ACTH levels

[pvolter]

My doctor ordered an acth and cortisol level because I had hyperpigmentation and lots of new big freckles.  After googleing these tests I didn't know if just an acth level (not a stim test) would be diagnostic...will it?  And also both tests were done at about 3:30 p.m. I work third shift and wondered if staying up all night and sleeping all day would affect these levels.  I had only been awake for about two hours.  And I was not fasting.  Does this matter?  Thanks for your help.

[Hashi60]

Hi

Did u get Stim Acth test after steriod injection because this will decrease Acth?

Also, was it the high dose-Acth test, 24 hour cortisol urine and plasma Acth and morning cortisol, Dhea/Dhea sulfate;  this is what my Endo used, He said it was more accurate, but either will do. Adrenal primary or secondary can sometimes be little tricky to diagnose, if you are on certain meds. you may need to stop prior to testing at least 1 week, but you have to stay away from steroid injections. Normally, one should stay 2-3 months from steroid injection before performing this Acth STIM test especially if you are trying to determine if you may Addison's Disease. My Anesthiologist- pain doctor and Endocrinologist both said this.  It is written in all the medical journals. It will skew the tes.

Here are Stim  test:

High-dose ACTH stimulation test — This test consists of measuring serum cortisol immediately before and 30 and 60 minutes after intravenous injection of 250 µg (85 nmol, or 40 IU) of cosyntropin, which represents the entire contents of the vial obtained from the pharmacy. This dose of cosyntropin results in pharmacological plasma ACTH concentrations for the 60-minute duration of the test.

This test probably will be replaced by the low-dose ACTH stimulation test described above. The advantage of the high-dose test is that the cosyntropin can be injected intramuscularly (IM), because pharmacologic plasma ACTH concentrations are still achieved. The low-dose test has not been evaluated after IM injection and may not provide valid results by this route.

I pray you do not have this AI or SI because it is not easy to treat and a constant struggle balance electrolytes if you have Addisons because we nee glucocorticoids and mineralcorticoid and DHEA. However, I have to take all my hormones because of menopause.  I wish you good health ..

Let me know how it goes when you get second opinion to get another Stim Acth test. At least I would do this....giving our symptom.

Don't give up ? :)

Cheers,


Nikki

[rumpled]

If they *binned* the tube, even on ice, yeah, it can degrade.

My tan changes (my ACTH is 400 or so now - goes up to near 4000 off suppressive meds) so yes, I can say that it can vary and darken - some from sun exposure and some from the hormone just changing.

One set of tests does not a diagnosis make... you need several sets - and done correctly - with the incorrectly done ones (lab error and bad times) removed.

[ShellyC23]

Usually this type of test is done in the morning while fasting.  I'm sure your results would have been affected by the circumstances you describe however your doctor should have made it clear to you what the test were and how you needed to prepare for them.  Sometimes a full day cortisol profile may be carried out if they suspect Addision's Disease (which I was diagnosed with at age 19)

[pvolter]

Well, I got my results today.  My acth was low and cortisol normal.  I assume the tests were not done properly.  I do know that they put the tubes on ice but did not spin.  My doctor thinks I'm insane and gave me antidepressants and nerve pills which I have no intention of taking because I am not depressed!  In fact, I am feeling much better, though not normal.  I'd like to tell you all my experience and see if you feel it's possible I have some sort of adrenal problem.  Back in november my head started itching like crazy, especially at night.  It was tormenting.  There was no rash or bumps or even dry skin.  I would get a mild itchy rash on my neck that would come and go and had swollen lymph nodes on my head and behind ears.  I used special shampoos and creams to no avail.  In the midst of this I had a torn rotator cuff and was treated the first week of december with two interarticular joint injections.  That is when the real problems began.  I had what is called a cortisol flare and the pain was much worse for three days and then got better.  However, I began having severe dizzy spells, couldn't keep my balance and my vision was so blurry I couldn't see three feet in front of me!  I had horrible palpitations, terrible night sweats, excruciating headaches that even hurt my face and ears and even my gums!  I also had tremors, muscle cramps and spasms, and I would get feelings of numbness and tingling in various places.  I was so very tired and my mind was so foggy and my memory was so bad that I almost burned the house down twice because I forgot I was cooking!  Also, I have a nagging dull pain in my right side under the ribs.  I have no gallbladder, no appendix and have had a normal cat scan recently. This all lasted the entire month of december. In spite of all of this I didn't go to the doctor because I was so sick that I didn't realize how sick I was.  I literally couldn't hold my head up at times.  It would just fall over!  I didn't work the entire month.  After a few weeks when my mind started coming back I noticed that my skin had darkened, not alot because I'm very pale normally, but alot for me.  Also I noticed I was getting lots of new freckles all over, even where the sun don't shine!  All of these symptoms lasted for an entire month.  Now, the only symptoms I still have are headaches, the abdominal pain, mild hot flashes and new freckles are still coming.  They start out very small and get bigger, like an age spot.  The tan that I had is gone.  Is it even possible for that to wax and wane with Addisons? BTW, I also had a normal brain scan.  I can see why the doctor thinks I'm crazy with these symptoms and normal tests, but I am not the hysterical type.  In fact, I don't usually go to the doctor unless I'm near death! Anything that anyone could tell me to help me out would be appreciated.  I'm so frustrated!

[rumpled]

Your doctor has to take into consideration your shifts - or he should. Cortisol varies based on how you sleep. In a normal person it is 8am peak to midnight lows. My [good picky] doctor would not accept your tests done not fasting and would have calculated when you woke up and wanted the test done on a day where you had a *normal* for you waking period and had a draw shortly after waking, after at least an 8 hour fast.

You are correct, one test is not diagnostic. It is though part of the testing that is done before you have a stim test - you want to see if this test is abnormal before sending off to a stim test. I do hope the lab also did the test correctly - chilled tube, spun immediately and frozen promptly. I cannot tell you how often the ACTH test is botched and the results come out lower from lab handling. If it sits in the bin the sample degrades.

Other indicative tests are sodium and potassium and I hope he ran a cortisol as well - should run the whole loop (ACTH and cortisol work together).