What Does My ACTH Stimulation Test Report Indicate?

Posted on Thu, 11 Aug 2016

Question: I had an asthma attack on Mother's Day (Sunday May 8, 2016) and was in the hospital until Thursday May 12,) when I was released they had me on oral steroids (prednisone 40 mgs) they are attempting to taper me off the prednisone -- I am currently on 15 mgs a day and just had a ACTH Stimulation test

Results below: cortisol time 1 (11:15a)
Specimen 1 = 5.9 MCG/DL
Cortisol time 2 (12:00p)
Specimen 2 = 6.5 MCG/DL
Cortisol time 3 = (12:30p)
Specimen 3 = 6.4 MCG/DL

I do not understand what these results mean - and if there has been damage to my adrenal or pituitary glands -- I would like to get off this prednisone as soon as possible (having all of the negative side effects -- weight gain, moon face, irritability, difficulty sleeping...) but I am afraid it has done permanent damage to my body -- please help

Thank you

Answered by Dr. Mirjeta Guni (1 hour later)

Brief Answer:
Please See below:

Detailed Answer:
Hello,
Your report is very clear and i can understand your concern.

While taking cortisone for relatively a long time ( over 2 weeks) it happens that the ACTH (the hormone that stimulates the adrenal glands may be inhibited and this puts the glands in a ''sleepy'' state let's say.

When the corticosteroids are stopped ( especially in the cases when they are not tappered) then may happen that the gland is not '" waked up'" and it can not produce enough cortisol, resulting in a adrenal insufficiency.

It may lead to serious events like hypotension, hypoglycemia etc and should be prevented. That is why the stimulation test is done. It verifies that the adrenal glands are woken up and can act adequately even in stressful situations where the adrenal gland should produce more cortisol.

Even if the '"sleepy'' state is set in most of the cases it is reversible so you do not have to worry that much.

A normal test is considered when cortisol level raises over 18 mcg/dl after stimulation, otherwise it means that the adrenal glands are in that '' sleepy'' condition and the physician should be careful with the corticosteroids withdrawal.

Hope i have been helpful and answered your query.
Kind regards,
Dr.Mirjeta

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Mirjeta Guni (2 days later)

I have been tapering down from the intial 40mgs-- went to 30mgs -- for 2 weeks, then 25mgs -- for 2 weeks, then 20 mgs for 2 weeks-- now on 15 mgs (with the results of the last ACTH stimulation test noted above... Feeling very jittery, high blood pressure (150/98), unable to sleep-BUT tired...

It's difficult for me to know if these s/sx are from taking the medication, or withdrawal symptoms from tapering or some combination of both ...but this medication is unbearable (my asthma appears controlled currently) and i would like to get off this prednisone completely...and sooner than later...
Any advice on the best way to achieve this safetly?

Thank you

Answered by Dr. Mirjeta Guni (2 hours later)

Brief Answer:
The best way to achieve it safety is by starting hydrocortisone.

Detailed Answer:
Welcome back.
I can understand your concern but the decision to stop the prednisone should be taken by your treating asthma physician.
If you want to stop it, you should start hydrocortisone in order to prevent a probable adrenal insufficiency. It is has less side effects than prednisone and is used to substitute the function of the adrenal gland.
This is the only way you can follow if you want to stop prednisone without risking an adrenal crisis.
Wish you good health.
Kind regards,
Dr.Mirjeta

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Above answer was peer-reviewed by : Dr. Priyanka G Raj