Fatigue, headache, hypoglycemia. Undergone cortisol stimulation test. Help me reading the test report

Posted on Thu, 25 Apr 2013

Question: I need an edocronologist
I would like help understanding my labs. I have been very fatigued with headaches and lightheadedness. I also experience hypoglycemia. My B/P can get very low. I had a Cortisol Stimulation test ordered by a hematologist. During that particular test, they forgot to take my ACTH level but my b/p before the test was 84/42 and cortisol was 9.1. After the injection the cortisol went to 23.1 and my b/p went to a normal range. I also felt great for a few hours. The Dr. called me back in to get the ACTH (that was forgotten) another morning. That particular test showed that my ACTH was 8.0 and my cortisol was 3.7. Please help me understand these low normals and if it could be causing my fatigue, h/a's and low b/p. Side note: My b/p can be within a normal range, but I still feel horrible so I don't think the low b/p is the only reason for feeling sick. Also, I'm not a runner which I know can contribute to lower b/p.

Answered by Dr. Rahul Tawde (4 hours later)

Hi,
Thanks for writing in.You have undergone synacthen stimulation test because your BP & basal cortisol were low. Cortisol value > 21after syncthen stimulation is normal. But it doesnot rule out recent onset central hypocortisolism. Your ACTH is also low for the cortisol value. This too suggests a possible central hypocortisolism. A short course of coticosteroid replacement is worth trying to see improvement in symptoms and BP. Hypocortisolism can cause both lethargy and low BP so at this juncture we can assume that these are due to low cortisol. I suggest you see an endocrinologist in person & discuss the treatment options. Im sure he would evaluate and get some more tests including MRI sella and be in a better position to help you with this problem.
So in nutshell you do have low cortisol but with normal syn stim test.corticosteroid replacement
is worth considering after complete evaluation.
Hope this helps
Shivaprasad

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar