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Adrenal Insufficiency Community
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Avatar universal

Help ACTH STIM Test Results

I am totally new here and wanted to introduce myself and say high to all:0). I am 38 Year Old male, Have been an athlete and or worked out since the age of 12 (super active). For the last 10 years or so I have been super fatigued/tired, don't recover well from exercise, terrible reative hypoglycemia, muscle twitches, tan year round (i used to be white/pail as could be, now I carry at tan year round) short temper, sleep like crap. I can't seem to handle heat or a ton of direct sun. I will get sick for a day or 2 nauseous/fatigued/headache (it is not water usually i will drink 2 liters of water while out hiking for the afternoon.

I have taken 3 different Saliva cortisol test and all 3 looked the same, cortisol was in the tank upon waking and slowing rose throughout the day. The complete opposite of what it should look like. I finally talked my doctor into doing an ACTH Stim test. I have only got back the Cortisol results at this point, But they are very interesting??

From all that I have read on intercepting ACTH results your base line Cortisol should double at 60 minutes. According to this test is should be >18 at 60 minutes I only rose 8!!! Please see results below.

Baseline Draw- 19.7, Standard > 5

30 Minute Draw- 26.4, Standard >7 Above Baseline Result, JUST UNDER BY .3

60 Minute Draw- 27.7, Standard >18 Above Baseline Result, 10 UNDER THE BARE MINIMUM IT SHOULD HAVE RISEN!!!

I am a little confused on how to interpret these results?? Like I said I should have the rest of the numbers in a few days.

Thanks
4 Responses
Avatar universal
Well I just got off the phone with my doctor and for some reason he did not check the box for baseline ACTH (which really *****). I was sitting in a chair for the test

He did get 30 and 60 minute aldosterone but again no baseline!!

30 Min= 20.8

Upright=4-31

Supine= Less than or equal to 16

60 Min= 22.7

Upright= 4-31

Supine= Less than or equal to 16

I have no idea how or why my doctor did not get a baseline ACTH!!! That really frustrates me, I really don't want to do the test again. For the 1st 15 minutes, I didn't just feel noxious, I really thought I was going to throw up. Then I just got super tired for the next hour or so, super hard to stay awake during the test,must have yawned at least 40 times!! Then the rest of the day, I felt amazing!!! I felt like my old self, my workout out was awesome, my head was clear and I had energy. What now??
Avatar universal
COMMUNITY LEADER
Some doctors will pass patients who double the baseline. You are still pretty low (to me a patient) and under the limit so it really depends. Some doctors go for the double no matter what, some a magic number that I can't find in papers, and others just some weird level that I don't know.

I hope this is a fail and you get the meds you need. Let us know!
1 Comments
Thanks so much for the message, I appreciate it:0).
I just want to make sure on what the test is supposed to be interrupted that this would indeed be a fail??  My baseline was 19.7 and at 60 minutes I was at 27.7 so I came no where near doubling??   According to the test I should have rose 18 point minimum and I only went up 8.

What would be my next step??
Avatar universal
COMMUNITY LEADER
Your doctor should then start you on replacements.

The standard replacement medication is cortef or hydrocortisone. It needs to be taken twice a day to mimic a normal body. Some will give you varying doses depending on your history (you may have other disorders) or their training but it can vary from 20mg on up.

Some give prednisone. It is once a day, but lasts long which is both good and bad. If you use it all up yeah, if not it can create a side effects like steroid induced Cushing's. Dexamethosone will do the same.

Depending on you renin and aldosterone results you may or may not need fludrocortisone. This helps hold sodium and keep your blood pressure up. I need it.
2 Comments
He did get 30 and 60 minute aldosterone but again no baseline!!

30 Min= 20.8

Upright=4-31

Supine= Less than or equal to 16

60 Min= 22.7

Upright= 4-31

Supine= Less than or equal to 16
I am going in tomorrow at 7:30 am to do a ACTH draw since it was not done during my ACTH stim test??  

I met with the doctor today, after I am done with the ACTH draw he wants me to start on cortisol 3 times a day, approx every 4 hours, something like 10, 5, 2.5.  Do you do better on twice a day??

BTW, thanks for all your help:0)

Bryce
Please see below the results from my Saliva cortisol. I have done this test 3 times over the last 5 years with 2 different companies and the results have been almost identical!

Morning 3.5 Reference Range 8.0-10.0

Midday 2.2 Reference Range 3.1-7.3

Afternoon 1.9 Reference Range 2.1-3.9

Evening 1.6 Reference Range 1.5-2.5

Ideas?? I will post my ACTH draw results as soon as I have them:0)

Bryce
Avatar universal
COMMUNITY LEADER
The salivary cortisol tests show the same as the stim test.

It can take a bit to learn what dosing does best for you. I did 20mg, 15 on waking, 5 at 3-4pm. This mimics a normal body. Taking it often ... Does not mimic a normal body. But it may be what you need. Most people cannot take it past a certain hour or cannot sleep others need a smidge just to sleep.

Learn your new body.
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