cortisol elevation on UFC but dex OK

[sue3708]

Hi, I am a 38 year old female who had a serum cortisol that was elevated.  The endo. ordered a 24 hour urine which was slightly elevated , the upper limit was 50 and mine was 53.6.  The endo. then followed with an overnight dexamethasone suppression test and I suppressed.  My pit. MRI only showed prominence with a superior convex border but no signs of tumor or lesion.  This was done on a 1.5T with and without contrast.  I also had an MRI of the abdomen, for an unrelated issue, and the adrenals were fine.  The Endo. did a 24 hour urine 5-HIAA also which was fine.

Should this be followed up on?  I am concerned regarding the cortisol elevation.  Oh I am 4'11" and weigh 125....so maybe a little overweight but ot much.  I am having some mentrual irregularities and some facial hair growth.  All bloodwork for PCOS was neg.

I am thinking of getting a second opinion.

[Anita Ramsetty, MD]

Dear Friends,

I have very much enjoyed my time on Medhelp and have learned from you even while hosting our Ask-A-Doctor forum for Diabetes. Sadly I am leaving the Medhelp community as my own practice has become busier and time constraints have proved quite challenging. So from April 7th 2008 I will be officially away from Medhelp, but you can still find me at our practice website www.endocrinehelp.com, so please drop me a  line if you wish. Most likely a new physician will be hosting the Diabetes forum for Medhelp in the future, so please continue to check in with the Medhelp community.
All the best to you and blessings for the future,

Sincerely,
Anita Ramsetty,MD

[Enoch Choi, MD]

A second opinion is always reasonable.

The overnight dexamethasone suppression test is reassuring to decrease the possibility of cortisol-producing adrenal tumors, a pituitary tumor that produces ACTH, or a tumor in the body that inappropriately produces ACTH. A high-dose overnight test can additionally help distinguish a pituitary cause (Cushing's Disease) from the others.