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Adrenal Fatigue Testing Overview:

In order to gauge your current state of health, our clinic will often request copies of your last two years of medical testing and will often recommend further testing as needed.  Our clinic does request some testing that is and not commonly performed in more "mainstream" medical clinics.  24-hour heavy metal testing with provoking agent, neurotransmitter analysis, food sensitivity testing, comprehensive stool testing and Candida antigen testing are commonly recommended by our medical staff.   Some of these are discussed in detail in the links in this section.

What to Expect on Your First Visit:

First office visits typically last 45-60 minutes.  Your doctor will review your intake form with you and gather a detailed medical history.  A partial physical exam is usually performed and medical records are often requested from your primary care physician and/or other doctors.  Specialty laboratory testing may be recommended.  Most clients are offered an initial protocol consisting of nutritional supplementation, dietary and life style recommendations.

First Visit: Blood Test

To assess and identify kidney, liver, blood sugar and other key factors such as blood cholesterols. The results are explained to the patient, giving him/her a fuller understanding of the blood chemistry, so that they may take control.

Patients are required to fast for 14 hours before the test. Water may be drunk freely, but not tea, coffee, juices or other beverages. Appointments are normally arranged for mid-morning so that food and drink can be consumed up to 8pm the previous evening. On the day of the appointment, any prescribed medication should be taken with water as normal.

Patients are recommended to bring food to eat after the blood sample has been taken. Diabetics should advise the clinic, and separate arrangements will be made.

First Visit: Urine Analysis

To establish exactly how the kidneys are functioning. Patients are required to collect urine over a period of 24 hours. This should be as near the date of the blood test as possible, but must not include the 14 hours fasting period prior to the appointment.

A recommended timetable is that the first urine of the day should be excluded, than all subsequent urine for the next 24 hours collected in clean plastic containers. (If collection starts at 8am, this process must be followed until 8am the following day.) Eg. Appointment 10am Friday, fasting commences Thursday 8pm. Urine collection starts Wednesday 8am. until Thursday 8am.

Containers should be clearly labeled with the patient’s names and brought to the clinic at the time of their appointment.

First Visit: Resting ECG for Doctors Report

The electrocardiograph (ECG) determines the condition of the heart and measures its actions and the pulse.

The doctor in charge reports any findings in his medical notes.

Specific Adrenal Fatigue Testing:

ACTH is made in the pituitary gland in response to the release of another hormone, called corticotropin-releasing hormone (CRH), by the hypothalamus. In turn, the adrenal glands then make a hormone called cortisol, which helps your body manage stress. Cortisol is needed for life, so its levels in the blood are closely controlled. When cortisol levels rise, ACTH levels normally fall. When cortisol levels fall, ACTH levels normally rise.

What is the Adrenocorticotropic Hormone Test?

An Adrenocorticotropic Hormone Test measures the level of adrenocorticotropic hormone (ACTH) in the blood. Both ACTH and cortisol levels change throughout the day. ACTH is normally highest in the early morning (between 6 a.m. and 8 a.m.) and lowest in the evening (between 6 p.m. and 11 p.m.). ACTH levels may be tested in the morning or evening if your doctor thinks that they are abnormal. Cortisol levels are often measured at the same time as ACTH. The ACTH hormone test requires blood to be drawn from the vein in an arm to check for problems with the pituitary gland or the adrenal glands.

Indications and Contraindications

The ACTH testing is done to check for:

• A problem with the adrenal glands or pituitary gland. A high level of ACTH and a low level of cortisol (or low ACTH and high cortisol levels) could be caused by a problem with the adrenal glands. Low levels of ACTH and cortisol could be caused by a problem with the pituitary gland.
• Overproduction of ACTH. This may be caused by overactive adrenal glands and the release of too much cortisol (one form of Cushing's syndrome).
• Decreased level of cortisol caused by damage of the adrenal glands (Addison’s disease).
• Dysfunction of the pituitary glands resulting to decrease in ACTH production

You may not be tested for ACTH if you are:

• Pregnant or menstruating
• Prone to or have infections
• Severely injured
• Stressed
• Have undergone imaging tests (i.e. PET scans) that uses radioactive tracer one week before the ACTH testing

How do you prepare for the Adrenocorticotropic Hormone Test?

