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High ACTH, normal cortisol, stress during test

Hi,

My 10 month baby had a blood test for ACTH and cortisol. The result came back that ACTH is 5 times normal (57 while normal range is 0-10) and cortisol is normal. She has no clinical symptoms aside from dark skin, however her dark skin has been fading slowly. Her face is actually a few shades lighter than her legs now.

During the blood test, she was poked numerous times with a needle, and held down so hard that blood spots have appeared on her skin. She was also crying non stop for about 20 minutes.

Could stress during the test cause such a high level of ACTH, or does stress only cause a small fluctuation?

How likely can this be Addisions, given such a lack of symptoms?

Thanks.
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973741 tn?1342342773
I sent your question over to a member who has been here a while and might be able to help you.  Hopefully they show up.  That's a frustrating problem and especially involving your infant.  Keep the faith and I'll see what I can read on the subject.  hugs
Helpful - 0
1 Comments
Thanks so much. I've been trying to read up on the issue, and it seems stress can affect the numbers, but I'm just not sure how much. Was also thinking, when bursts of ACTH gets released, how high can those numbers go? I've actually been so stressed about this, and we're waiting for an appointment with another doctor.
973741 tn?1342342773
Anything involving our beloved babes is VERY stressful.  I understand one mom to another.  I also have read that stress absolutely can influence the result!  And from what I've read, quite a bit.  Your ACTH is probably high worrying about this.  :>/  They will likely retest.  Things may be okay though if stress elevated that number.  And presumably, your baby is not under the same stress and therefore, the level will come down, right?  When is your doctor's appointment for her?
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1 Comments
Our appointment is in two weeks time. Not sure whether stress will still be a prob if it’s the blood test freaking her out. She’s at a point where there’s a huge stranger danger thing going on at the moment too. She gets really worked up when anyone else apart from my fam tries to touch her or hold her. Even at a doc appointment for myself, she will be nervous and is really quiet, until she realises it’s not about her. Then she’s super happy when we leave :)
973741 tn?1342342773
What about trying to distract her.  That's what I did with shots with my sons.  I would either hold them and talk and play in one direction or they'd lay them down and I'd do my tried and true best entertaining and they'd sneak in the other direction and get the shot in.  Then it is only the second that it is happening and not as dramatic of an experience?  That might help with keeping her stress free.  
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Unfortunately doesn’t work because they need to put the strap on her arm first to try and find the vein. She starts crying when they put that on :( I think she doesn’t like it when people touch her arm/hand because of her eczema, but she’s fine with shots because that’s on her thighs. *sigh* I don’t know. I’ll see what the other doctor says first
Unfortunately doesn’t work because they need to put the strap on her arm first to try and find the vein. She starts crying when they put that on :( I think she doesn’t like it when people touch her arm/hand because of her eczema, but she’s fine with shots because that’s on her thighs. *sigh* I don’t know. I’ll see what the other doctor says first
973741 tn?1342342773
Ya, see what the doctors say.  If stress is involved with an elevated number, they may factor that in as all little ones would get stressed during the test.  So, you initially sounded the alarm or the doctor noticed himself/herself to do the test because of the darker skin?  That is getting better?  It would be good to know if the doctor is really concerned or not.  And remember that determining if there is something like Addison's going on is to your daughter's benefit because then you know what you are dealing with and can take appropriate action.  Diagnosis is always scary and hopefully she won't receive one but on the plus side, knowing gives you what you need to also keep her healthy in the long run.  Let us know how the doctor's appointment goes.  hugs
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1 Comments
The original paed did the blood test because of her dark skin, which was always present at birth. Recently, she’s actually become more fair though, which is why I’m questioning the need for the original test. The paed is someone who wants to test for everything, so I’m very aware of this fact since I’ve been seeing him for a while, although my baby is thriving and doing well. Mind you, consultations with this doc is 10 minutes at most.

We went to see the paediatric endocrinologist today though, who asked me first thing if the blood test was traumatic. She did a detailed family history review, weighed and measured her and checked her blood pressure, which was through the roof because she was crying. She explained to me it’s unlikely that it’s Addisons, with the lack of symptoms aside from dark skin, which is only a soft symptom. A large part of diagnosis is also based on clinical symptoms. She explained that although her ACTH is high, Addisons can go much higher. Coupled with normal cortisol and a no other symptoms, together with her age and ruling out CAH because of a previous blood test, she doesn’t think it’s anything we need to worry about. She told me even if we repeat blood tests, it’s likely that ACTH will be high again because of stress, and mentioned if cortisol is still within normal, there’s no treatment anyways. We will be reviewing her growth in a few months time for now.

Hope this explanation helps others looking for answers. :)
973741 tn?1342342773
Wow, so glad you came back with this detailed update!!  And really, super happy to hear that the endocrinologist gave weight to the theory that the test trauma itself caused the test result!  That's not going to be the case for everyone but definitely a factor people should be aware of!  

So, I'm so happy you have this information from an endo!  And that your baby unlikely has addisons!!  Your regular doctor sounds a bit of a pain. LOL  I like a thorough doctor but that sure put you and your baby through a lot. I would let him know these results and that you were super stressed by it all!!!  yeesh.  

Anyway, keep us updated on her progress and I'm so pleased it all worked out well for you and your babe.  hugs
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