Pituitary and/or adrenal and headache?

[Andren]

I apolgize for asking my question in this forum, however the other endocrinologist forum is full. My neurologist, internist and neurosurgeon are grasping for an answer to my intractable headache (I was diagnosed with obstructive non-communicating hydrocephalus at the age of 29, I am now 34)--as nothing has worked (in terms if medication, accupuncture, surgery, pain clinic, etc.)  I am also being treated with Cartia for high BP. My question is, could my headache be caused by an adrenal or pituitary problem? Please continue reading.

What causes low ACTH production (other than high cortisol, stress)? Whithout the stimulation test, my ACTH and cortisol do not interchange as expected (Could it be that there is a problem in the "adrenal-pituitary-hypothalmic axis? i.e..could it be that the hypothalamus is producing too little CRH?) I have listed the nomal ranges (based on labs) for the previously mentioned test;I have also included the labs drawn in July of this year. ACTH and Cortisol are from a standard ACTH stimulation test.  

In reference to the labs below, I do understand that the linerity of the method used does for ACTH does not detect ACTH below <5.0)

[LABS FROM 9/26/07]

Prolactin 20.7  (3.8-23.2)
ACTH basline:<5.0 (lab did not report normal range)
ACTH (60min.) <5.0 (lab did not report normal range)
Cortisol baseline: 2.9 (2.5-25.0)
Cortisol (60min) 25.2 (2.5-25.0)
Thyroid panel normal (Free T3 slightly high).  FSH, LH, Estradiol all normal.
DHEA not done

[LABS FROM 7/11/07]

Prolactin 59.8 (3.3-26.7)
Cortisol AM 2.3 (4.0-22.0)
DHEA 17 (130-980)
Testosterone <12 (6-82)
FSH, LH, and Seritonin all normal)

THANK YOU FOR YOUR HELP!

[sue577]

i am going too see a endocrinolgist soon, ive had my femail organs out know i my breast started leaking , they did a blood test prolactin levels are elevated. what could that be from . i feel dizzy ive past out at the fair my kidneys were going into renal shut down could this all be related? thanks wanda

[Anita Ramsetty, MD]

Hi,
Before I answer, please know that I can approach this with caution. I do not have the priviledge of knowing your complete history or other medical information, and those are quite a few laboratory results you have provided for me to review. If you would like a more complete consultation, please visit my practice website at www.endocrinehelp.com, or do speak with an Endocrinologist in your area.
That being said: it is possible that your hypothalamus is producing too little CRH, but that would likely trickle down into adrenal insufficiency eventually leading to an abnormal stimulation test at some time. Your adrenal glands gave quite  a brisk response so they are functioning well, making a clinically troubling dysfunction of the HPA axis unlikely.
The other question was about your headaches and that is trickier. Truthfully that is best answered by your neurologist and neurosurgeon. I do not think adrenal insufficiency would cause headaches unless it led to low blood pressure or low blood sugars, or was caused by something serious like a mass or bleeding in the pituitary. Pituitary masses can cause headaches, but I am sure you have had a scan to evaluate for this as well. Perhaps a second opinion from a different neurologist/neurosurgeon who may be able to review all your data with a different approach may provide an answer.
Take care.

[Andren]

See previous post, I forgot to mention abnomal menses.