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Can stress affect the tests that much?

Guest Endlessness


Guest Endlessness

Hi everyone!


I have been seeing my endocrinologist for a year now trying to figure out a few symptoms I've been having:


- Extreme fatigue

- Extreme hair loss

- Brain fog/poor memory

- Heart palpitations

- General feeling of being unwell/that something is very wrong


He did a lot of tests that came back normal, but last time I saw him, he ordered a bunch of adrenal tests just in case. The results are abnormal:


Cortisol Total Serum: 20.8 [4.6 - 20.6]

ACTH Plasma : 79 [6 - 50]


There was also this abnormal result test:


Creatine Kinase: 21 [29 - 143]


I have a few questions about those, if you wouldn't mind helping me until I see my doctor! I'm looking for a bit of input while I'm waiting very impatiently for my appointment :P


1. I didn't know I had to take the tests between 7am and 10am. I took them (fasting) at 11:23am. Is that why they are elevated?


2. I was a bit stressed while getting the blood drawn because I was tired and dizzy from not eating, and well, having a needle poked in your arm isn't really relaxing! Can it also be the only reason why it's elevated?


3. I realize that they are not THAT high compared to the range. How elevated would they be for someone who has Cushing's?


BTW, I don't have any of the classic signs (moon face, stretch marks, neck and trunk fat)


Thank you so much for your help!



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Morning testing is not a good diagnostic test for cushing's. Cortisol testing for cushing's needs to be done at night.


A cortisol sample taken at 11 AM would generally be a bit lower than one at 8 AM in a normal person, not higher (depending on a number of factors depending on when they woke up, etc.).


Your plasma ACTH is quite high but a single high morning plasma ACTH is not indicative of Cushing's on its own. If Cushing's is suspected you need proper testing for it - 24 Hour Urinary Free Cortisol and Mignight Salivary Cortisol and/or Midnight Serum Cortisol.

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The reference ranges take stress into account in awake subjects, where the levels are higher than sleeping ones... if you're high, you're HIGH. It could be very useful to have serum and saliva sampling on a few days at 8 a.m., 4 p.m. and midnight. These are the only times for which there are reference ranges. Doing so would document if/when you have a reversal of normal circadian rhythm, a hallmark of Cushing's.

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Thank you so much for your answers!


My endo had me redo the tests at 8am and 5pm. When I saw him this afternoon, he said the ACTH was high in the morning but normal in the PM, and the cortisol was normal for both tests. He says he doesn't think I have a problem related to my pituitary gland and moved on to something else.


I just want to make sure that he is right. I would like to know your opinion on my lab results, as I have no idea what they really mean!



ACTH 63 (6-50 pg/mL)

Cortisol 19.4 (4-22 mcg/dL)



ACTH 22 (6-50 pg/mL) *it says "reference range applies only to specimens collected between 7am-10am."

Cortisol 8.2 (3-17 mcg/dL)


If you were me, would you pursue this further and press for more tests, or is it pretty clear I don't have any problems?


Thank you for your help again!

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