Cushing's Syndrome w/ Low Testosterone caused by Adrenal?

[adamb00]

I'm a 19 year old male, that feels like a 13 year-old boy sometimes... Blood work and Urine Tests are below...

What I'm experiencing is:
*Central Obesity
*Moon Face
*Buffalo Hump
*Excessive Body Hair Inconsistent With Familial History
*Extreme Fatigue
*Relatively High Pitched Voice in comparison to peers
*Non-Broadening of Shoulders
*Feel younger than peers that even I am older than
*Small Penis/Underdeveloped
*Hypertension
*Heart Palpitations
*High Blood Pressure
*Red Face
*Acne
*Anxiety/Depression
*Trouble Getting To Sleep Even Though Tired


What concerns me the most is while they consider my testosterone 'normal', it's 368, and in combination with my symptoms and age, couldn't this be considered low?  Additionally, as you can see from the below lab work, I've out-of-range (high) cortisol levels, and out of range (extremely low) ACTH levels.  

*Being that normally High Cortisol + Low ACTH = Cushing's Syndrome w/ Adrenal Tumor, could Adrenal caused Cushing's Syndrome cause Low Testosterone Levels?  
*My doctor ordered two additional UFC's to compare to what are below, and we're waiting to hear back.... but in interim.... what is your input based on what we know right now?

Test

Aldosterone                                              
Result: 4.3    ng/dl         Reference Range:  3.0-10.0

Plasma Renin Activity                              
Result:  1.8    ng/ml/h    Reference Range:  0.6-4.3

Cortisol AM                                              
Result:  1.3    mcg/dL    Reference Range:  <1.8 (Low Dose DST Suppression)
Adrenocorticotropin Hormone (ACTH)    
Result:  < 5    pg/mL    Reference Range:  7.0-50.0
Total Testosterone    
Result:  368    ng/dl      Range:  262-1593
Free Testosterone    
Result:  12.3    ng/dl      Range:  7.4-22.6
Luteinizing Hormone (LH)    
Result:  2.9    U/L      Range:  1.0-9.0
Follicle-Stimulating Hormone (FSH)    
Result:  2.4    U/L      Range:  5.0-15.0
17 OH Progesterone    
Result:  130    ng/dl      Range <200
Cortisol,Free,Urine    
Result:  33.8    mcg/gcreat    Range:  1.3-27.5
Creatinine,24 Hour Urine    
Result:  2.27    g/24h   Range:  0.63-2.50
Cortisol,Free,24 Hour Urine    
Result:  76.8    mcg/24h    Range:  4.0-50.0

[rumpled]

Most doctors will consider that you "failed" the DST. However, there are a few experts out there that look to that test as not one of exclusion, as it is not very reliable (I personally know of more people that failed it than passed it and I know a lot of people with Cushing's), and most people that fail it have pit source when they seem to have iffy source tests. By that I mean my tests appeared to show adrenal source as my ACTH was always normal, but in reality, it was my pituitary. I did have a pituitary tumor and later when I had my adrenals removed, it also confirmed pit source. This has happened many times and it takes a lot of testing to show source.

My ACTH is very high now that my adrenals are out, and a delay in getting to the centrifuge results in an 800+ point drop in my results (at Quest) and the range is only 6-28... however, my highs are something like 2524 and 3117 when it gets to the lab faster. Who knows what I could get if I had a chilled tube now - ooooh!

[adamb00]

I'm seeing an Endo at the NIH.  Plasma Renin was completed at NIH.... ACTH completed at Quest Labs.  The tech was very thorough and I do believe it to have been accurate.  The Endo ordered more UFC's to see.... but curious as to why you indicated probably pituitary due to the Low Dose DST Supression?

[rumpled]

Was your ACTH done properly - was it in a purple topped EDTA tube, chilled and the tech took it, quickly labeled it and put it in the centrifuge immediately after the draw? If not, and it went into the bin, it is invalid. It degraded. Renin too. Those two are fussy tests and if not handled right with the tech, die in the bin.

That being said, I had normal ACTH and had Cushing's. It can happen. Now my tumor is way happy and my ACTH is super high.  You have the UFCs to be suspicious. The T would drop due to the cortisol - studies support that.

You need to get to a proper neuro-endo and get an MRI and see if you have pituitary or adrenal. Likely pituitary looking at your suppression test. But yes, you look like Cushing's syndrome and you need a doctor that knows how to treat it.