Understanding synacthen test results please

I have no idea what the results of my recent synacthen test mean, so am hoping that someone might know. I have exhausted Google! My GP is chasing my endo for another appointment, but it is taking a while to get anywhere.

First bloods: Cortisol 623 nmol/L (range 180-620)

30mins after test: Cortisol 682 nmol/L (range 180-620)

23 Replies

  • I don't know all that much about it, but I would say despite your good starting point you didn't really respond to the test, I would have thought it should have risen more than that if your adrenals were responding correctly. What time were the starting bloods taken?

  • The first test was at 9.00am, the second was at 9.40am. It was a fasting test, and I also hadn't taken my levothyroxine that morning.

  • Well if you'd just had the 9am test that would have been a good result, normally should be between 500 - 700.

    But you then had the synacthen test and I would have thought if your adrenals were working your cortisol would have shot up. I imagine that's why your GP is chasing up the Endo?

  • Hi, I also thought the 9 am test should be 500 - 700. Mine was 173, I was very stressed during the test ( which I assume would make my cortisol higher) and yet the Endo I saw said my result was fine. I thought at the time he was wrong.

  • Have a look at this link - it gives you a good interpretation of the results. The way I am reading it is that is should have gone up by at least 170 and yours definately didn't.


    Moggie x

  • Thanks Moggie

    This is brilliant


  • Many thanks for your reply.

    My lovely GP gave me the results, but admitted she didn't really know how to interpret them, and any treatment has to be by an endo anyway. I also have a nice endo, but the cogs in the NHS are working so slowly <no surprise> so there is probably already a "letter/appt in the pipeline" from her which is still gathering dust in the out-tray. Pushing the doctors to actually do something is a skill I have learned to do since being on this site.

    I have been lurking on this forum for a while, and have learned so much, but this latest test result is just one thing I can't find any info on!

  • Gosh Moggie, where on earth do you find this information?! I have printed it out, and am reading and re-reading the SST info, it makes sense to me (once I get past all the big words). Many thanks. This SS test was something I hadn't expected to be given, so I wanted to try and understand the results prior to any appt I have, and this certainly helps.

    Like you, Jow11, and many other people, I always have the expectation that I will be fobbed off by doctors because everything is always "in range". Having some knowledge about these health issues has meant that I now usually manage to have sensible discussions with doctors and, unbelievably, they have taken note of what I have said.

  • Your welcome - maybe take a copy into your GP when you next see her so she will know what she is looking for next time.

    Moggie x

  • good find Moggie - Endo bible!

  • It does have lots of very useful info in it and I do/have used it quite a lot to look things up - maybe one to add to your favourites Spare.

    Moggie x

  • Yes I already put it in my extensive list of links, thanx.... just trying to remember them is the problem! one day I will try & remember how to do a proper database. J x

  • I'm sure the whiz kid that is Rod would be able to tell you how.lol.

    Moggie x

  • So by what I am reading you should now be offered a long synacthen test or pituitary testing.

    Have a good look around the website as it gives details of both the above mentioned tests.

    Moggie x

  • To be fair, I don't think the GP should have been the one giving out the results anyway - I was only seeing her to request her help in getting to the endo sooner rather than later. She printed out all my test results for me (another lesson I learned here) and, although it would be nice, I don't expect her to be an expert endocrinologist.

  • No I think you misunderstood me - I was not critising your GP just thought it would be helpful for her to have the info so if she was ever in the same posiion again she would know what she is looking at.

    Moggie x

  • I didn't take it as criticism whatsoever. I think having a GP who actually acknowledges that they don't know enough about something is pretty good - it's the "holier than thou" ones which make me cross.

  • Yours is an unusual situation in that your morning cortisol was above range and ordinarily would exclude an adrenal issue.

    Usually if there's a problem it's very low in the morning and the endo is looking for it to rise above 550. That could be doubling or tripling of numbers. So, someone who started at a reading of say 200, if they went to 551, that would be within range. That's the NHS benchmark. However a minimum rise of 170 is expected, whereas yours didn't. Mine normally only increases by about 95-97. My starting point is about 203/220. So, I can understand why your GP doesn't know how to interpret them. I suspect they'll need to repeat the test or offer you a long version or day curve analysis.

    The main thing is how you feel and whether your current symptoms are of adrenal insufficiency or excessive cortisol.

    Push for a quicker appt with your endo.

    Best if luck x

  • Thanks behappy, I think my poor, Hashimoto body likes to do things just to be different.

    I don't feel great, but I have also only just found out that I am lacking in certain vitamins (thanks to all the info gained on this site, I asked for the tests), so I guess it will take a while to figure out which symptoms belong to which problem.

    My GP said that it would take 5 days to get the letter sent from the surgery. I almost volunteered to type it myself and drop it off. I will chase it up though, battling the system is something we shouldn't have to do.

  • Hiya, I do sympathise. It's hard to know what's going on. I would add that My GP normally puts in a phone call to the main hospital endo whenever something strange or urgent crops up and then calls me that day to advise what he said. Otherwise it's a letter.

  • I think the NHS uses pigeon post. And probably uses the same pigeon to diagnose test results.

  • I work in an NHS lab, sadly not one that does thyroid testing, & I can assure you pigeons would be a massive improvement!!

  • Thank you so much Moggie! I have been looking for something like this for sooo long. Awesome!

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