Test Result : CAH??

[Rubisingh]

I am 26 years old married woman. I have  Hypothyroid, frequent period( every 18-20 days) and Hirsutism. I am taking
Synthroid( half of .075 MG), Aldactone 50MG( twice a day). My Thyroid level is normal now. My doc did all my blood work.

There result are :
Test Name                Result     Ref. range

ACTH               :   22.5 pg/ml    0.0-56.0

Cortisol Baseline  :   16.1 ug/dl    2.5-25.0
Cortisol (45 Min)  :   25.6 ug/dl

17-OHProg (0 Min)  :   3.82 ng/ml    0-1-3.3
17-OHProg (45 Min) :   4.81 ng/ml

My Question is what disease I have. Is this CAH??  What is these result showing. Should I consult with doc? And What medication should I take?

[rumpled]

I am sorry, I did not what you wanted help with? I know I speak other languages and I just am not certain. Can  you say it another way?

[Rubisingh]

Thanks for your support... Please suggest me on the above question as per your understanding... that will be great help for me.

[rumpled]

I sent you the chart, or rather a link to the chart in PM. Email addresses in the boards are not allowed - for your safety so spammers can't see them.
I am assuming your doc is an endocrinologist. The chart I had had US levels on them - but perhaps your levels need to be adjusted since they are non-US and I did not account for that...

[Rubisingh]

I forgot to sent you my email id : sameer.gupta.***@****
Please send me the link to the chart,  it will great helpful.

Thanks!!

[Rubisingh]

Thanks for your support!!

I am not sure why, but my Doc took me ACTH Stimulation test of 45 Min. As you can see in my test result, my ACTH level, Cortisol level was normal before stimulation. But my 17 OHP was high. And after ACTH Stim test, the cortisol and 17 OHP level increased. But how much they should increased, I am not sure. But apart from thses I have other symptoms like frequent period( in every 18-20 days), excess hairs on my body ( hirsutism), and hypothyriod. So please suggest that I have LOCAH and which another doc I should consult.

Because Yesterday I had my doc appointment, and she told me that I have LOCAH and she prescribed me Dexamethasone 0.5 MG along with Aldactone 100 MG( BID). She didn't give me any medication for regulating my period.

What should I do, I am worried. Because she also told me that Dex has so many side effect. Please advise. And If I plan for a baby, then should I take extra care??  

I dont know so much about Cushing Syndrom, So please suggest that I have that or not??

Thanks!!

[rumpled]

You would have late onset - LOCAH which is also non classical.

I am not sure why they did your ACTH draw at 45 minutes - usually it is 30 and 60...
"A single blood test, drawn in the morning and looking at adrenal steroid levels (17-hydroxyprogesterone, androstenedione and testosterone), may be sufficient to make the diagnosis of CAH. An ACTH stimulation test is done to confirm the diagnosis. A dose of ACTH, or adrenocorticotropic hormone, is given intravenously. Blood samples are taken before the medication is given and again a half-hour and hour later.
People without CAH respond to ACTH stimulation by releasing cortisol into the bloodstream. In NCAH blood samples taken after the dose of ACTH show large amounts of 17-OHP, the “raw material” from which cortisol is normally made. The results of the ACTH stimulating test are plotted on a “Nomogram”, see Figure 2 below, to determine whether the values indicate a diagnosis of CAH."
I will pm you the link to the chart, but you are well below the values - so your doctor is likely to tell you that you do not have CAH.

Cushing's is very similar in testing and symptoms. You did go up a bit from the stim test but it was not done correctly IMHO as even for Cushing's the intervals are 30 and 60 minutes from baseline. ACTH tests are done as well to determine if the issue is adrenal or pituitary but that can be misleading as my ACTH was totally normal and I had pituitary Cushing's, so you need to really get an expert and test a lot. Other tests are saliva, blood and urine cortisol, if you are on birth control CBG, pituitary hormones, adrenal hormones, adrogens and thyroid hormones. Cortisol can effect the entire body.

[Rubisingh]

Thanks for the response.

Could you please tell me the name of the genetic test to confirm CAH? I read that there are 2 type of CAH - classic and Non-classic. I want to know which one I have??

Yes It was a stimulation test. In this, First they took my blood sample, and then gave me a injuction of Cortrosyn. Then I had to wait 45 min. After that again they took my blood sample.

I provided both the figures of my result( before and after 45 min).

And please let me know what is cushing syndrom and what testing is required to confirm this disease??

Thanks for your help!!

[rumpled]

If the doc suspects CAH, there is a genetic test to run to confirm.

I am not sure what type of cortisol test this was? It was a stim test? Using Glucose, CRH?

Is the doctor also testing you for Cushing's syndrome?