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Have central hypopituitarism. Awaiting MRI. Took ACTH injection.What dose it indicate

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Practicing since : 2001
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Recent DX: central hypopituitarism unknown cause. Awaiting MRI. I felt great with the ACTH injection. Pretty good with the corticortisone. Somedays, initially I feel a little jittery and then my body adjusts and I feel fine. I didn't feel that with ACTH. What causes would make me respond outstanding to ACTH (no side affects at all-I finally felt normal ie b/p went up to normal, fog disappeared, no dizziness) and ok to cortocortisone. (just a little jittery initially-only sometimes though same dose)
Posted Wed, 15 May 2013 in Thyroid Problem and Hormonal Problems
Answered by Dr. Shehzad Topiwala 46 hours later
Hypopituitarism is a complex condition that is best diagnosed and managed by a qualified endocrinologist only.
It requires a systematic evaluation that typically entails a detailed history , physical examination followed by a work up that involves lab testing as well as imaging modalities like the MRI that you have recently already had/been scheduled for. Bloodwork includes tests like CBC, CMP, 8 am cortisol, prolactin, TSH, free T4, Total T4, Total T3, T3 resin uptake, IGF1, FSH , LH, Estradiol. ACTh stimulation tests and serum / urine osmolality are further warranted based on results of preliminary testing. If one truly has hypopituitarism, the most critical hormone to first replace is cortisol. If you indeed have this condition, then it is expected that taking hydrocortisone in the correct doses ie 20-30 mg daily in divided doses, will be really beneficial. It is then to be ascertained which other hormones are deficient and warrant replacement. These could be levothyroxine, desmopressin, estradiol and progesterone. If you are found to have true hypopituitarism affecting the cortisol axis then it is understandable that when you received the ACTH injection, you felt better because that is one of the pituitary hormones that may well be affected due to the nature of the condition. there are myriad causes of hypopituitarism and the list is exhaustive. It requires an extremely thorough assessment
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