• You may not be able to eat or drink for 10 to 12 hours before an ACTH test. Your doctor may ask you to eat low-carbohydrate foods for 48 hours before the test. Be sure to ask your doctor if there are any foods that you should not eat.
• Many medicines can change the results of this test. Be sure to tell your doctor about all the nonprescription and prescription medicines you take. If you take a medicine, such as a corticosteroid, that could change the test results, you will need to stop taking it for up to 48 hours before the test. Your doctor will tell you exactly how long depending on what medicine you take.
• Do not exercise for 12 hours before this test.
• Try to avoid emotional stress for 12 hours before the test.
• Collecting the blood sample at the right time is often important. Your blood will be drawn in the morning if your doctor wants a peak ACTH level. Your blood will be drawn in the evening if your doctor wants a low (trough) ACTH level.
• Talk to our doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will mean. To help you understand the importance of this test, fill out the medical test information form.

How does it feel? How long will it take?

The blood sample is taken from a vein in your arm. An elastic band is wrapped around your upper arm. It may feel tight. You may feel nothing at all from the needle while your blood is being drawn, or you may feel a quick sting or pinch depending on your sensitivity to pain. The ACTH test may last for a few minutes.

Expected effects after the test:

Normally, there are no major effects after the test. Commonly, patients may feel a little sore and slight bleeding may occur on the needle site. Bring a light snack as you might feel a little lightheaded due to fasting before the test. In rare cases, people with high ACTH levels may also experience bruising.

Special instructions after the test:

After drawing the blood, cover the needle site with a bandage and apply pressure on it for several minutes. If the site becomes swollen, do warm compresses few times a day. You may resume your regular diet and your daily activities after the test. However, it is recommended to avoid strenuous activities and to report persisting pain, bleeding and swelling on the needle site.

Interpretation of Results:

An adrenocorticotropic hormone test measures the level of adrenocorticotropic hormone (ACTH) in the blood.

Results of an ACTH test are usually available in 4 to 6 days.

Normal Value- Normal values vary from lab to lab

6 a.m to 8 a.m	Less than 80 pg/mL or less than 18 pmol/L
6 p.m. to 11 p.m.	Less than 50 pg/mL or less than 11 pmol/L

High Values-

High levels of ACTH may be caused by:

• Emotional or physical stress (such as recent surgery or severe pain).
• Diseases such as Addison's disease, Cushing's disease, or a tumor in the adrenal glands or the pituitary gland.

Low values-

Low levels of ACTH may be caused by:

• Damage to the pituitary gland from surgery, radiation, stroke, head injury, or a tumor.
• An increased amount of cortisol from a tumor in the adrenal glands (Cushing's syndrome).

Condition	ACTH	Cortisol
Cushing's disease	High	High
Adrenal tumor (Cushing's syndrome)	Low	High
ACTH made outside the pituitary gland	High	High
Addison's disease	High	Low
Hypopituitarism	Low	Low

Notes:

The interpretation of the ACTH test is complicated because many things can change the results. Blood must be collected in special tubes, placed on ice, and processed quickly. The time of day when the blood is drawn can also change the results. ACTH test results should be compared to medical information gathered from other tests, especially the blood cortisol level. 

Inferior petrosal sinus sampling is a test that measures the amount of ACTH from a channel (inferior petrosal sinus) near the pituitary gland. This test may be done along with an ACTH blood test when the levels of both ACTH and cortisol are high. It is used to tell the difference between ACTH made by the pituitary gland and ACTH made somewhere else in the body. This test may only be available at large medical centers.

The Right Diagnosis and Treatment for Adrenal Fatigue

Once the comprehensive review is completed for each patient, our doctors and our team of medical professionals will evaluate your diagnosis. At this point, our doctors will spend one on one time with you to interpret and explain your results. Together you will explore your goals and discuss your treatment plan options. These treatment plans can be implemented using multiple modalities such as medications, hormones, diet, supplements, behavior and lifestyle changes, and alternative therapies. Our doctors will prescribe a preventative and comprehensive treatment plan that is tailored to your needs and fits into your lifestyle.

Patients Medical’s  Personal Approach to Adrenal Fatigue

Our doctors and our team at Patients Medical will regularly monitor your progress and track the effectiveness of your program making adjustments if necessary. Our goal is to support you and advise you every step of the way.

We work in conjunction with your existing doctors. Any gaps between specialists are filled to ensure we support your overall health and well-being. While we treat serious medical conditions such as Alzheimer’s, Diabetes, Parkinson’s, Multiple Sclerosis, anxiety, depression, and heart disease; the primary objective of our staff is prevention and early detection of disease.

We are located at: Patients Medical PC, 800 Second Avenue, Suite 900 (Between 42nd & 43rd Street), Manhattan, NYC, New York, NY 10017.