Who is confused? My surgery or me?

[ChinaWuntoo]

I was asked by the GP to remind him, when I reached 3mg in my tapering, that I should have a synacthen test. I have now done so. However, I am being sent for an ACTH blood test

Is this the same thing (I don't think so as I have not been asked to miss the steroid dose and there is no indication that this ACTH test involves two samples of blood etc).

Or is there something I am not understanding?

Before I challenge the GP I'd be grateful for any clarification from members here.

Thank you.

[PMRpro Ambassador]

Synacthen, the stuff they inject for the test, is artificial (synthetic) ACTH, hence the name.

Is your level of knowledge what the GP said (or didn't say) - have you not yet had any info regarding appointment time and what you do/don't do?

[ChinaWuntoo in reply to PMRpro]

I had no response to a letter reminding him about the test. I did receive a standard form for an 'ACTH' blood test (reason stated for the request is "f/u" which I don't understand and the accompanying letter stated that it is a "routine" test) and told to book an appointment at a local blood test clinic, not a hospital, with no instructions regarding Prednisolone or any 'warning' that the test would be any different to a normal blood test. I also received a form requesting a lipid profile test (which suggests to me that my request for a synacthen test may have been actioned by a second doctor who was confused?).

I am holding off booking an appointment until I may be able to clarify with the GP.

[PMRpro Ambassador in reply to ChinaWuntoo]

f/u usually means follow up and yes - with the extra info, it does sound as if someone has requested a test to measure ACTH in blood - also sometimes of interest in poor adrenal function. But unless the local blood test centre has resus facilities available. I'd be surprised if they do synacthen testing - not they are likely to be required but patients CAN have an allergic reaction. And at the very least there should be an instruction to request a 9am appointment.

[ChinaWuntoo in reply to PMRpro]

Many thanks. It seems to me that my GP (or another GP at the surgery) has not agreed to a synacthen test - or he has not yet got round to reading my letter (which would make sense, actually).

Wait and see, I think, until the end of this week when I need a new prescription for Pred which, if it is not done, will need me to shout louder.

And I did mention in my letter that it was thought that stress triggered my PMR in the first place: this is not helping present stress levels.👿

[DorsetLady PMRGCAuk volunteer]

Are you being sent to local hospital as an out-patient for test?

Have you have a early morning basal cortisol test at GPs? If so, that may have shown low levels and a suggestion that follow up more detailed test be actioned.

If not, GP may have requested the ACTH test anyway...

[ChinaWuntoo in reply to DorsetLady]

Not a hospital, just a local blood test centre.

Not had an early morning test.

Why would the GP request an ACTH test? Could it be a preliminary'prior test to a synathen test?

I visited the surgery this morning because I had heard nothing (blood test form arrived after I got back home) and the receptionist said she would chase-up my letter (of two weeks ago).

My letter also requested that I stay on 3mg of Pred for an extra two months as I wonder (with good reason!) whether I am teetering on a flare. No response to that either.

I thought the GP might telephone a response but ...

[DorsetLady PMRGCAuk volunteer in reply to ChinaWuntoo]

PMRpro has replied re test- and I’d be included to stay at 3mg anyway.

[ChinaWuntoo]

Thanks to you both for your help. I think I am not the one who is confused!

As an aside: this Forum empowers us so much. This morning I asked the receptionist what has happened to my request for 168 tablets at 1mg. The reply was that this was actioned in March alongside some 2.5mg tablets. I tried to explain that this was a former prescription, that my doseage changes every 8 weeks. I tried - and eventually gave up when she said she would action my request (which, of course, she has no authority to do as it is technically a new prescription). But - 'whatever'.