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Addison's Disease Message Board


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Rumpled said in a previous post "since most labs do not perform the test accurately (chilled lavendar toped tube, promptly spun, frozen immediately) and ACTH degrades within minutes at room temperature thus making your results lower than they really are. So if your tub was tossed in a bin, your ACTH was probably much higher. Always get copies of your tests before you leave the office and next time you get your ACTH done, pester to spin and freeze immediately, do it at 8am, and be fasting."

My son (13 yrs old...labs in previous post) did not fast, and I can't say that I have confidence that the tube was the right color or handled correctly.
I'm wondering if that would have made his cortisol lab result lower also than what it actually was (it is under a little from the normal range.) The 24 hr urine was also somewhat low, and I'm not sure how that was handled, although they did tell us to refrigerate, so hopefully they did also.
Since he did not fast, would that make the cortisol lower?

We've decided to see a pediatric endo at the Seattle Children's Hospital or possible one that visits Boise (where we live) on a monthly basis. Maybe we should get these tests redone? Also, the endo we are seeing thinks that something has changed with the ACTH stim test (an ingredient has been replaced?) and didn't want to do that test yet. According to this PA, they had a challenge trying to administer this test recently. Does anyone have any info on this?

Thanks!
Hello...
This is my experience. I have had urine tests effected by the lab having them sit out after I brought them in refridgerated. That *appeared* to make my tests come in lower but since I could not say for sure they were mishandled nor could I get a good sample from a chilled one, there is no way to know. All I know is that when I took my tests to a doc or lab and I saw them process it in front of me, my tests tended to be higher and when jugs were taken away and just set away, they tended to be lower. I only got high results from properly handled specimens. Also, some of the preservatives can interfere with the testing - none, or one of them is ok, but one of them will kill the test. I cannot remember what it is off the top of my head.

As for the cortisol blood test, it has to be done at certain times of day to be diagnostic. Fasting is preferred but not mandatory but my better docs want an 8am fasting, or 4pm (this is usually not fasting). Why this timing - to coincide with the body's diurnal rhythm. 8am should be the highest and 4pm should be roughly half. Abnormal is to have them the same or the 8am to be low. Loss of rhythm is telling as well. Many doctors like to do midnights as well and also this can be accomplished with saliva testing but saliva tests free cortisol will blood is serum (both cortisol but different forms and some people do not "spill" free cortisol hence will not get high UFCs or saliva tests due to medications or other reasons just due to their bodies - it can happen - high cortisol binding globulin). Midnight should be close to one. That is how you sleep. It then rises during the night and gets you up in the morning. It then falls naturally during the day. This is a normal person.

Usually a good endo will repeat the tests multiple times anyway - once is not enough.

The challenge with the stim test is that the ingrediant used to do the stim - CRH - is in shortage. It is a chronic thing.

Sorry to hear your son has problems.





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