I have secondary adrenal insufficiency and hashimotos. I’m well medicated on hydrocortisone and T3 only. My new endo wants me to have another ACTH stim test done. My last one told me I only needed to stop the hydrocortisone 24 hours prior to the test but this one wants me to taper over two weeks and stop completely, being off of it for a week before the test. This seems completely unreasonable and dangerous to me. What is the general rule of thumb before the test - stopping for 24 hours? Thanks!
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Msmustang1981
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More so that this new endocrinologist doesn’t believe in secondary - only Addison’s. I’m just trying to buy time until my usual endo comes back from medical leave.
the causes of secondary adrenal insufficiency are [my bolding] :
Secondary adrenal insufficiency is caused by impairment of the pituitary gland, resulting in a lack of adrenocorticotropic hormone (ACTH) production and subsequent decreased adrenal stimulation. Since the adrenal glands are not directly affected, the effect on mineralocorticoid production is minimal, as ACTH primarily affects glucocorticoid production.[2][3] Principal causes include:
Pituitary adenoma or craniopharyngioma: Tumors in the pituitary gland can suppress production of adrenocorticotropic hormone (ACTH).[2] High-dose irradiation (>30 Gy) to the hypothalamus or the pituitary gland can cause ACTH deficiency.[9]
Surgery or radiation: Pituitary gland surgery and/or radiation can lead to destruction of ACTH-producing tissue.[2]
Exogenous corticosteroid use: Exogenous corticosteroids suppress the stimulation of the hypothalamus and the pituitary gland to secrete CRH and ACTH, respectively.[2][3] These cases may present with symptoms of cortisol excess (see Cushing's syndrome).[3]
Sheehan's syndrome: Loss of blood flow to the pituitary gland following childbirth[2]
Pituitary apoplexy: Bleeding or impaired blood supply to the pituitary gland[2]
...
I have never heard of the pituitary healing after it has received damage from any cause. So I would be like you - I would think your doctor's instructions were completely unreasonable and dangerous too.
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