# ACTH Stimulation Test



## TickledPinkTwice

I haven't read the report or heard from the doctor but I do have my numbers from ACTH Stimulation test.
My ACTH was 32.9
Cortisol level at 0 min was 5
Cortisol level at 30 minutues was 19
Cortisol level at 60 minutes was 25
*Cortisol level quintupled!*
Aldosterone levels were 7 then 35 and then 47. 
*Aldosterone level septupled!*

I don't have my Aldosterone results yet.
Has anyone had this test done, my doctor is out of the office and I'm getting anxious, so I have been doing my own research?lol It appears that my ACTH is somewhat low, my cortisol is low and it definitely more than doubled suggesting Secondary Adrenal Insufficiency.

This is the note beside my 60 minutes result:
A normal serum cortisol response to 25 units (250 ug) of ACTH (Cortrosyn) stimulation is a rise of at least 7 mcg/dl from the baseline and a peak of 20 mcg/dl. The peak value is the most informative. These criteria do not apply if the baseline cortisol is >20 mcg/dl, as the patient may already be maximally stimulated by endogenous ACTH. With acute ACTH or CRF deficiency, the serum cortisol response to stress is low, but the response to ACTH stimulation is normal. In these situations, consider other tests to evaluate adrenal function

Some more information I have found:
*Interpretation for secondary adrenal insufficiency *
ACTH will be low- Usually below 35, but most people with secondary fall within the range limit. Although uncommon, values for ACTH can reach into the low 40s.
*Talking about secondary adrenal insufficiency*
typically serum cortisol levels will double or triple from baseline. The lower the baseline cortisol, the more likely it is that the patient's cortisol will increase by a large amount

So somethings are saying normal and other things are pointing towards secondary adrenal insufficiency, especially with the mri results. Uhhh I hate waiting.

This seems to be most in line with what I have found.
*In healthy adrenals, the cortisol level should double within 60 minutes. For example, if the cortisol level was a 25 before the stim (base level), then after the stim should reach at least 50.
In primary adrenal insufficiency, the base level usually starts at least a little lower, like 15 (can be much lower) which is the most common number I see and acth stim might raise cortisol level to 20, which would not be doubling and thus support the diagnosis of primary adrenal insufficiency.

In secondary adrenal insufficiency, the base cortisol can double from a low base value and I've seen tripling, quadrupling, quintupling (5 stimming to 25, 6 stimming to 30), sextupling (4 stimming to 24, 5 stimming to 30), septupling (0.7 stimming to 4.9) and decupling (2 stimming to 20, 2.7 stimming to 27.6) and recently a stim that almost tridecupled (1.25 - 16 went up 12.8 times) and a stim that quadecupled (went up 14 times 1.7 stimming to 24, after 1 1/2 hours reached 27.5 for sexdecupling). These examples illustrate how extreme secondaries stims can be. Most secondaries only double or triple and usually start with a base cortisol value of at least 10. The base cortisol can be very low because of the bodies lack of natural acth. When the synthetic acth is given in the stim test, the patients adrenals go hog wild because they can work, just not getting enough ACTH from the pituitary gland.
Insecondaries, serum ACTH will usually be in the bottom half of the range to the very bottom, but not usually below the range (98% of secondaries are in range on the serum acth). I have seen a few secondaries (going by stims doubling or more from low base number to indicate they are secondary) whose serum acth was just above the middle of the range or as high as the 40′s. Again, I like to see it in the upper third of the range (assuming a range of 10 - 60 as they almost always were until a couple of years ago), but now many different ranges are popping up and most are flawed to the lower end of the range ie. 5 - 27 which is the range where most secondaries test at in the serum acth test. Further proof that the labs get their ranges from the sick people who are given the test. In my opinion, acth ranges have become even more flawed compared to what they were before. If I were to draw up a healthy range for the serum acth, I think a range of 48-55 would likely be closer to healthy range.*

Any help and thoughts are appreciated!


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## TickledPinkTwice

Adding another level


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## TickledPinkTwice

I am STILL waiting on the doctor to call me back:/
I did however find this " A result of doubling of more of aldosterone may help in tandem with a cortisol stimulation that doubled or more confirm a diagnosis of secondary adrenal insufficiency"


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## Octavia

TickledPinkTwice said:


> " A result of doubling of more of aldosterone may help in tandem with a cortisol stimulation that doubled or more confirm a diagnosis of secondary adrenal insufficiency"


I have no idea what that says. It makes no sense to me at all (not because I think it's wrong...I just plain can't figure out what it's trying to say). What does it say to you?


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## TickledPinkTwice

Octavia said:


> I have no idea what that says. It makes no sense to me at all (not because I think it's wrong...I just plain can't figure out what it's trying to say). What does it say to you?


An example would be my Cortisol level went from 5 and quintupled to 25 and my Aldosterone level went from 7 and almost septupled to 47. Both results went from low base values and more than doubled.


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## Octavia

Okay, I see now. Thanks for the clarification. (I think the author could have written it a little more clearly...but then again, I am not accustomed to reading stuff about adrenal insufficiency, so making sense of the brief excerpt did not come naturally to me.)


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## TickledPinkTwice

It is hard to find any information or anyone who seems to know anything about Adrenal troubles. I am just so incredibely frustrated that I have still not heard from the doctor after calling the office numerous times. I have the results and the nurse said they have all the labs that the doctor just needs to review them. This is getting ridiculous. They have had the Aldosterone results since Monday, and all the other ones for over a week....


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## TickledPinkTwice

It's just so hard when feeling bad takes over your entire life. I don't have time to feel this way. I have a full time job and 3 year old twins


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