Mildly reduced cortisol, mildly increased ACTH

[A.B.]

I'm aware that the combination of reduced cortisol and increased ACTH is suggestive of primary adrenal insufficiency. In my case, these parameters are only mildly abnormal so they are a bit in a grey area. I'm interested in hearing other people's inputs or experiences in this matter because I find them quite valuable.

Do doctors tend to underestimate the importance of these findings?

Did anyone have success with low dose cortisone therapy? If so, in what timeframes can improvement be expected? Days, weeks, months, a year?

Are further lab tests aimed at elucidating HPA axis function and integrity justified? If so, what lab tests should I get?


Mildly decreased cortisol = ~90% of lowest reference value.
Mildly increased ACTH = ~110% of highest reference value.

 

[rlc]

Hi A.B., RE

I'm aware that the combination of reduced cortisol and increased ACTH is suggestive of primary adrenal insufficiency. In my case, these parameters are only mildly abnormal so they are a bit in a grey area. I'm interested in hearing other people's inputs or experiences in this matter because I find them quite valuable.

Do doctors tend to underestimate the importance of these findings?

Did anyone have success with low dose cortisone therapy? If so, in what timeframes can improvement be expected? Days, weeks, months, a year?

Are further lab tests aimed at elucidating HPA axis function and integrity justified? If so, what lab tests should I get?


Mildly decreased cortisol = ~90% of lowest reference value.
Mildly increased ACTH = ~110% of highest reference value.

Many doctors do not understand these tests, they are not trained in them, Cortisol can still be in normal range but you can still have severe Addison’s

To find out for shore if you have AI you need an ACTH stimulation test which you get from Endo’s. This involves being injected with synthetic ACTH and then blood tests are done to measure the bodies’ responses to it.

Without having this test done you will be left in no man’s land, not knowing what is really going on.

This article explains what you need to know http://suite101.com/article/adrenalinsufficiency-a1543

“When adrenal insufficiency is suspected, blood for an AM cortisol level along with an ACTH level and an aldosterone level is drawn. With a normal range of 9-25, mcg/dl, blood cortisol levels higher than 19 generally rule out the possibility of adrenal insufficiency. Levels lower than 3 suggest adrenal insufficiency, and levels between 3-19 are indeterminate. In primary adrenal insufficiency, the blood ACTH level is high. A low cortisol with a high ACTH is sufficient to diagnose primary adrenal insufficiency; a low ACTH with a low cortisol level is seen in secondary adrenal insufficiency. Further tests can be used to differentiate pituitary from hypothalamic causes in secondary conditions.

Regardless of the cortisol level, if adrenal insufficiency is highly suspect, an ACTH stimulation test is performed. In this test the patient is given an injection containing cosyntropin, a synthetic form of ACTH. Cortisol levels are tested prior to administering the drug and at 30 and 60 minutes after the ACTH is given. In adrenal insufficiency the rise is blood cortisol levels is negligible. A longer version of the test can be used to determine if abnormal results are due to pituitary or adrenal disease.”

Hope this helps

All the best