Short Synacthen Results - Help!

[Sparkle44]

Hi I had a Short Synacthem Test on 28-08-2018 and got the results today.

My test was done at 9am. I have recently been diagnosed with a 3mm part cystic pituitary adenoma.

My Cortisol (nmol/L) results are as follows:

Baseline at 9am - 190

After 30 mins - 394

After 60 mins - 490

I have nothing to compare the results too. There are no normal reference ranges! All I know is I am exhausted every morning despite 8+ hours per night I don’t feel like I have slept for a minute!!

My ACTH (ng/L) was 18.

Potassium (mmol/L) 4.4

Sodium (mmol/L) 141

I don’t have any reference ranges but would be greatful for any thoughts on my levels. I was told morning cortisol should be between 300-400 nmol/L.

Hospital is of the view that anything over 420nmol/L at 30 or 60 minutes is a normal response.

I don’t feel right in the mornings! Severely fatigued/ weak /nauseous / faint on standing!!

All views would be greatly appreciated!!

[Hidden]

Okay, I'm no expert but this is my view on it. Your am cortisol is low it should be around 500 at 9am in the morning & yours most certainly isn't! However you showed a good response but all that proves is that your adrenals are working well. However as your cortisol is low means that it is your pituitary gland that is the problem & that falls in line with saying you have a pituitary adenoma. This means that you have secondary adrenal insufficiency which needs treating with Hydrocortisone. Now hopefully your Endo is experienced with pituitary/adrenal issues, those that aren't will say that you responded well to the synacthen test & therefor you are fine! If you are on Facebook then join the UK Addisons info & support group where you find some excellent support. I have secondary adrenal insufficiency from a pituitary adenoma which caused Cushing's disease, now the tumour has been removed my pituitary doesn't work properly!

[Sparkle44 in reply to Hidden]

Hi Pauline,

Thank you so much for your response! I am sorry to hear about what you have been through!

I don’t suppose you know where I can get a quote from concerning the am cortisol of 500 as I would love to take this to my Endo appointment. The last SST that was done in March had my baseline as 152.

Unfortunately, I am questioning the expertise of the Endo as the report came back saying that my results were fine and I didn’t need any steroids? I certainly don’t feel fine!!

Endo also said that she doesn’t think my 3mm adenoma is causing my symptoms but she wants to re scan me in a year to check if the cystic part has changed.

Have only spoke to her on the phone since I got my adenoma results which is poor and due to my hormones being out of balance she left me a prescription for DHEA without any discussion of the side affects. Pretty poor service really!

All literature which can strengthen my case will be very welcome. I am not on FB sorry. Thanks again!

[Sparkle44 in reply to Hidden]

Found this online from the Endocrinology.Org website which is helpful. It recommends early morning cortisol to be 500-550nmol/L just as you said! Many thanks 😊

endocrinology.org/media/176...

[Hidden in reply to Sparkle44]

Have a look at Addisons.org.uk for more information, also cahisus.co.uk look for hypopituitarism, it also shows a chart which shows what cortisol levels should be during the day. cahisus.co.uk/pdf/CIRCADIAN...

[Sparkle44 in reply to Hidden]

Huge thanks x