Weird ACTH stimulation test results. Cortisol decrease

[lyebye0]

I cannot find information on the web on my ACTH stimulation test results.  Maybe one of you guys can help? By way of background I have typical cushings symptoms but my early labs including 24 hour urine were normal. So of course doctors have been dismissive.  I had a brain MRI for tinnitus and convinced the radiologist to include the pituitary and a microadenoma was found.  Now doctors are taking me seriously thank goodness.  I had a an ACTH stimulation test a couple of days ago and these are the results posted online:
Base cortisol 42.0
30 min cortisol 26.0
60 min 49.2

Normal range for morning (test done at about 9 am): 6.2-19.4

Any thoughts? Thanks!

[lyebye0]

Thanks rumpled!  I am taking your advice and looking into a pituitary specialist.  Houston seems to have several.

[rumpled]

Post back when you have more information!

[rumpled]

The normal ranges don't always apply during a stim test. What the doctor is looking for is activity.

Normally that test is done for low cortisol and not high so it is a bit weird. Usually a dexamethasone test is done for high.

I would guess that any one of the stim tests would interfere with testing for a while. I would wait at least 2 weeks. It is a good idea anyway to let your body recover from the test.

[lyebye0]

Also, will the ACTH injection affect the salivary tests?

[lyebye0]

The nurse just called and advised that the doctor thought my ACTH results were fine.  I don't think that my results could possibly be considered fine.  Would the base cortisol of 42.0 when the range is 6.2 - 19.0 justify a diagnosis of cushings?  Still waiting on midnight salivary results

[rumpled]

Yes sadly there is a learning curve.
If you did not keep the urine cold while you had it and then dropped it off and they kept it warm, bacteria can interfere with results. Sadly they say with the preservative to just keep at room temp but it is not enough.

The dex test is the worst test IMHO. I flunked all but had it.

Find a larger hospital or university. I think they do have centers in LA.

[rumpled]

Was it done at 8 am?

It is odd... But I had a similar event during one of my stim tests where I dropped in the middle and it confounded the docs.

I will say that a stim test is probably the last test in the line of testing when you have a pituitary tumor not the first... And now you have to wait weeks for the stim agent (was it ACTH, dex or what? Looks like an ACTH stim test) so that no test is influenced by the agent.

I had Cushing's too and a normal urine (was it kept cold, did the lab keep it cold, was it hlpc?) can mean little... It takes a lot of testing with urine blood and growth hormone and other things can mimic Cushing's.

Are you at a pituitary center?

[lyebye0]

I am not at a pituitary center, I can't find one in Louisiana.  I believe it was ACTH.  I suppressed on the dex test.  I have no idea if the urine was kept cold and I no longer see that endo.  He pretty much dumped me after the test was within normal limits.  I was shocked then but not so much now.  I have other results that I am waiting on including the midnight salivary.  I am so glad for these message boards and I have been encouraged by your responses to others so thanks for responding to me!!  I have only recently been crushed by these symptoms, starting in December, although I probably have been having mild symptoms for a while.  There is a definite learning curve!