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What Does The Following Test Report Indicate?
Question: I had the low dose atch stim test. The following are my results.
Cortisol base 16.9
cortisol at 30 mins 17.6
cortisol at 60 mins 15.6
my aldosterone has been level was 1 a month ago and 12 3 weeks later. Atch was 42. Been very ill and week. Wondered if I have adrenal insufficient
what do these results mean?
Cortisol base 16.9
cortisol at 30 mins 17.6
cortisol at 60 mins 15.6
my aldosterone has been level was 1 a month ago and 12 3 weeks later. Atch was 42. Been very ill and week. Wondered if I have adrenal insufficient
what do these results mean?
Brief Answer:
These reports are not suggestive of adrenal insufficiency
Detailed Answer:
Hi XXXXX,
Welcome to HCM. I had gone through your question and understand your concerns.
The interpretation of these blood tests depends on how these blood tests are done and which lab these blood tests are done. Cortisol is a pulsatile hormone and the lab values differ at different times.
Please share the units of the lab tests or upload the reports.
I will explain the blood tests
1. Baseline cortisol : 16.9 (it is normal if the value is in microgram/ decilitre)
The normal is 6-23 ug/dl. We usually do ACTH stimulation tests when the values are less than 10 ug/dl.
2. On stimulation the value should be more than 18 ug/dl. Here it is slightly low than normal. Again the value depends on the quality of ACTH (Synacthen) injection used for test. Synacthen will get easily damaged if it is not stored properly at low temperatures.
3. ACTH is normal (Elevated in adrenal insufficiency or low in pituitary insufficiency)
4. Aldosterone
Values depends on serum potassium, sodium, posture of the body during tests and medications you are on. Normal value is 4-31 ng/ml. Again this test has to be interpreted with other tests like renin. So your value of 1 is low and 12 is normal.
These results are not suggestive of adrenal insufficiency. So no need to worry.
I suggest to:
1. Repeat the ACTH stimulation tests at a good centre.
2. Do serum electrolytes
3. If Cortisol on stimulation is less than 18 ug/dl, do an ACTH levels.
4. If results are not clear do additional tests like insulin tolerance tests, Imaging of adrenals/ brain, before starting treatment.
Hope I have answered your question. If you have any further questions I will be happy to help.
Regards
Dr Ajish TP
Consultant Endocrinologist
These reports are not suggestive of adrenal insufficiency
Detailed Answer:
Hi XXXXX,
Welcome to HCM. I had gone through your question and understand your concerns.
The interpretation of these blood tests depends on how these blood tests are done and which lab these blood tests are done. Cortisol is a pulsatile hormone and the lab values differ at different times.
Please share the units of the lab tests or upload the reports.
I will explain the blood tests
1. Baseline cortisol : 16.9 (it is normal if the value is in microgram/ decilitre)
The normal is 6-23 ug/dl. We usually do ACTH stimulation tests when the values are less than 10 ug/dl.
2. On stimulation the value should be more than 18 ug/dl. Here it is slightly low than normal. Again the value depends on the quality of ACTH (Synacthen) injection used for test. Synacthen will get easily damaged if it is not stored properly at low temperatures.
3. ACTH is normal (Elevated in adrenal insufficiency or low in pituitary insufficiency)
4. Aldosterone
Values depends on serum potassium, sodium, posture of the body during tests and medications you are on. Normal value is 4-31 ng/ml. Again this test has to be interpreted with other tests like renin. So your value of 1 is low and 12 is normal.
These results are not suggestive of adrenal insufficiency. So no need to worry.
I suggest to:
1. Repeat the ACTH stimulation tests at a good centre.
2. Do serum electrolytes
3. If Cortisol on stimulation is less than 18 ug/dl, do an ACTH levels.
4. If results are not clear do additional tests like insulin tolerance tests, Imaging of adrenals/ brain, before starting treatment.
Hope I have answered your question. If you have any further questions I will be happy to help.
Regards
Dr Ajish TP
Consultant Endocrinologist
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I had one other atch stim 2 months ago because I was hospitalized. my heart rate climbed every time I stood. they ruled out pots and said the stim was a low normal. my cortisol at 30 mins that time was 18.3 base was 13 and my atch was 13 . sorry I don't have the ability to upload labs. anyways they said I'm constantly dehydrated and my sodium and potassium levels go from low ka to normal then low na to normal.
to date I'm still very weak and shaky. I was told it was something endocrine related but they haven't pin pointed it yet as everything else was ruled out.
I have hashimotos but normal thyroid levels.
however was told perhaps my adrenal glands were being attacked and that why I feel the way I do and may take a while for the dust to settle so to speak in otherwords show up on labs
very frustrated and at this point feel a trual of meds should be warranted
to date I'm still very weak and shaky. I was told it was something endocrine related but they haven't pin pointed it yet as everything else was ruled out.
I have hashimotos but normal thyroid levels.
however was told perhaps my adrenal glands were being attacked and that why I feel the way I do and may take a while for the dust to settle so to speak in otherwords show up on labs
very frustrated and at this point feel a trual of meds should be warranted
Brief Answer:
See detailed answer
Detailed Answer:
Hi XXXX,
I understand your concerns.
Here ACTH is on the lower side. Aldosterone levels are not reliable when potassium and sodium levels are low or high.
When adrenals are attacked the ACTH (the hormone from pituitary to stimulate adrenal) will increase. So in adrenal insufficiency the ACTH level will be high (more than 100 at least, usually more than 500). Here either you are normal or you are having a problem with your pituitary gland - producing less ACTH and thereby less cortisol.
The ideal test to do in this situation is an insulin tolerance test if facilities are available, followed by an MRI scan of pituitary.
If in doubt, what I will do is to give a trial of small dose of safe steroids like hydrocortisone. If your symptoms are due to low cortisol, this will improve dramatically.
Hope this will clear your doubts.
Regards
Dr Ajish TP
See detailed answer
Detailed Answer:
Hi XXXX,
I understand your concerns.
Here ACTH is on the lower side. Aldosterone levels are not reliable when potassium and sodium levels are low or high.
When adrenals are attacked the ACTH (the hormone from pituitary to stimulate adrenal) will increase. So in adrenal insufficiency the ACTH level will be high (more than 100 at least, usually more than 500). Here either you are normal or you are having a problem with your pituitary gland - producing less ACTH and thereby less cortisol.
The ideal test to do in this situation is an insulin tolerance test if facilities are available, followed by an MRI scan of pituitary.
If in doubt, what I will do is to give a trial of small dose of safe steroids like hydrocortisone. If your symptoms are due to low cortisol, this will improve dramatically.
Hope this will clear your doubts.
Regards
Dr Ajish TP
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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