Always so cold, low blood pressure 77/42 sometimes. low blood sugar. acth stimulation test ok. but sometimes low cortisol. ideas?

Sounds adrenal: B"sd this is challenging - does sound like adrenal insufficiency - probably due to hypothalamic / pitiutary dsyfunction. The options are extensive work up, or limited work up with a trial of glucocorticoids and possibly mineralcorticoid - fludrocortisone. Steroid therapy has its own significant side effects, so needs to be expertly managed, with frequent attempts to wean off the steroids.