Resolved question:
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.
Submitted:
4 Days
Category:
Endocrinologist
Hello.
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,
Regards.
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.
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Hello,
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.
Regards
Deepu
Deepu
Hello.
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,
Regards.