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cyclical cushings
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cyclical cushings

rumpled--this is especially for you--but anyone else feel free to join in with advice.  i asked you quite a few months ago about a friend who suspected she might have cushings--I wanted to know what tests she should have done.

She has finally started some testing.  The gal she has seen has done a saliva test--which came back with low cortisol.  She has also had a 24 hour urine test which came back low cortisol also.

She has not had a period since she had her baby (over 2 years old?)  They say she does not have sheehan's.  She has no reflexes, her face is puffy and rounder than it used to be, and she has a small fat hump on her back and the middle body weight gain.

I went back through the paperwork my doctor gave me with symptoms of both low cortisol and low thyroid----she actually seemed to have more symptoms of low thyroid and low cortisol.

When my husband went off his thyroid meds, his face puffed up.

My friend had a stim test done on monday--but here in our dinky little town--i told her to make sure they did certain things----she went in fasting--not because they told her, I think because I told her.  When she got in, she told them that it was supposed to be done as close to 8am as possible, and she also told them that the tubes were supposed to be put on ice---she said the lady just said , oh.

She also said that they only did a 60 minute draw---that the 30 minute draw wasn't necessary---I've never heard that before.   She is waiting for her doctor to get the results.  She is also diabetic.

I had forgotten what you said about cyclical cushings---how sometimes the cortisol levels will be low.

Are there any other tests she should have to pursue this--it is very obvious that she has something wrong.   I did suggest thyroid testing, including antibodies.
12 Comments Post a Comment
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657231_tn?1390151580
Yeah... cyclical is deceptive - one day or so low (it can be a week, month or hour!) and then you will hype up and it is like a nasty roller coaster.

My tests were all over - and I failed all stim tests (so I was fine, just fine...). The guidelines for testing do note that the cyclical form does exist, but that it is very rare (hah!). Under those guidelines I would not be here.

I learned to test, for me, when I felt great! That is when my cortisol was high and my aches were gone. People had to gauge acne, aches etc to know and it is easy to miss the window.
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what do you think of the lack of reflexes that she has?
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Do you think that she should continue to also pursue the correct thyroid testing?    We live in the wrong part of the country to find good endocrinologists.
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657231_tn?1390151580
No idea on reflexes - could be a separate issue.

If she has high cortisol, it would suppress TSH. She can try to regulate her thyroid but it will be jumping all over. Still, she may feel better to at least be on something than nothing.

Good endos are hard to find anywhere.
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Avatar_n_tn
One of the papers i have from my doctor says slow reflexes are a sign of hypothyroidism.

Maybe she can find a doctor that will go by symptoms instead of the stupid TSH.
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1756321_tn?1377771734
I had no reflexes with hypothyroidism.  This has returned somewhat with thyroxine althought i'm not optimally treated by any means. I thought i had cyclical cushing's but my buffalo hump is due to insulin resistance.
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I had no idea the hump could be caused by insulin resistance--she is diabetic, could that cause it also?   i felt like her symptoms matched hypothyroid more than cushings when I read through a list of symptoms.
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1756321_tn?1377771734
"The investigators conclude that individuals with buffalo hump should be closely monitored for insulin resistance and diabetes." - Elevated insulin associated with buffalo hump in Australian study

I could of told them that! LOL
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596605_tn?1369950227
The hump is associated with metabolic syndrome which causes the fat distribution to get weird. I've got a little hump too. It likes to grow when i gain weight. Jerk hump!

Folks with insulin resistance, PCOS, and Cushings can get the hump. I've got a good friend who is on the AIDS antivirals who has a hump and has lost a lot of facial fat because of metabolic syndrome caused by his meds.
Horselip
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1756321_tn?1377771734
Yes that's true.  Metabolic syndrome is also known as syndrome X or insulin-resistance syndrome; the majority of patients with PCOS have insulin resistance and/or are obese; insulin resistance is a listed side effect of highly active antiretroviral therapy (HAART).
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red star--how did you finally distinguish between cyclical cushings and insulin resistance?

So If I'm understanding you right, my friend could be hypothyroid, since her cortisol tests low---she did not have the 24 hour urine test, I was wrong, but she did hav the 24 hour saliva test, which was low.  The puffiness in her face could also be caused by low thyroid---my husbands face puffed up when he tried to go off his meds.  Her lack of reflexes could be due to low thyroid, and the fat hump could be because she has been diabetic since she was 16 (I think)--she is around 28, now.  She is not obese, but she is thick through the middle, which I keep hearing can be due to low cortisol.

She has also never had a period since she had her baby---and I  know that low thyroid can cause that also.

Did I follow you right?
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1756321_tn?1377771734
Your friend hasn't been diagnosed as hypothyroid yet? Look up myxedema skin pinch test.  Myxedema is unique to hypothyroidism. I cannot pinch any skin anywhere but the tops of my hands.

I've had many tests for Cushing's disease which were all normal. And yes i know you can miss Cyclical cushings but since correcting my severe magnesium deficiency and starting thyroxine i am noticing improvements in various symptoms.

My insulin resistance symptoms (that i know of): very high hip-to-waist ratio (was 0.96 now 0.95 - a healthy waist-to-hip ratio for women is 0.80 or less, men 0.90 or less), buffalo hump (over 12 years), acanthosis nigricans (brown to black velvety hyperpigmentation of the skin usually found in body folds), skin tags, grown 3cm (i blame this symptom on insulin resistance).  My fasting glucose and two hour glucose tolerance test were both in normal range.

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"Can you be insulin resistant and still have normal blood sugars?

Yes! A person who is insulin resistance can, and often does, have normal fasting blood glucose levels and normal blood sugar after meals. People with insulin resistance can even “pass” an oral glucose tolerance test (OGTT).

But in order to maintain normal glucose levels during an oral glucose tolerance test, a person with insulin resistance will overproduce insulin. Elevated insulin levels is called “hyperinsulinemia.”"

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"Studies show an increased frequency of thyroid disorders in diabetics, and a higher prevalence of obesity and metabolic syndrome in people with thyroid disorders.

That’s because healthy thyroid function depends on keeping your blood sugar in a normal range, and keeping your blood sugar in a normal range depends on healthy thyroid function." - Thyroid, blood sugar & metabolic syndrome by Chris Kresser

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"Low serum and intracellular magnesium concentrations are associated with insulin resistance, impaired glucose tolerance, and decreased insulin secretion. Magnesium improves insulin sensitivity thus lowering insulin resistance. Magnesium and insulin need each other. Without magnesium, our pancreas won’t secrete enough insulin–or the insulin it secretes won’t be efficient enough–to control our blood sugar." - The Insulin Magnesium Story by Dr. Sircus
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