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I've been suffering from joint pain and severe fatigue for at least 6 years.  I have been dianosed by several psychiatrists as NOT having depression so, at least according to them, my symptoms are not caused by any mental conditions.  I have chronically low levels of ACTH and Cortisol.  My CT scan showed pituitary abnormalities of Empty Sella Sydrome and a bent "stalk".  I have been practicing "good sleep hygiene" and using CPAP for at least 3 years in hopes of this helping my fatigue with no positive results.

Morning serum Cortisol levels are (normal range is 7-25 ug/dL): 3.1, 7, 7.5, 5.3, 1.9, 1.5, and 1.3
Morning ACTH levels are (normal range is 10-60 drpg/mL): <5.0, 6.1, 6.7, 5.2, <5.0

My three ACTH Stim tests are:
TEST 1: Cortisol levels (t0=1.9; t30min=8.4; t60min=11.9)
TEST 2: Cortisol levels (t0=5.3; t30min=4,9; t60min=16.9)
TEST 3: Cortisol levels (t0=1.5; t15min=18; t30min=21; t45min=21)

My hs-CRP was 6.9, but they said it needed to at least 8.0 to "prove" inflammation.  Some other hormone tests have come out at the bottom but not under the normal range.

All three Endocrinologists, including the last one that I've been seeing at the Mayo in Rochester, MN, say my Pituitary Gland, ACTH and Cortisol levels, and adrenals are just fine and there is nothing wrong with me, contrary to everything else I have researched and my PCP and Mayo Internist think they are NOT fine.  I have requested using low-dose hydrocortisone (Less than 15 mg/day) for pituitary/adrenal support NOT replacement therapy.  I have been told "Absolutly NOT".  I'm at a loss at this point as to what else to do.  My Mayo Internist wants me to see a Rhuematologist down there since the two I have seen near my home haven't helped with my joint pain and fatigue.  In those two visits 3 years ago, My RA Factor was negative and my Vitamin D Deficiency was found has been resolved and they pretty much said they can't help me.  If I end up seeing the Mayo Rheumatologists and they don't find anything wrong, I am going to be evaluated again for depression again.  Since I'm pretty sure I'm still not depressed, they will send me to an Alternative Medicine doc.  Does anyone have different ideas on what could be causing this low ACTH and if it's realted to the joint pain and fatigue?  Any ideas or even wild guesses would be greatly appreciated.  I'm getting kind of desperate since this has affected my entire quality of life and I am unable to work.
2 Responses
920782 tn?1253328402
okay no arthritis and test come up okay. Have any of your doc's said anything about fibromyalgia? google it and see if u have the tender points. This also makes u very fatigued.
Avatar universal
I was diagnosed with Fibro in May 2007 by the Mayo but have since be "undiagnosed" by the same people in May 2009.  In those two years, I went through a 3 month intensive Pain Management program and they said, although I was doing everything right, that I was showing no improvement in signs or symptoms.  I also took Lyrica and Cymbalta and several other drugs recommended for "fibro" for over a year with no positive results.
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