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Cushing syndrome (need help)?
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Cushing syndrome (need help)?

Cushing syndrome (need help)?

I did twice 24 cortisol urine test the first one was 300 ug/day and second was 314 ug/day ( the range is 28---213 mcg/day)

I did twice ACTH plasma test the first one was 21.5 pg/ml not fasting at 3pm and second was 5pg/ml at 9 am fasting  ( the rangeis 7.20--63.3)

I also did dexamethazone suppression test 1 mg over night and the cortisol level went down to 0.91
(the range between 4.5---24)

I have high blood pressure , high uric acid , feel tired all time , gain weight , moon face , weakness and heart beating most the time after eating ,depression , upper back pain when i walk or stand for long time  , i am male 31 years old

does it mean i have cushing or not my internal doctor seem he doesnt know what to do !
4 Comments Post a Comment
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657231_tn?1390151580
I thought I already responded to this - sorry about that...

Your urine tests are elevated. The ACTH tests may or may not be accurate depending on the handling (chilled tube, spun immediately, frozen promptly).

The range the lab gives is not the range for the dex test that is the normal range - however, you suppressed which for most doctors would be a fail, but for a expert would be a *source* test.

You have to see an expert. A GP cannot and does not know how to test for or treat Cushing's. You need a neuro-endo at a pituitary center. First you have to determine if you have it and then you have to determine source - pituitary, adrenal or other.

A normal endo can take over, but unless they are smart, they may just dismiss you on the suppression test.
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Avatar_m_tn
thank you for your answer , but is there anyway i can reduce my cortisol level from going up ?

also  is there other test to do ?
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Avatar_m_tn
i dont know if that will help

my potassium serume is 4.6 (range between 3.5 to 5)
      
      sodiume serume is 140 (range between135-145)

urinary creatine 0.52 gm/l  (range between 0.60 -1.68 g/L)

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657231_tn?1390151580
Alas, there is no way to stop cortisol without medical intervention.

As you are male, you may be able to avoid surgery and take one of the newer medications, if they are approved in your country. There are a couple of short-term meds but they are not good options and have to be watched carefully.

Yes, there are other tests. Your doctor needs to do a LOT of other testing - including more cortisol testing like 8am cortisol serum, more 24 hour urine testing, midnight saliva testing, plus all pituitary, thyroid, androgen and all the rest of the adrenal hormones. That would be basic and a lot of the tests would have to be done over and over just to show a consistency.

There is no one test to rule Cushing's in or out - so you have to test to show you have it, then test (a stim test, MRI or IPSS) to show or confirm location. It just is not an easy thing.
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