Need Help With ACTH Stimulation Test Readings!!

Dear Ask The Doctor: I would really appreciate an OPINION on my results from a ACTH stim test. Basline cortisol 5.6 ACTH is pending last time it was a 13 value range 10 to 60 30 min Cortisol 17.7 60 min Cortisol 20.8 Test states in 1989 cortisol greater than or equal to 20 is strongly against diagnosis of adrenal fatigue and it is reassuring to also see a rise of 7 mcg dl above baseline. DHEA S is 244.3 range 98.8 to 340 Is this hypopituitarism and if so why is DHEAS normal? Any insight would be greatly appreciated! Thank you!

Dear Katherine: The ACTH stimulation test is performed to assess the functioning of the adrenal glands. It is used to diagnose or exclude adrenal insufficiency and also to distinguish whether the cause is adrenal (low cortisol production) or pituitary (low ACTH production). This test involves the injection of synthetic adrenocorticotropic hormone (ACTH) and measuring the amount of cortisol produced in response by the adrenals.In healthy individuals, the cortisol level should double from a value in the 20s within 60 minutes.

Analysing your results, the base cortisol level is low along with the low readings of ACTH, this suggests reduced secretion of ACTH from the pituitary leading to reduced stimulation of the adrenals for the secretion of cortisol. As such, when the external ACTH is supplied the adrenals work fine, cortisol secretion is incresed from the base level. This is suggestive of a secondary adrenal insufficiency due to hypopituitarism.

DHEA sulphate is an andrgen hormone produced by the adrenals in both males and females. Its normal value suggests normal functioning of the adrenals and cause of low cotisol secretion is not primarily in the adrenals but some other location (pituitary gland) that is a secondary cause.Hypopituitary does not necessarily affect all the hormones secreted by the pituitary, one or more hormone secretion, may or may not be affected.