Adrenal Insufficiency Support Group

These are the labs that my son had gotten. I am confused about the aldosterone. The first set of results are AFTER ACTH stimulation. Aldosterone seems to be low for having had acth stimulation (14) - what do you think? Also, does anyone know why renin would be 2.7 before acth stim and 1.6 after? Any insight would be appreciated... also, any info about how extreme stress would play a role in these results

These results are after acth stim:

aldosterone 14 reference range: <=21

renin: 1.6 reference range: 1.2-2.4

DHEA: 140 reference range: <15-312

17OH Pregnenolone: 348 reference range: 29-180

Androstenedione: 39 reference range: 17-72

Deoxycorticosterone: 54 reference range: 2-19

DHEA: 358 reference range: 170-585

Dihydrotestosterone: 16 reference range: 8-33

Progesterone: 49 reference range: <10-15

Specifice CMPD S (11 - DEO 202) reference range: 12-158

testosterone total: 152 reference range 100-320

A1c: 6.7

These are before acth stim:

Biochemistry referred tests:

Renin 2.7 o minutes before giving cortrosyn/cosyntropin reference range: 1.2-2.4

ACTH (compromised by sitting room temp for 30 minutes) 27 reference range 10-60

17-OH Pregnenolone 217 reference range: 44-235

17-OH Progesterone: 52 reference range 10-138

Androstenedione: 36 reference range: 17-72

Deoxycorticosterone: 14 reference range: 2-19

DHEA: 280 reference range: 170-585

Dihydrotestosterone: 22 reference range: 8-33

Progesterone: <10 reference range <10-15

Specific CMPD S (11-DEO 88 reference range: 12-158

Testosterone, total: 152 reference range: 100-320

maybe b/c his blood pressure was lower on the second draw?

Here is a better representation of my son's labs.

Not sure how cortisol is a reflection of a the test since he was under extreme stress again.

btw IT SEEMS TO ME THAT THESE REFERENCE RANGES ARE NOT TAKING INTO ACCOUNT ACTH STIMULATION ON ANY OF THEM.

aldosterone, s:

BEFORE = IN LAB (THIS IS A TEST THAT THEY CLAIM WAS NOT DONE YET AND WON'T BE READY FOR OVER A WEEK EVEN THOUGH IT IS COMING FROM THE SAME LAB THAT OTHERS HAVE COME BACK FROM)

AFTER = 14 reference range (<=21)

____________________________________________________________ ___________

RENIN:

BEFORE = 2.7 reference range 12-17 years (1.2-2.4 ng/ml/hour)

AFTER = 1.6 reference range 12-17 years (1.2-2.4 ng/ml/hour)

____________________________________________________________ _____________

DHEA-SULFATE:

BEFORE - THIS IS A TEST THAT THEY CLAIM WAS NOT DONE YET AND WON'T BE READY FOR OVER A WEEK EVEN THOUGH IT IS COMING BACK FROM THE SAME LAB THAT OTHERS HAVE COME BACK FROM)

AFTER - 140 reference range Tanner Stage III (<15-312)

____________________________________________________________ ____________________

17 - OH PREGNENOLONE:

BEFORE - 217 44-235 reference range pubertal (44-235)

AFTER - 348 44-235 reference range pubertal (44-235)

____________________________________________________________ __________________________

17-OH Progesterone:

BEFORE - 52 reference range TANNER STAGE III age 10.7-15.4 = (10-138)

AFTER - 122 reference range TANNER STAGE III age 10.7-15.4 = (10-138)

____________________________________________________________ ________________________

ANDROSTENEDIONE:

BEFORE - 36 reference range TANNER STAGE III age 10.7-15.4 = (17-72)

AFTER - 39 reference range TANNER STAGE III age 10.7 -15.4 17 = (17-72)

____________________________________________________________ ________________________

Cortisol, serum: (under extreme stress/screaming/crying)

BEFORE - 18 reference range 1-15y 8:00a.m. (3-21)

AFTER - 26 reference range 1-15y a.m. = (3-21)

____________________________________________________________ _________________________

Deoxycorticosterone:

BEFORE - 14 reference range pubertal children and adults 8:00a.m. = (2-19)

AFTER - 54 reference range pubertal children and adults 8:00a.m. = (2-19)

____________________________________________________________ ___________________________

DHEA:

BEFORE - 280 TANNER STAGE III age 10.7-15.4 reference range = (170-585)

AFTER - 358 TANNER STAGE III age 10.7-15.4 reference range = (170-585)

____________________________________________________________ ___________________________

Dihydrotestosterone:

BEFORE - 22 reference range TANNER STAGE III 10.7-15.4 years = (8-33)

AFTER - 16 reference range TANNER STAGE III 10.7-15.4 years = (8-33)

____________________________________________________________ ____________________________

PROGESTERONE:

BEFORE - <10 Reference range 1-16 years old (<10-15)

AFTER - 49 VERIFIED BY REPEAT ANALYSIS reference range 1-16 years old = (<10-15)

____________________________________________________________ ___________________________

Specific CMPD S (11-DEO):

BEFORE - 88 reference range pubertal children and adults = (12-158)

AFTER - 202 reference range pubertal children and adults = (12-158)

____________________________________________________________ ____________________________

TESTOSTERONE, TOTAL:

BEFORE - 152 reference range Tanner Stage III 10.7 years to 15.4years = (100-320)

AFTER - 152 reference range Tanner Stage III 10.7 years-15.4years = (100-320)

____________________________________________________________ ___________________________

thank you again....

Just in reply to your ref range comment..

Its worth getting a definition in you mind of what reference range is. Basically under a stim tests they are irrelevant as soon as the Cosyntropin is injected.

Reference range is 2 standard deviations (about 95% of pop) for a measurement given a certain criteria. The obvious criteria are things like male vs female, age, cycle positions, lying or sitting etc etc. ACTH stim, major cardiac events, asthma attacks, after running a marathon etc are all non defined events that may "normally" exist outside the ref range for that test. AI people generally seem to have at least some chemistry outside of the range even if they are being treated. One of the big problems we face is the cyclic nature of cortisol replacement. When you had your last pill directly affects many tests, so the reader has to examine the "why" vary carefully, not judge on ranges.

If you really want to understand this stuff here is the rundown (its a big job). Find exactly what the steroidogenesis is about;

http://upload.wikimedia.org/wikipedia/commons/1/13/ Steroidogenesis.svg

Look at what glands produce what and how the system flow goes together. Its handy to print this and write numbers from your tests on it.

For each of the steroids find out what the stimulus hormone is (mainly from the pit)

Draw a big flow chart.

You also have to know the Renin-Angiotensin-Aldosterone system

http://en.wikipedia.org/wiki/Renin-angiotensin- aldosterone_system

When you have the flows you can figure out what ACTH stimulation actually does. You'll be able to draw little arrows on your printed drawing.

First pass though you'll see a rise in Cortisol and DHEA AND their precursors. You also see a rise in the Aldosterone precursor (corticosterone), but not Aldosterone itself. (Since that works on "measuring" potassium levels) Keep in mind too that adrenal androgens are not a big source for males. (Which is pretty well why his testosterone didnt budge)

Yes this is a huge ask. Things like this takes me hours. I cant just look at a test and see a bright light!

Bob