Concerns About Low ACTH and Cortisol Levels
30-year-old female, weighing 140 lbs at a height of 5'7". Hello everyone, I wanted to share my situation: For quite some time, I have been experiencing extreme fatigue, significantly low blood pressure (98/64), nausea, intolerance to cold, unexplainable hot flashes, fluctuations in weight, ocular migraines, dizziness upon standing, irregular menstrual cycles, decreased libido, and persistent brain fog. Additionally, I have been diagnosed with Hashimoto’s but have yet to start on any medication, and I have not utilized any steroids. Recent laboratory results taken two weeks prior to the stimulation test indicated: - Cortisol: 5 - ACTH: 6.3 - DHEA: 92.9 - Testosterone: 3.3 - An MRI conducted in 2023 returned normal results, although it was performed without contrast. During the ACTH stimulation test (while fasting), the results were: - Plasma ACTH: 12 - Cortisol levels increased from 7 to 19, eventually reaching 23. The endocrinologist deemed this as a “normal response.” My worries include: - Given the low levels of ACTH and cortisol, I am concerned this might indicate early or partial secondary adrenal insufficiency or problems related to the hypothalamic-pituitary-adrenal (HPA) axis. - Could my Hashimoto’s or chronic inflammation be affecting my HPA axis? - Does the absence of contrast in the MRI suggest that certain subtle issues like a microadenoma or hypophysitis might have been overlooked? - Are my low libido and irregular cycles indicative of a more extensive pituitary malfunction? - Is it possible that the ACTH stimulation test was inadequate since it primarily evaluates adrenal function rather than pituitary activity? Any advice or shared experiences would be greatly valued. I’m not seeking to simply label my condition; rather, I genuinely do not feel well and wish to avoid being disregarded again. Almost three years of feeling unwell has left me exhausted, and I long to regain my sense of self. Thank you in advance for your help.
Answers (1)
7/2/2025, 8:20:41 PM
OpenHealth AI
Thank you for sharing your extensive concerns and symptoms. It sounds like you are experiencing a challenging time with your health, and your symptoms are certainly deserving of thorough attention. Here are the main points to consider regarding your situation:
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Concerns About Hormone Levels: Your low ACTH and cortisol levels, along with the symptoms you're experiencing, may indicate potential adrenal insufficiency or dysfunction in the hypothalamic-pituitary-adrenal (HPA) axis.
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Impact of Hashimoto’s: Hashimoto’s thyroiditis can impact overall hormonal balance and may contribute to your symptoms, including fatigue and menstrual irregularities.
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MRI Considerations: While your MRI results were normal, the absence of contrast can limit the detection of some subtle conditions. If there's concern about abnormalities like microadenomas or infections, discussing further imaging options with your doctor may be beneficial.
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Implications of Your Symptoms: Your symptoms such as low libido, irregular menstrual cycles, and brain fog can be indicative of broader hormonal imbalances, potentially involving the pituitary gland.
Actionable Steps:
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Symptom Tracking: Keep a detailed symptom diary that includes your fatigue levels, menstrual cycle patterns, and any changes in your other symptoms to provide valuable information for your healthcare provider.
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Follow-Up: Schedule a follow-up appointment with your endocrinologist to discuss your concerns about hormonal levels, the significance of ACTH and cortisol findings, and the potential for further testing or imaging. Specify your need for clarity on how Hashimoto’s may affect your endocrine health.
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Monitor Blood Pressure and Symptoms: Continue to monitor your blood pressure regularly. Take note of your symptoms related to blood pressure changes, such as dizziness, and share this information with your provider.
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Self-Care Measures: Focus on establishing a healthy daily routine, including balanced meals rich in nutrients, regular hydration, and adequate sleep. Incorporating gentle exercise, like walking or yoga, can help manage stress and improve overall well-being.
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Support Systems: Consider reaching out to support groups for those with chronic conditions like Hashimoto’s or adrenal issues, as connecting with others can provide emotional support and practical advice.
It's crucial that you feel heard and understood during this process, so advocating for your health and expressing your concerns clearly to your healthcare provider will be vital. Remember, you're not alone in this journey, and seeking help is a significant and positive step.
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