - so your doctor is pretty silly not to run a GH test .GH is what the pituitary puts out, IGF-1 is what the the body uses after GH is converted to IGF-1 in the liver - so usually just measuring IGF-1 is fine.
Find another endo - take your tests with you.
If she won't do the test you ask for, you need to switch doctors.
it's the hypoglycemia that is causing the IGF to skyrocket - and that's due to low cortisol - believe me - once you've had a ITT test - you'll be able to pick your symptoms - or at least someone who knows you very well will. It's like watching an artificial collapse, you get the sweatiness etc - it's just a bit exagerated. Wouldn't be surprised if you get a high prolactin as well. .