Cortisol and ACTH Test

[cypercat]

Son suffered a brain injury and seems to be suffering from central hypothyroidism from his injury. TSH levels are low - recent blood work showed that his morning cortisol level was low. They wanted him to have the ACTH Stimulation, which he did and they called and said that he responded to the stimulation test - they were happy about that. But I don't know what that all means. To me this proves that his adrenal glands are working but since they are concerned about the pituitary gland does him responding tell them that his pituitary is NOT communicating to the adrenal glands? We are waiting for doctor to come back into the country to do a followup with them. So while we wait I thought I would see if all of you could help with questions to ask since we are so new to all of this.  

His symptoms are fatigue, insomnia, headaches, cold intolerance, low body temperature (97.0 - 97.3), irregular blood pressures, inability to exercise - brings on headaches, weight loss - seems to be starting to put weight back on, no real appetite for teenage boy. He is on 125mcg of Levothyroxine. I don't have any blood work numbers to share as of yet.

Overall son is doing well following his injury is just seems that we need to get a better handle on the endocrine system and then I think his recovery will go even smoother.

I guess my question would be what does having a low morning cortisol number (3) mean and what does it tell them that he responded to the acth test?

Thanks

[cypercat]

Here are the latest lab results - anything pop out to any of you genius people here

Cortisol - 2 (3-21)
Peak ACTH - 29 (>20)
Free T4 - 1.3 (1.0-2.4)
TSH- 1.16 (0.43-4)
IGF-1 - 657.2
IGF-BP3 - 4.7 (3.5-10)

Repeat TSH Surge - 8% (50-200%)

[cypercat]

Thanks - I wanted to post his lab results from 8 months ago. We have done a whole new set I just haven't gotten those results back except when they called and said his cortisol was at 3. I also wanted to mention the recent ACTH test was the low-dose stim test and it was done in the afternoon. I am pretty sure he said that his cortisol number was pretty high after this test - I am thinking she said 29. They said that no further test would be needed but the head dr. is out of town and hasn't had a chance to go over all the numbers.

Here are his lab results from Feb 08

Cortisol - low dose stim - peak cortisol - 22.2 (>20)
GH - IGF-1 - 642.4
IGFBP3 - 4.3 (3.5-10)
OVERNIGHT - peak GH - 26.3 (>10)    Mean GH - 12.8   Number of Peaks - 2 (2-4)

Thyroid - TSH surge - Nocturnal rise in TSH - 11% (50-300%)
peak TSH 1.65 (0.5 - 3)
Free T4 - 1.5 (1.0 - 2.4)
TSH - 1.17 (0.37 - 6)

Other labs
LH - 11.5 (4.8 - 20.4)
FSH - 8.3 ( <3.0 - 10.5)
Testosterone 490 (110-975)

Note on bottom of paper sent - Traumatic brain injury with normal cortisol, growth horomone, vasopressin and pubertal horomones. Testing and symptoms consistent with central hypothryroidism.

They repeated these same test several weeks ago and I haven't received the updated numbers I just know they called and said his cortisol was at 3 and they needed him to come back in to get the ACTH stim test and then they called and said he responded and I think they said the number was 29.

If anyone could help explain the numbers I would appreciate it. He was in a research study for head injury and endocrine issues so we don't have much contact with the drs. I don't really know how they are coming up with Central Hypothyroidism since most of his numbers fall in the normal range. I think they are concerned about the nocturanl rise in TSH.  I also told at the hospital that this doctor is one of the best in the country and that she will look at the numbers but will also look at symptoms.

Any thoughts? or do any questions come to mind that I should ask when we meet face to face.

Thanks

[kitty9309]

http://www.nlm.nih.gov/medlineplus/ency/article/003696.htm

The above explains the test and results.

His starting morning cortisol is VERY low. I know you don't have the numbers yet, but the cortisol should go up to at least 18. They may be saying that his number did increase, but if it didn't increase significantly from that low value, I would question the doctor further.

Also some of his symptoms look like he may be overmedicated with his levo. You said his TSH is low and he is on 125 mcg. If the TSH is truly low, below 0.5-ish, his dose shoudl be lowered by the doctor.