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Addison's Disease Message Board

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Also, although, again I highly recommend you talk to your doctor... in some ways it seems odd that you would be so high when you weren't before. But, there's a couple of things to think about ....1) during pregnancy your adrenal response (normally) would increase 60 to 80 percent 2) the ACTH test (and I'm assuming you had the high dose 250 ug test because that's what appears to be most often given) gives you what is called a superphysiological dose - more than your body could ever produce on its own to see how your adrenals work 3) what you are given for the test is a shot of the hormone that the pituitary produces - if you have a primary deficiency, your adrenal glands won't respond adequately or at all to that hormone because the adrenal glands aren't working right. if you have a secondary deficiency, the theory is that your response won't be good because your adrenals will have started to not respond as well because they have not been getting ACTH from the pituitary ( i think effectively the adrenal gland falls a asleep - I've seen it referred to as atrophy). I've read for secondary deficiency, that if the ACTH test were repeated the next day, the response would be higher (I think because your adrenals woke up a bit). 4) From what I could see from doing my own research for myself, the information out there about what test results are right for pregnancy in this area seems to be on the sparse side ( probably because there's not a lot of testing in pregnant women for this issue).

I've seen all sorts of estimated ranges as to where your AM cortisol should be in your 3rd trimester. I've seen 25 to 35 as the right range. In a medical journal article (cite to follow), Ihe authors note that in 4 different studies, the following ranges were considered normal 13.7 to 37.7, 20.9 to 50, 21.6 to 31.2, and 24-36.2 (American Journal of Obst & Gynecology 183:669-73(2000). In this article, among other things, 6 women with normal adrenal function were given the low dose ACTH test (1 ug as opposed to 250). The highest result achieved was a bit over 50. That's only 6 women though and I wonder if those 6 women would have gone higher with the high dose test, or if with more normal women, the range would have been different.

So, anyway, from what you said before, it sounds like your AM cortisol is way, way too low even if you weren't pregnant. Low blood pressure is a classic sign of low cortisol. I don't know why you would score so high on the ACTH stim test, although perhaps it is a lab error. Or maybe you are secondary and normally your pituitary wouldn't be putting out the right amount of ACTH, but your adrenals have woken up from being stimulated during pregnancy ( I think the placenta produces a hormone like ACTH) . Perhaps you could have a secondary deficiency and because you're pregnant your adrenals have really woken up and when given ACTH they react well (but again, if you have a secondary deficiency, your body would not be supplying the right amount of ACTH and so it won't react to stress appropriately to trigger your body to make enough cortisol when it's needed).

I searched high and low for myself for a study dealing with ACTH stimulation tests in women that had a secondary deficiency because of a true pituitary problem. I didn't find anything other than articles looking at women who's response was suppressed because of taking steriod injections for lung maturity. In fact that study I cited about, looks at that issue. That study involved only 8 pregnant women who were taking the steriod injections and none of them had ACTH response rates that went above 30. In a later article (which I still can't find) another researcher uses that study to conclude that 30 should be considered the cuttoff for the 250 ug ACTH stim test in pregnant women in late pregnancy (although he's not sure himself if that cutoff is correct).

Again, please keep in mind that I'm not a doctor. I'm only sharing with you things I read when I was pregnant and worried; and I'm strongly suggesting that you speak with your doctor. Please don't not talk to your doctor and also not take the medicine you've been prescribed. Please get answers to all your questions and if you don't trust your doctor, try to get a second opinion quickly before you just decide not to take the medication. Also, you need to know from your doctor whether you should be treated during delivery since this is a highly stressful time for your body and if your body isn't going to produce ACTH and cortisol correctly, you would need to be medicated during delivery (and I believe for days later). If you need such treatment, your endo needs to communicate this to your OB.

Take care of yourself. (hugs)

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