ACTH test - help with interpretation please

[Cuileann-6]

Hello again.... forgive me for posting yet another question.... still in the fact finding stage! I'm questioning everything my gp has told me in the past, so I'm just revisiting an acth test my gp agreed to to rule out Addison's (she was not interested in finding out about adrenal Fatigue as such ) I had the 30 minute test. It was done at 9am.... on an empty stomach (gp didn't tell me this. Just knew).

My baseline, before the injection, was 428nmol

After injection, 555nmol

I was told this was normal. Is it?

Thank you

[gabkad]

Adult/ChildMorning5-23 micrograms per deciliter (mcg/dL) or 138-635 nanomoles per liter (nmol/L)

You baseline is good. Your response is not fabulous.

pathology.leedsth.nhs.uk/dn...

'Adrenal insufficiency is excluded by an incremental rise in cortisol of > 200 nmol/L and a 30 min value > 600 nmol/L.

The above definition only defines adrenal insufficiency. The definition of normality is problematic since there is considerable variation in healthy individuals and a significant overlap with patients who have adrenal insufficiency.

In ACTH deficiency the response to the short test may be normal or reduced.

The response to Synacthen is not affected by obesity.

There is no difference in cortisol response between iv & im administration.

Baseline and incremental cortisol values do NOT apply to women taking oral contraceptives or to pregnant women.

There is quite marked variation in the measurement of cortisol in the post-Syancthen samples by different laboratory methods (Clark et al 1988).'

[Cuileann-6 in reply to gabkad]

Very interesting! Thank you gabkad. I wonder if the year could be skewed by HRT too? Do you feel it sounds be worth investigating further? Maybe do a saliva test? Just going to read the link you sent.

Thanks again! Xxx

[gabkad in reply to Cuileann-6]

Yes, that would skew it too.

[Cuileann-6 in reply to gabkad]

Ok, thank you.... you've helped steer me in the right direction! I guess the fact that I struggle to get out of bed, but still awake at 1.30am points to a disrupted cycle. Thanks for your input. Xxx

[gabkad in reply to Cuileann-6]

It is possible you may have something like hypopnea (partial airway blockage during sleep). This prevents the brain from getting into deep sleep. It's sort of like the brain has decided, nope, not getting into deep sleep because what if she stops breathing altogether. Most people with hypopnea have worse sleep than people with mild apnea because at least those people get deep sleep, albeit they stop breathing for various amounts of time.

Just curious: when you fall asleep are you on your back, side, or front? Has anyone told you that you snore?

(Hypothyroidism can cause both hypopnea and apnea because the tissues in the throat are puffy... and the muscles are floppy. This reverses when thyroid hormone therapy is at the right level. But there can be other reasons.)

[Cuileann-6 in reply to gabkad]

Interesting you should ask that, as I was diagnosed with Sleep Disordered Breathing Last June, and have used a CPAP machine since. I looked into that, as was trying to diagnose the crushing fatigue. I have no doubt it is beneficial for me to use this every night z I find it hard to sleep without it now - but it didn't help my symptoms at all, and in fact symptoms have increased over past 6 months in particular. Interesting what you say about the throat tissues being floppy, as my neck is swollen.... I've never really had a double chin, even though I am overweight, and I often feel like something is pushing on my windpipe, but I could also put this down to slight anaphylaxis, which I started with a year ago. Well, thank you for your well informed and generous input. I appreciate it very much! Sleep well x x x

[gabkad in reply to Cuileann-6]

HRT should help to reduce neck fat by sending it 'south'. But if the double chin is due to having a short lower jaw, then that's a whole 'nother story. Your neck circumference should be less than 15 inches. I can't remember now maybe 14.5. It's less for women.

Large tonsils and adenoids will also block the airway during sleep.

APAP machines can be less unpleasant because they are variable pressure depending on what is needed. They are more expensive but they have a computer readout about what happened during sleep.

Excellent that you are successfully using the CPAP. That shows you are a motivated person.

[Cuileann-6 in reply to gabkad]

Thanks gabkad - yep, no-one cna accuse me of not being determined!! ha ha That's really interesting about the APAP - I'd not even heard of them - I shall look into that, as I am keen to give myself a complete over-haul!! I think my throat swelling might be down to anaphalaxis mostly, but I am beginning to think I aught to at lease have my neck checked.

