hand with IV

 Good Morning!


You may have heard talk about adrenal gland suppression due to long-term steroid use.


I am here to tell you today that adrenal suppression from steroid use is real and can cause a serious condition called adrenal insufficiency.


If you are the type of person who wants to know the details of medical conditions and procedures, this blog is for you.


To diagnose adrenal insufficiency, your doctor may order a simple cortisol blood test, and if that shows low cortisol, you may be asked to schedule an ACTH Stimulation test.


An ACTH (cosyntropin) stim test is used to test the functioning of your adrenal glands (which sit on top of your kidneys).  The test is designed to determine if your adrenal glands are secreting a vital hormone called cortisol which is necessary for most body functions.


In adrenal insufficiency (AI), this cortisol is suppressed or non-existent.



Due to suffering from severe fatigue, low blood pressure, and lightheadedness, I had a cortisol blood test.


When the cortisol test showed up significantly low, I was scheduled for an ACTH stimulation test to confirm adrenal insufficiency and to check my adrenal function.


I was told by my endocrinologist to hold my steroids for 24 hours prior to the test.  I was also instructed not to eat or drink after midnight, which I thought was odd.  I would check with your doctor for exact instructions prior to an ACTH Stim test.


My test was to take place at the outpatient infusion center at my hospital, where folks receive chemotherapy and other types of infusions like the one that I was to receive for my test.  


Yes, that's right, this test requires an IV.



Expect the test to take 2-3 hours total.  I recommend you bring a buddy for company or at least plan to have someone drive you home.


The reason I advise a driver is that for some people, the test can make you feel woozy.  Plus, you may not feel the best since you are instructed to hold your steroids.


I also advise that you bring drinks and food.  However, don't eat or drink until you get the green light from your infusion nurse.  A book, iPad, or other types of entertainment will help keep your mind off the test and make the time fly.



Lastly, bring your steroid medication and your emergency steroid injection (If you have one due to already having an AI diagnosis).


When I arrived at the center, a nurse led me to a small private room where there was a reclining chair and a TV.



The test proceeded as follows:


1.  The nurse inserted an intravenous line into my arm.  Many people have it in their hands, but I have tiny veins, so the arm was a better choice.


The nurse used the kind of IV set-up that can be capped off so that injections and blood draws can be done off the same vein.  This technique is essential so that you don't need to be stuck numerous times for this procedure. 


The lack of this type of IV set-up is one reason why others report an unfavorable test experience (i.e., multiple needle sticks).


2.  The nurse drew blood from my IV site to check my baseline cortisol level.


3.  She then injected cosyntropin, a synthetic version of cortisol.  The cosyntropin is used to hopefully stimulate the adrenals to make cortisol.  (Some report feeling lightheaded when injected).


4.  30 minutes later, blood is drawn again for cortisol levels.  This blood draw will be repeated once again at the 60-minute mark.


So in all, there should be 3 blood samples taken. 



That's it!  The IV is removed, and you should eat and drink at this point before leaving.  Remember to take your morning dose of steroids at this juncture.


I must say that I loved my infusion nurse and the center where I had my test!  I have heard stories of people who had a very negative experience with their ACTH Stimulation test.  However, my test went swimmingly well, and I had no complaints.  In fact, it was quite pleasant!


Here are a few reasons why I think my ACTH Stim test went so well.


1.  My nurse was very familiar with the test and adrenal insufficiency (OK, I grilled her on it first foot-in-mouth).  


For those of you with adrenal insufficiency, you will understand why a knowledgeable nurse is unusual, as most of the time, medical professionals are clueless about this diagnosis and treatment.


2.  The infusion center was well-run and did not appear to be understaffed or overbooked.


3.  I did not have any adverse reactions to the test.



I received the results the next day. 


Unfortunately, I still have adrenal insufficiency, but my numbers showed improvement from my last cortisol test, so I am hopeful that things will continue progressing in the right direction!


Take care, friends!