I have an ACTH stimulation test scheduled for tomorrow ordered by Dr. Jacobs and I am a little nervous about it. Anyone get this test done? How did it feel? Anything come out of taking it etc…?
It was just a standard needle jab, nothing came of it although I never got the result.
Its not just a needle jab.
Maybe you are thinking of just checking blood levels of acth?
The stimulation test is to c how your adrenals react to stress. Can they put out enough cortisol when demanded.
I feelt really good after the injection. Then unfortunetly i felt really bad later that night and i think my recovery took a step back for quite some time after that test.
The test is a burden for the adrenals if they are allrdy taxed.
I know that the now have the same test but they inject much less acth so its not so much stress and its also speculated that some ppl do not react to this “micro” version but have a normal response to the regular test. Also speculated that some ppl who do not respond to the micro version may have a form of adrenal failure alltho they respond in range for the regular acth stimulation test.
How did the test go?
So, Is there an advantage to doing this test over the 24 hour saliva test? Or do people sometimes do both tests?
I just felt a little hot, a little light headed. Am awaiting the results and I will let you know as soon as I get them…
So, Is there an advantage to doing this test over the 24 hour saliva test? Or do people sometimes do both tests?
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I wouldent say one or the other test hold advantages over the other but they do test completely different things.
A 4xsaliva 24 hour test is just like measuring your cortisol in the blood 4 times a day theoreticly. Its just more convenient to do so in saliva than in the blood as the patient then can do this from home and not going into the hospitall 4 times that day. But many doctor do not think that saliva cortisol readings are a very accurate reading. The jury is still out on saliva cortisol readings if you ask doctors.
Acth stimulation test has the ability to measure what happends with cortisol when the person is under alot of stress. The saliva tests can not do this as it would be impossible to evaluate what kind of stress the subject is under on the day of the saliva readings.
When a person is under alot of stress the acth would increase if everything was working properly and the cortisol would rise if the adrenals were functioning properly. This is the situation you are trying to create with the acth stimulation test.
So in short:
Saliva tests could possibly point you in the direction that something is not working properly if the results are strange. It could not on the other hand tell you if the problem is with the pituary or the adrenals themselves or somewhere else. And the debate if the test results themselves are reliable is still non conclusive (my opinon and most docs).
Acth stimulation test can according to most doctors exclude failing organs if the results are satisfiying to the practioneer. And adrenals that fail to produce enough cortisol directly points toward organ malfunction.
The huge ranges for normal cortisol value make this an even harder situation to evaluate. Then take into consideration that all other hormones are measured in total but also free or bioavailable versions. Why this is not done with cortisol i have yet to find an awnser for. We know for instance that a high total T with a low Free T or bioavailable T can still cause symptoms. Why isent cortisol measured as total and Free too?
The results of my ACTH stim test according to Dr. Jacobs trended towards having CAH or 11 beta hydroxylase defieciency but weren’t totally conclusive in this regard which makes it more difficult in my mind to decide on a course of treatment. I told him about the daily stress/anxiety that I am under etc.
Told me I may benefit from a half mg daily of dexamethasone. Thoughts anyone?
Hey
Please tell us more about the results and ranges if you have it available.
I really have no oppinion on helping ppl treating adrenals, or enough knowledge for that matter. I think adrenals are serious enough to let doctors do that for you.
Im guessing your results show a normal response in progesterone yet not a very good response in cortisol considering your doctors thought, is this so? Thats very interesting if this is the case. More than 1 person here have had elevated progesterone including myself. I did not know enough to ask for testing of progesterone and other acth dependent hormones when i did my stress test. If your points toward something i would redo it even tho i felt like crap after the test.
Please ask your doc for copies of results if you dont have them.
I spoke to Dr. Jacobs on the phone and all he mentioned was that he did the “formulas” regarding the test and came up with a number in the 7’s range which accoring to him was high but not overtly so that a definitive diagnosis of CAH can be made.
We spoke for about 40 minutes and that was the gist of the test results. I will ask him for a copy of the results though.
Im anxious to hear about your results.
So much in our symptoms points towards adrenal malfunctioning. Maybe not adrenal failure so this possible enzyme defficiancy is very interesting. Especially considering many have had elevated progesterone. And most if not all are very ill affected by stress.
On top of that all that i know of seem to do better when cutting out sugar and fast carbs.
Keep us updated.
Anyone else had an acth test when checking for more than just cortisol to determine how the enzymes are working ? Why on earth dident my doc know to test for possible enzyme defficancies when i did the damn test especially considering i had shown elevated progesterone before. Its like they are doing the bar minimum alll of the time. Argh .)
Cheers
Nothing yet eh? 
Im abit exited about this possible theory as i actually believe it could be the one! It would also explain that some of us have so high dht for instance and low lh / small testicles and perhaps even genital changes as documented in litterature (in children but still).
