Thank you for posting your query at DoctorSpring.com
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,