Synacthen stimulation test

Hi, I had the test 2 years ago with a follow up test 6 months later as the results were very low. I had to stop taking HRT for 6 weeks before the test and preds 24 hours before the test. ( I was on 6mg at the time). They normally do the test at 9am in the morning and you can take the preds as soon as the test is finished, It usually takes 45 minutes. As a result I was changed from preds to hydrocortisone which I took for the six months between tests. As there was no improvement in my levels I was then changed back to preds, which I am still taking after 7 years. 

 

The test can be done while you are still taking corticosteroids - luckily, as the idea is to find if your adrenal glands are CAPABLE of producing cortisol - not whether they ARE doing so. If you had to stop taking pred and they weren't working you would become seriously ill in the meantime. The result is different but it still indicates whether your adrenals COULD produce cortisol. It does require interpretation by an expert who is aware of all this. And, by the way, a single morning cortisol blood test is a total waste of resources - it tells you nothing. Before having a synacthen test you do not take any steroid for 24 hours - i.e. that morning's dose is delayed until after the test is completed. There is also next to no point in doing the test until the patient is down to about 7mg or below - that is the physiological dose, the same as your body produces in the form of cortisol which is essential to life. The body doesn't care what sorticosteroid it is, synthetic or natural.

However - how are you feeling at 5mg? The best realistic test as to whether your adrenal glands ARE producing cortisol is how you feel as you reduce at this level. If the adrenals are NOT able to produce cortisol you will start to have symptoms of adrenal insufficiency and the most obvious is increasing fatigue rather than feeling more energetic as you get to a lower dose of pred.

Production of cortisol is dependant on a whole slew of factors and only one is covered by the synacthen test. Basically it tells you whether the fuel tank is full - not whether all the electrics and tubes controlling the passage of the fuel are functioning properly. 

I had the Synacthen test a few weeks ago.   I was on 6.5mg Pred and  I was getting increasingly fatigued and dizzy etc.

My results showed that there was a very slight response.  The Endocrinologist said if I could get to 5 mg he would like to do another one.   I have been feeling so bad I have gone up to 8 mg for a few days.   I am not sure if it is a big enough increase yet.  

As Lindylulu said, they do it first thing in the morning so you can take your Pred straight afterwards.  It is an easy test to have, nothing to worry about at all.

Best test I ever had,  Rheumy thought the GCA had gone into remission but did not want to take me off pred  (he was so lovely).   So Acth test............went at 8am and took a book, comfortable chair, warm room  - fell asleep and they woke me up when it was finished with a cup of tea and my page marked in the book.  I managed to read about 3 pages...............result  everything working and up to speed.  Which was a bonus as it can take up to one year for them to become fully functional, which is why you have to carry your Blue Steroid card with you for that year.

 

Hi!

I had a synacthen test a year last March and had an anaphylactic shock during it!! When I came around I was surrounded by anxious faced nurses, white coats, oxygen masks and cooling fans!! Took about a fortnight to get my sea legs back!!! The rheumatology department at my local hospital had never seen anyone react this way to synacthen!! I was on 7mg of prednisolone at the time and the endocrinologist said that was too high to get an accurate result, I'm NEVER having it done again!!!

I guess my adrenal glands are working because I'm on 2mg now and have good energy levels! Although a little dizzy now and again so maybe taking a bit of time to kick in fully.

Andrea xx