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Hello,I would like an endo. to review my question:
I’ve been dx with Adrenal Insufficiency twice in 2012 due to long term steroid use from my many chemo treatments and eventual allo-stem cell transplant.
My cortisol levels have been on the low side of normal since 2013 but my ACTH is only 6.

Since this past June I have the same symptoms of adrenal fatigue as before and this time my dr decided to skip the STIM test and go directly to the metyrapone overnight test. I took the pills at night and had my labs drawn at 8am the next day. Unfortunately the dr split the orders on two different escripts and the lab only did the cortisol total and ACTH. (not 11- deo. & cortisol free)

My results:
Cortisol total 5.8
ACTH 479

The dr said that those results were enough to confirm I don’t have adrenal insufficiency. What are your thoughts? I know being able to produce high ACTH is good, meaning my pituitary gland is working correctly but can it be too high and isn’t can’t the cortisol on the low side of normal mean something as well?
Thank you.

Category: Endocrinologist

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Category: Diabetologist
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Thank you for posting your query at
A high ACTH with low cortisol means the Adrenal glands are at fault.
(Primary Adrenal Insufficiency)
Use of Steroids would cause secondary Adrenal Insufficiency...Low/Normal ACTH and low cortisol.
Cause of Adrenal failure needs to be looked for..
Let me know if i can help you further,

Patient replied :

Thank you. I figured that out myself. My question wased based on the Metyrapone overnight test what does the ACTH of 479 mean? New Endo stated that means I DO NOT have adreneal insufficienty, I disagree and was hoping for a more clinical answer that the on I can find ont Google for free. Thank you.

I am Dr.DS Sebastian, In House Physician of DoctorSpring. I understand that you are not particularly satisfied with the consult reply you have received. I am trying to cordinate with an Endocrinologist on call to get you a better and more detailed reply. Sorry for the inconvenience caused. If you have some additional queries / clarifications please let me now.

Thank you for the follow up.
High ACTH on Metyrapone test means that your pituitary is responding well. so the adrenals are also recovering from the suppressive effects of the steroids.
Its a positive sign. You need to repeat serum cortisol at 8AM to look for recovery, and also a post cosyntropin test to check cortisol synthesis by the adrenal glands
Hope this was helpful,

Dr. J Muthukrishnan
Category: Diabetologist
1. 10th Asia-Pacific Pediatric Endocrine Society  Fellows meeting, Seoul, Korea, Oct 2008
2. Eighth ICMR Course on Genetics and Genetic Counseling – Jul 2008 – SGPGI, Lucknow
3. Annual Certificate Course on Endocrinological Laboratory Techniques at National Institute of Nutrition (ICMR) Hyderabad,India, ( Aug-Sep 2006) 
Fellowship: Endocrinology, Diplomate of National Board, National Academy of Medical Sciences, New Delhi, 2008, Medwin Hospital, Hyderabad
Senior Residency: Diplomate of National Board (General Medicine), National Academy of Medical Sciences, New Delhi, 2002
Residency: MD, General Medicine, 1997-2000, Armed Forces Medical College, 2nd position in University
Medical School: MBBS, Armed Forces Medical College, 1992
Dr. J Muthukrishnan and 4 other Medical Specialists are ready to help you

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