Unusual Symptoms

Doctor's File Notes Endocrinology eConsult February 6, 2026

Provider to Provider Consult - Feb 06, 2026 with MR at UCSF Endocrinology Practice

Notes from Care Team
A Note to Patients: Symptoms are concisely summarized to inform treatment recommendations. For reasons of privacy and brevity, this note does not attempt to capture all experiences that were discussed.

ECONSULT
MR at 2/6/2026 3:19 PM
I am requesting an eConsult from Endocrinology for 84 y.o. man for additional evaluation. None of the current endocrine SmartTexts apply: My clinical question: 84 yo man with history of chronic fatigue who has been on hydrocortisone for many years (prescribed by outside provider for low energy). Patient has been weaning and completed a cortisol stimulation test to rule out adrenal insufficiency. At the time he took the test, he was taking hydrocortisone 5 mg BID (10 mg total per day). Econsult is to help interpret the cortisol stim test results. Thank you. If this clinical question is deemed too complex for eConsult, please; Route back to me and I will discuss further with the patient.

SPECIALIST'S E-CONSULT RESPONSE
84 yo M with h/o AI, who has been on HC for many years for fatigue. Cort stim testing done in attempt to wean off HC. Pt was taking HC 5 mg bid prior to cort stim testing. It is unclear to me, looking at the results, whether the pt took HC 5 mg the AM of the testing or whether he held it. Results of the testing are:
01/28/26 0/:37 ACTH, Plasma

If pt held the HC for at least 12 hours (ideally 24 hrs) prior to the testing, then he is fine, and he can stop the HC; the results indicate there is no AI.
If he took the HC within 12 hrs of the testing, it is a bit trickier since a small % of the HC can be measured by the assay; however, he is taking a very low dose which probably doesn't have a huge impact (esp since the ACTH is detectable).
If he did in fact take the HC within 12 hours, I would recommend repeating the test or at least repeating the AM labs.
Specifically, I tell pt's to HOLD the HC for 24 hrs (ie, take dose the AM prior, don't taken afternoon or PM dose, and do not take any tabs on the AM of the blood draw) <
-- get AM ACTH and cortisol drawn, and then take the HC thereafter and send provider a MyChart message.
If the AM labs show that cortisol is >14 micrograms/dL here at UCSF, then pt does not have AI and he can stop all meds.
IF the AM labs are <=14, then cort stim testing should be repeated. He should HOLD the HC dose for 24 hrs (ie, take AM dose of HC the day before test, but don't take the PM dose and don't take dose on the morning of the testing until after all labs drawn).
MNR, MD

I spent 11-20 minutes reviewing and completing this eConsult.

This eConsult is based on the clinical data available to me and is furnished without benefit of a comprehensive evaluation or physical examination. The above will need to be interpreted in light of any clinical issues, or changes in patient status, not available to me at the time of filing this eConsult. Please alert me if you have further questions.