Thanks for you input, once again, wishing you all the best xxx

[Glynisrose]

After hours of waiting my doctor told me that often the tests proved negative I said it depends whether you believe in adrenal fatigue or adrenal FAILURE

[Cuileann-6 in reply to Glynisrose]

Totally!!!!! - it's only just dawned on me that my GP, of course :O(, would be looking solely at Addison's, and not anything in between normal and total collapse. It's driven me to investigate this further. I think I will do a saliva test next. Thanks for your encouragement :O)

[Katepots]

Hi,

HRT can affect your thyroid meds. Do you really need to be on it? There are other ways of controlling flushes etc...

[Cuileann-6 in reply to Katepots]

Hey there Katepots, how are you today? hmmmm yes, I'm thinking of stopping the HRT patches - I only tried them to see if they would help treat the fatigue.... I didn't really get terrible hot flushes - just a hot back of the neck - and I've actually gottan worse anyway since taking them - so I guess it's pretty clear that the fatigue and muscle weakness are not caused by menopausal symptoms.

Thanks - you've given me the courage to come off them. I know Oestrogen is reeheeally bad for Thyroid problems, so, it seems madness to stay on them - my only thought was that I didn't want to rock the boat, as it were, but this is a time for decisive action!! lol - I shall look into how to come off them safely just now. I'll just write an up-date for my GP, as I do not want to see her again. ever, if possible :O) Thanks again :O)

[Katepots in reply to Cuileann-6]

Im ok thanks. Just saying goodby to my son this weekend as he's moving to Canada. Very sad but he's happy.

I feel like that about my dr!

Great re HRT, I've stopped all my menopausal symptoms with diet. No alcohol is crap though so I have the odd binge then put up with the suffering for a few days 😩

The saliva test for cortisol might give you a better result. My short synacthen test they said was normal but saliva testing showed high levels.

Your baseline I'm thinking was quite high, were you stressed? Then hardly raised when you had the injection of synacthen so I'm guessing that your adrenals may be struggling, if you were stressed you might have been using up all the body's reserves so why there was no big increase. I'm certainly no expert though and may well be put right!

I would be asking if that was a normal baseline to be starting with??

[Cuileann-6 in reply to Katepots]

oh Katepots - I feel for you! I have a 22 year old son, who has been off on his travels in the past for a year (only through Europe) - but still, it was a wrench. Like you say, it's comforting to know that they're happy.... but it doesn't stop the pain. Take Care of Yourself :O)

What you say is helpful - yep, just walking into my Doctor's surgery was stressful that morning... so, possibly elevated the levels. I'll go ahead and do a saliva test next. I feel I need a bit more info.

Thanks again, Lots of love xxx

[Katepots in reply to Cuileann-6]

Thanks. Bittersweet! I'll just have to holiday lots 😀

Good luck with tests, kept us posted. Ask any questions you need to and if I can I will help, but there's always someone that will know the answer.xx

[Cuileann-6 in reply to Katepots]

Thanks Kate. Love this forum! Everyone is so encouraging. Lots of love xxx

[Cuileann-6 in reply to Katepots]

Katepops.... do you know anything about the 30 minute cortisol test? I'm still trying to analyse my test results.... the conversions on-line are totally confusing - I just wondered if you knew if the levels I posted are abnormal. One of our 'colleagues' said they weren't fantastic - which I took to mean that after the 30 mins, my levels should have gone up more. I read on-line that they aught to double.... but it was in a different measurement, and my brain grew tired! ha ha.... Thanks :O)

[humanbean]

I am not knowledgeable on the subject of adrenal testing. However, you might like this link :

imperialendo.co.uk/Bible201...

You don't have to read it all! Do a page search for ACTH, see if you can identify the test you had done, and compare what it says should be done with what was actually done. It also gives figures for what kind of results should be expected under different circumstances.

But please note this comment on Page 2 :

IMPORTANT NOTE: Any reference ranges provided apply specifically to Imperial College Healthcare NHS Trust (ICHNT). If using this resource at a difference centre, please check your local lab's reference ranges.

[Cuileann-6]

Thanks Humanbean.... I shall look into that! Sending lots of love xxx