Hi ckl,

I am sorry I missed your original question, but if the question is: Is it always necessary to inject some sort of "stimulant" in order to measure ACTH, the answer is "no."

It sounds like your doctor is measuring your son’s ACTH levels, as part of routine monitoring of blood tests. Like 17-ohp, androstenedione, and testosterone, measuring ACTH levels is another way of helping doctors determine if a patient is under good adrenal control.

An "ACTH Stimulation Test" is done for a different reason. In that case, you WOULD inject a stimulant called "cortrysn" into the bloodstream in order to stimulate the adrenal glands to produce ACTH and cortisol. This test is used for DIAGNOSTIC purposes, to determine if someone has CAH, not as part of routine monitoring. It is also generally only necessary to do the Stimulation test, when a child’s baseline levels are somewhat borderline, indicative of a milder form of CAH.

As for PRA, you do get different measurements lying down or standing up, but from what I understand, "normal" values can vary quite a bit from lab to lab, so it’s very difficult to talk about "normal" values.

For what it’s worth, you son’s doctor sounds pretty "on top of things" from what you have posted about her in the past. (At least in my opinion!)