ACTH Stimulation test results

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Greetings everybody, 

I had a ACTH stimulation test last week and these are the results:

cortisol basal 106 ng/ml

cortisol_30'    190

cortisol_60'     228

The endo thinks that AI is ruled out in light of these results, which makes me happy. The baseline seems a little low to me tho, specially considering that he did the test on my first appointment -- so I had not fasted for at least 8 hours.  Should I bother getting a second opinion or the results are good? 

I am euthyroid (TSH 1.6, low normal fT3, fT4) on Levothyroxine if that is relevant. 

Thanks!

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  • Posted

    I've got an inactive pituitary which means secondary Addison's (and low thyroid etc etc), so of course I see everyone's symptoms as matching mine! So take what follows with a kilo or two of salt...

    Your ACTH stimulation test shows that your adrenals are responding as they should to a shot of natural ACT hormone if/when your pituitary sends one. My baseline (just 34) was a lot lower than yours but my endo said that my pituitary had been degrading slowly over about 10 years. So if by any chance you have an early stage pituitary adenoma [which is v unlikely. incidence is v low], you just /might/ start to notice its effects but I still think that you'd be wasting your money on a second opinion at this stage.

    I'd suggest you just take a look at the symptoms of PA and file mentally for reference in the coming years. An easy but important thing you can do is get a regular eye test and ask the optician if the "field test" shows any evidence of degraded peripheral vision. If so, that's a red flag.

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    • Posted

      Just thinking right now, if it is a pituitary problem, wouldn't TSH be suppressed too? I had elevated TSH when I first went to the gp half a year ago because of severe fatigue. My ACTH was 14.4, not sure how valid that number is, because again protocol was not followed (no chilled tube).  I feel stupid for not asking the doctor if I could come back for the test another day even though I knew about the test protocol. He made it sound very urgent so I didn't say anything..

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  • Posted

    First, I'm just another innocent bystander, not an expert. And remember my warning about a kilo of salt!

    One can have an non-functioning PA [which is hard to disgnose because it doesn't do anything except get in the way - which is what I had] or a functioning PA, where excess stimulating hormone is released - too much ACTH or prolactinoma in men and non-near-term-pregnant women or growth hormone etc. So i guess [wildly] that there is a variant that produces too much TSH.  

    Have a look at the wikipedia article at

    en.wikipedia.org/wiki/Thyroid-stimulating_hormone

    There are various possibilities shown. But your endo will know this stuff a lot better than we do. Your figures are really not that far out of line so really don't point to a PA (or at least not one of any significance.

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