Please god make this the one
Edit: Have no time to research now but If Ketoconazole could suppress this enzyme than possibly fin could to.
The imidazole derivative ketoconazole and the aromatase inhibitor aminoglutethimide have been evaluated as possible agents with which to achieve decreased production of adrenal steroids. Ketoconazole is relatively unselective, inhibiting both cholesterol side chain cleavage and 11β-hydroxylation
I was told in a different thread to go read up on gaba on the mental section.
So i took a brief look at the thread i thought i was reffered to. I did not look much into the mental section before cause i have previously had very little mental issues but since my last Trt episode where i seem to have been getting more anxiety from its become more relevant.
According to conversation with Dr jakobs above one can assume (perhaps wrongly…) that the findings of this ACTH test this time had some results that suggested or infact measured elevated DOC levels, the very same hormone discussed (among other derivates of progesterone) in the gaba thread in the mental sides forum here: viewtopic.php?f=24&t=668
Jakobs speak of possible 11b hydroxylas defficancy or CAH. Now im thinking he concluded that since the response of ACTH injection showed elevated DOC levels and possiby only a modest elevation in Cortisol after same injection. To me that would be the only way to come up with 11 b hydroxylase defficiance from an acth test. Again im a novis so i could be off allrdy here but thats what i make of below pathways.
pathway and more:
caresfoundation.org/productcart/pc/rare_forms_cah.html#_11β-Hydroxylase_Deficiency
Progesterone goes up after injection so that enzyme is working but Cortisol remains on the low side compered to DOC so he suspects the 11b hydroxylase enzyme is defficient. But what if its not and its infact the convertion of DOC to DHDOC amd THDOC that is missing so DOC level remains too much elevated after ACTH injection?
Considering that 11 b hydroxylase defficiancy as i understand it is inherited genes from both parents and is to my limited knowledge always detected in infants or children because of sexual virilization at an early age, i suspect the fact that FIN dissrupts the convertion of DOC to DHDOC and THDOC leaving you with an elevated DOC is alot more likely than this gene mutation. If this is the case and my wild speculation here is correct it could perhaps also be proven “IF” 11b hydroxylase is always inherited. Then we must have these genes, or we cant have the deficiancy? So if elevated DOC is not a result of genes it would have to come from something else, possibly no convertion of DOC to 5-dihydrodeoxycorticosterone (DHDOC) and allotetrahydrodeoxycorticosterone (THDOC), a GABAa receptor-modulating neurosteroid with anticonvulsant properties
Im obviously a novis at this but to me this is very interesting. Is this something you have been aware that you can actually test? If so how come noone tested these levels after acth injection since so many have belived in gaba theories?
Dissclaimer: its late n im a bikemessenger 
I think mew has had the test you are talking about…acth interpreted with cortisol?
No thats not what im talking about in the previous post. Acth with cortisol interpetation is a regular acth stim test. Ive done this aswell.
What jacobs probably did is to measure more than the end product (cortisol) when subjected to acth. He must have measured all of the or atleast most steps in cortisol synthesis and also possibly comparing them by ratios to have come up with 11 b hydroxylas difficiency.
EDIT:
To simplify.
If we have an 11 b hydroxylase defficancy we would have an elevated ratio of progesterone and doc levels compared to cortisol. It would take more effort and more prehormones to produce the same amount of cortisol that a normal person would after a stressfull event.
These prehormones can be converted to androgens and ofcourse estrogens and possibly lower LH even in an adult male. On top of that elevated progesterone can lower 5ar and DHT levels.
Cortisol feedback is affected since the cortisol production ratio is impaired.
Now on top of of this, what if DOC is no longer converted in the same abundance to DHDOC and THDOC similar as to when on finasteride and now because elevated progesterone we would possibly have impaired calming affects from cortisol production. So whats to stop our stress reaction from a stressfull event?
Im definetly not saying this is whats happening or even that it definetly works this way but its atleast a pretty good theory (with my limited understanding) and it would explain pretty much all of the sideffects known to finasteride users.
I discussed this with my doctor today and he said i could do the acth stimulation test again with the 21 and 11 hydroxylase testing done aswell.
He also mentioned that suspicions of 11b hydroxylase defficancy was something they often suspected when ratios were measured in urine but that these findings never or very rarely could be duplicated in serum testing or even genetic testing.
My question to you is how was your values measured before and after acth injection? Via serum (blood) of by urine? It might be so that acth sim testing results is never measured in urine but forgot to ask the doc that. So what say you, blood or urine?
Any news of the actual test results?
Cheers!
As someone with high progesterone and insufficient cortisol response to ACTH, this theory makes the most sense to me so far.
Any ideas what tests I can take to explore this further?