Acth and cortisol test advice please

Hi My Lady Gp has now requested Acth and cortisol test I have no instructions only to be done 8 to10am and it's taken to the lab immediately...this seems a different procedure to when a private Endo requested a short baseline synachthen acth test which was taken over the course of 60 mins as they had to inject me with something but unfortunately I couldnt get to London that early. I'm now back with NHS Endo who my Gp said should be doing this test but she knows I have had no help from him till last month after 15months of failed phone appointments to which he has now added 10mcg to my 100 Levo my Gp said Endo should be doing this test as you convert very well and more t3 isnt the answer your fatigue and weakness no energy hairloss adreanals should be checked anyway my question is is this test the same as the test private Endo requested and I have no instructions whether to fast nothing my Gp off for 2 weeks now Thank You..

[radd]

Gsd2011,

Ideally your cortisol is highest in the morning so testing at this time will give an insight of maximum adrenal output. Cortisol & ACTH are often tested together to diagnose adrenal dysfunction, ie high levels of both may indicate Cushings, high ACTH & low cortisol indicates Addisons and low of both may be due to hypopituitarism but this test will only offers a snapshot moment of hormone levels.

Depending on results your GP might want to test sodium & potassium, aldosterone, blood glucose, adrenal antibodies, etc, and then depending on these results she might have to refer you back to endo for the short baseline synachthen ACTH test which measures serum cortisol before & after a synthetic ACTH injection.

A normal response after an ACTH injection is a rise in blood cortisol levels but sometimes the adrenals are too damaged to respond or results are unclear so an insulin injection is given to cause stress and trigger a pituitary ACTH response which is measured. Alternatively a CRH Stem test can be performed (hypothalamus) or CT scan.

Adrenal insufficiency can be caused by primary (ie adrenals incapable of making sufficient cortisol/aldosterone such as Addisons Disease), secondary (ie pituitary tumor) & tertiary (ie suppression of CRH by long-term corticosteroid use). However, many people with hypothyroidism suffer a large degree of adrenal insufficiency that isn’t recognised as severe enough to meet medical criteria for help but is capable of making us feel quite unwell.

Your GP sounds caring & is right in saying that T3 isn’t the answer to everything because boosting metabolism can widen the gap if adrenal function is impaired and can not keep up. I didn't fast for my 9am cortisol bloods, but you need to have stopped any supplemented adrenal supports such as adaptogens or glandulars for several weeks, and advise if you are taking HRT or a contraceptive pill.

[Hidden in reply to radd]

Thank You so much for the in depth reply when I went to a private Endo in April she was going to do the short baseline synachthen acth test but unfortunately I couldnt get into London at 8am for the test so I wasnt quite sure what this test involved obviously not as informing as the other test I have left off the b complex with biotin I'm just on ferrous sulfate, folate ,selenuim and my Levo so I can continue to take Thank you!

[humanbean]

If you look at page 68 on this document :

imperialendo.co.uk/Bible201...

you can read about how a Short Synacthen Test ought to be carried out. Unfortunately, to save money, many doctors don't order the ACTH part of the test.

If you read this link :

en.wikipedia.org/wiki/Adren...

you can see that there are more types of adrenal insufficiency than just Addison's Disease. If ACTH isn't tested then the only thing that can be checked for is primary adrenal insufficiency. But with an ACTH test the other types of adrenal insufficiency can be tested for too.

[Hidden in reply to humanbean]

Good Morning and Thank You for the information very helpful! this Acth cortisol test iam having will just only give an idea if anything is going on my Gp wont be actually going forward with anymore tests if needed but I shall give my Nhs Endo the results of this test and he can carry on from there hopefully! he is the one who should be ordering any related tests my Gp is right she has been really helpful in his absence