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Family Medicine (Expert Forum)
Endocrine Question
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
Questions in the Family Medicine forum are answered by Dr. J.M. Keyes. Topics covered include general health issues, adolescence, babies, child health, eating disorders, fitness, immunizations and vaccines, infectious diseases, medical tests and procedures, and senior health.
Endocrine Question
by jenmac, Feb 25, 2007 12:00AM
Hi! I'm concerned about having some sort of endocrine problem. I have a history of infertility...premature ovarian failure, and now at 40 I've continued to alot of different medical problems, my lab values came back I think on the low side. AM ACTH=6 and Serum AM Cortisol Level=9....DHEA-S=34, TSH=1.6, and T4=10.3,FreeT4=0.68, FreeT3=281, and T3Uptake=25.6. My concern is that I'm on 1mg of Estrogen a day (s/p TAHBSO at age33), I know estrogen raises cortisol levels....what would mine be if i wasn't on the estrogen....probably pretty low (i assume). Thus, are my levels indicating some sort of adrenal insuff. problem and should I be following this up with an ENDO DOC...or am I worrying for nothing. Any ideas or input would be great. Jen in NJ P.S. My Symptoms:weight gain, fatigue, clumsiness, and just a general "out of sorts" feeling....
Doctor's Answer
by Kevin Pho, MD, Feb 26, 2007 12:00AM
, Feb 26, 2007 12:00AM
It is difficult to predict what your cortisol level would be off the estrogen. If there is concern about adrenal insufficiency, an ACTH stimulation test should be performed.
This is normally accomplished with the administration of ACTH and then measuring the cortisol levels in response to this. Those with adrenal insufficiency would be an inadequate response.
This test should be discussed with your personal physician or endocrinologist.
As for the other symptoms, you can consider a referral to a neurologist. Testing for the vitamin B12 level can also be considered as well as brain imaging, like an MRI.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
This is normally accomplished with the administration of ACTH and then measuring the cortisol levels in response to this. Those with adrenal insufficiency would be an inadequate response.
This test should be discussed with your personal physician or endocrinologist.
As for the other symptoms, you can consider a referral to a neurologist. Testing for the vitamin B12 level can also be considered as well as brain imaging, like an MRI.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
