Is it possible to have undetectable cortisol levels in secondary adrenal insufficiency?
Young, previously healthy male with normal growth presenting with two syncopal episodes. Currently, only symptom is mild fatigue. Labs showed: Cortisol undetectable with ACTH 6-8, cortisol levels did not rise with cosyntropin but aldosterone stimulated normally, low IGF1, mildly elevated prolactin, elevated TSH and low free T4 (normalized later). CBG wnl and opiate/steroid assay were negative. MRI with small pituitary. Some of my colleagues think it is interference or assay issue, others think this is true central AI.
2 Answers
Mednet MemberInvited Expert
Endocrinology · Johns Hopkins Endocrinology and Pituitary Center
Answered on
Yes, you can certainly have undetectable cortisol in central AI. Low IGF-1 and low-normal FT4 would suggest hypopituitarism. Do you have a testosterone level? I would perform a GH stimulation test. An abnormal test would confirm pituitary pathology. Before this, however, I would carefully investigat...
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Mednet Member
Endocrinology · University of Missouri School of Medicine
Answered on
I agree with Dr. @Dr. First Last, it is very strange to see these elevated testosterone levels. And also to start thyroid replacement while trying to work through this.
I have a few clarifying questions. What work does he do? What are his hobbies/athletic interests? Do you have a testicular exam on...
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