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What Causes ACTH Deficiency?
Question: An endo recently told me that, based upon numbers below, that all was normal and the low ACTH had no medical significance. I'm thinking Isolated ACTH deficiency.
Recent bloodwork:
ACTH am levels of 4.1 and 3.2; reference 7.2-63.3/ug/dL.
Pre-ACTH Stimulation score for cortisol of 4.8 in a range of 5.0 - 25/ug/dL.15.5 at 30 minutes and 18.7 at 60. So my cortisol started below normal range and went up, so adrenals working.
Pre-stimulation T4 1.0 with reference of .08-2.2ng/dL.
T3 was 3.3 with reference range of 1.7-3.7 pg/mL.
TSH 3.27 with ref. 0.47-4.68 ulU/mL
Prolactin 18 with reference range of 3-19 ng/mL and I'm 55 years old.
All other pituitaries normal.
Family history: Cousin with Turner's Syndrome: Mother, hypothyroidism and hypoglycemia; daughter also has low ACTH; and have two nieces who are having undiagnosed problems that look very familiar to me.
Recent bloodwork:
ACTH am levels of 4.1 and 3.2; reference 7.2-63.3/ug/dL.
Pre-ACTH Stimulation score for cortisol of 4.8 in a range of 5.0 - 25/ug/dL.15.5 at 30 minutes and 18.7 at 60. So my cortisol started below normal range and went up, so adrenals working.
Pre-stimulation T4 1.0 with reference of .08-2.2ng/dL.
T3 was 3.3 with reference range of 1.7-3.7 pg/mL.
TSH 3.27 with ref. 0.47-4.68 ulU/mL
Prolactin 18 with reference range of 3-19 ng/mL and I'm 55 years old.
All other pituitaries normal.
Family history: Cousin with Turner's Syndrome: Mother, hypothyroidism and hypoglycemia; daughter also has low ACTH; and have two nieces who are having undiagnosed problems that look very familiar to me.
Brief Answer:
Adrenal
Detailed Answer:
You are obviously aware as you have yourself stated that you passed the ACTH stimulation test. If you are wondering why ACTH was ordered when endocrinologist advised to ignore it, here is one reason. When cortisol results are on the 'fail' side we endocrinologists then look at ACTH levels to try to discriminate between pituitary versus adrenal cause of cortisol deficiency. This is particularly useful if the ACTH levels are significantly elevated.
Adrenal
Detailed Answer:
You are obviously aware as you have yourself stated that you passed the ACTH stimulation test. If you are wondering why ACTH was ordered when endocrinologist advised to ignore it, here is one reason. When cortisol results are on the 'fail' side we endocrinologists then look at ACTH levels to try to discriminate between pituitary versus adrenal cause of cortisol deficiency. This is particularly useful if the ACTH levels are significantly elevated.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
My question was whether this could be isolated ACTH deficiency with secondary adrenal deficiency. My two ACTH plasma tests were very low. The doctor said that there was no medical significance to a low ACTH. This is not what I have read in my research. The fact that I passed the ACTH test meets one criteria for isolated ACTH deficiency. That endo told me I had nothing wrong with me. Are you also saying you know of no medical significance to a very low ACTH?
Brief Answer:
Follow up
Detailed Answer:
Yes I concur with the other endo. When I see someone in my practice with this type of presentation I advise the same thing that low ACTH in and of itself is not suggestive of a medical problem.
However, I must emphasize that diagnosing endocrine problems is not only about interpreting lab results but also evaluating a person live to look for evidence of disease.
ACTH stimulation test has been relied upon by endocrinologists worldwide for a number of years to effectively rule out adrenal insufficiency, be it primary or secondary.
That being said, no test in the world can be 100% accurate and that is why clinical examination in person confirms the impression. I would like to believe your endo has performed a thorough in-person assessment before making the judgement of you not having ACTH/cortisol.adrenal problems
Follow up
Detailed Answer:
Yes I concur with the other endo. When I see someone in my practice with this type of presentation I advise the same thing that low ACTH in and of itself is not suggestive of a medical problem.
However, I must emphasize that diagnosing endocrine problems is not only about interpreting lab results but also evaluating a person live to look for evidence of disease.
ACTH stimulation test has been relied upon by endocrinologists worldwide for a number of years to effectively rule out adrenal insufficiency, be it primary or secondary.
That being said, no test in the world can be 100% accurate and that is why clinical examination in person confirms the impression. I would like to believe your endo has performed a thorough in-person assessment before making the judgement of you not having ACTH/cortisol.adrenal problems
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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