Need help on ACTH/cortisol labs

[sue_1234]

I have a few years history of symptoms that are really life-altering.  Anyway, I had an endo appt. and some labs came in, but I don't see him for a few more weeks.  Basically, the morning ACTH and cortisol are BOTH in the high-normal range.  Is that okay or is it suggestive that the ACTH isn't shutting off?  Wondering if anyone with a pit tumor had this scenario?

[rumpled]

It is good they ran a lot of tests. Other pituitary hormones. Androgens (testosterones - estrogens and the dhea you had) and adrenal hormones. Plus other minerals, vitamins and and overall check on your health - cortisol can really do a number on you.

The renin/aldosterone loop plays a role in the BP - so does the sodium and potassium - so those numbers can vary with how you felt that day especially if you say you vary. Cortisol itself varies naturally by time of day so it should be tested at different times and many times.

[sue_1234]

They ran more tests.  Alot more.  What other tests would be pertinent?  I had an aldosterone(low-normal), renin(low or low-normal), DHEA-S (normal), sodium and potassium (both normal).

I am assuming these were just "screening" tests to see where to go from here.  

[rumpled]

Did they only run cortisol and ACTH? Sadly, some of the larger labs do mess up... so it pays to be diligent!
It takes a lot more testing to get Cushing's diagnosed - so I am surprised that they only ran so few tests. They should run more complete hormonal panels as cortisol messes up many hormones.
Get copies of everything.

[sue_1234]

Thanks, Rumpled!  I was fasting, had this done at 7:50 a.m., and it was done at the Mayo Clinic, so assume they know exactly how to do it correctly!!  I didn't pay attention to the color tube tops.

I am waiting on my 24-hour urine.

I have been having blood sugar problems, facial hair, weight that goes straight to the stomach, blood pressures whacky and more.

[rumpled]

Hello... it is very confusing. Cortisol and ACTH can be very confusing. ACTH is also very rarely done correctly.

Just a few baseline questions - was the testing done at 8am - and was it done fasting? Did they take the ACTH in a lavender topped tube, chilled, and put it directly in a centrifuge (proper) or in a bin (bad bad bad).

So ACTH that is borderline can be lab error - often really is. A point in time cortisol needs to be done more than once - just once is not enough. You can be cyclical, and you can just *miss* in a point in time test - so that is why saliva tests, urine tests and several rounds of tests should be done.

As for having that scenario - yes. It is possible for the reasons listed - but it could be other auto-immune disorders etc etc etc - so you really need a good doctor that knows how to test. It took them 12 years to hone in my pit tumor and that was 12 years AFTER my tumor was known... hah...