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765439 tn?1292964014

got my labs PLEASE read....

finally got my labs, id appreciate if you guys can read them...the columbioa endo claims I dont have an endocrine problem...but some of my labs are off! including cortisol and creatine!..please read them all if you have time and give me input on my next step!

creatinine w/egfr
creatinine 1.08 (.8 -1.30)

creatinine clearance
creatinine random urine 1826
creeatinine 24 hr urine 2.92 OUT OF RANGE (.63-2.50)   also says H
creatinine clearance OUT OF RANGE! 188 (85-125) also says H

cortisol free urine 70.4 OUT OF RANGE (4.0-50.0)
creatinine urine 2.96 (.63-2.50) performed by tandem mass spectometry

thats just the cortisol and creatine...which alone is out of range.....now here's everything else

cortisol 10.6 ref ranges 8:00 am (5-25)   4 pm (2-12)   post stim (25-50)   min normal increase -8   overnight  dexamethasone supp <5

ESTRADIOL- 22 (10-50)
fsh 2.9   pre puberty (<2) (post puberty (<10) so at 21 my numbers almost at the pre puberty level!!!!!!!!!!!!!1
LH 2.0 pre puberty (<2)   post puberty (<10)......IM AT PRE PUBERTY LEVEL

testosterone TOTAL- 535 (270-1070)...im mid range which isnt terrible but at 21  i feel i should be higher...but atleast im midranged.

basic metabolic pane
sodium 140 (136-146)
potassium 3.9(3.6-5)
chloride 100 (102-109) OUT OF RANGE!
co2 26 (24-35)
bun 13 (7-20)
glucose 65 (70-105) OUT OF RANGE
creatinine 1.0 (.6 - 1.2)
calcium 9.3 (8.7- 10.0)
T3 159 (94-170)
ferritin 55 (29-248) this seems low to me!
cholesteral 193.....im shocked this is fine...although almost above 200.

triglycerides 70 (30-200) THIS SEEMS LOW TO ME
hdl cholesteral 46 (40-59)
ldl cholesteral 133 (<130 is desireable) (130-159 borderline high)
t4 8.39 (5.41 - 11.66)
t4 free  1.21  (.7- 1.24)
tsh 1.13   (.32- 4.05)
Growth hormone- .29   range is less than 5......this seems low.....to me
prolactin 2.8 (2.5-17.0)
somatomedin c  267  (127- 424)
ACTH-  9 (7-69)........I SEEM LOW????
VITAMIN D 125 dihy 62  (15-75) ...ive been taking 10,000 units  a day...yippppe im not deficient!
vitamin d 25 hydrox......58 (30-80)...this is the ebst test....id lie to be at 70-80
HEMOGLOBIN A1C 4.8  REF RANGE 4.6......SO AGAIN I MOUT OF RANGE
glucose fasting 76 (70-105)  i didnt fast for any test?



there's some other numbers if someone wants to know mcv..or stuff lie that...i dont know if they are important..

PLEASE READ THIS....AND HELP ME.....MY NUMBERS ARE NOT NORMAL...MY HEMATOCRIT/HEMOGLOBIN IS ABNORMAL ION EVERY TEST  ITAKE.... my throid used to be 3.22 for my tsh now its 1.13?? i prefer it at 1.13 i  suppose but whys it changing really

thanks for any help....this took forever to type, but i hope my friends on this board will have some info for me....and reassure me im not crazy, and i have something going on here

if she would have done the hematocrit lie itold her that would be out of range also.
32 Responses
Avatar universal
COMMUNITY LEADER
Cortisol is abnormal. But the suppression on dex may wipe the results out in the eyes of the doc.

ACTH can be easily botched in the lab.

Estrogen may be low since you are male. Testosterone may be low due to high cortisol.

Are you going to see the doctor again or get a call?
765439 tn?1292964014
a call from this doc? she called me after my appointment one month ago(yes took this long to get the labs from her) she says my problems are not endocrine related....and he doesnt think my cortisol levels are abnormal cause im young....

all i know is my numbers dont look right to me, and i feel like crap everyday and doctors seem to think im normal......

and noone believes me lol.
765439 tn?1292964014
and my fsh and lh are around rpe puberty levels
Avatar universal
COMMUNITY LEADER
Take the tests and go elsewhere... you will not be the first nor the last to not be unhappy coming from there.
765439 tn?1292964014
i have no idea where else to go at this point..and idont have the money to keep GUESSING....i need some direction. i dont know what to do next> my dad is getting more frustrated with me...saying the columbia endo i begged him to see is saying im ok...

any guidance on my next step? cause right now im clueless...and since  idont work...im eating my dads money...

btw do y numbers look concerning to you? you said my cortisol might not be a problem because my dex was fine?
596605 tn?1369950227
I've got comments but need your blood counts like Hct, Hgb, MCV, etc. Also units would be helpful.
Horse
Avatar universal
COMMUNITY LEADER
If you do some research, you will see that the dex suppression test is used for Cushing's.
Here is an excerpt from a website:
"This test is performed when the health care provider suspects that your body is producing too much cortisol. It is done to help diagnose Cushing syndrome and identify the cause.

The low-dose test can help tell whether your body is producing too much cortisol. The high-dose test can help determine whether the problem is in the pituitary gland (Cushing's disease).

The level of cortisol in the blood normally regulates the release of ACTH from the pituitary gland. As blood cortisol levels increase, ACTH release decreases. As cortisol levels decrease, ACTH increases.

Dexamethasone is a human-made (synthetic) steroid that is similar to cortisol. It reduces ACTH release in normal people. Therefore, taking dexamethasone should reduce ACTH levels and lead to decreased cortisol levels.

If your pituitary gland produces too much ACTH, you will have an abnormal response to the low-dose test, but a normal response to the high-dose test."

You had a normal result on the dex test, and therefore, the doctor is saying what you had was normal. Not all doctors think this way, but this is the mainstream thinking however. The doctor is, according to the new guidelines, supposed to do several tests - which that endo did - and if there is clinical suspicion, which I guess they feel there is not, they can continue to test, or opt to not test. There are a few things that can raise cortisol - normally it is a disease process, but there can be other things. The doc would have to evaluate you, your history and do an exam to see how it all fits.

I can't tell you where to go. There is or will be a doctor search feature here soon.

Weird that you had high TIBC before and low ferratin now.

Of all the tests, only the cortisol seems the most concerning and the dex will wipe it out in the doc's eyes.
765439 tn?1292964014
so if im correct....you are saying my labs are normal then???
acth of 9 is normal?
pltelet counts below the range everytime are normal?...idk


and ive never heard of a doctor that requires a doctor to refer u to to them.....i just called the hematologist, and they said  a doctor must say i  need to be there. I have insurance where refferals arent necessary also
596605 tn?1369950227
Hi TD-
Here's my take:

-Your adenoma is probably not a secreter.

-The ACTH was borderline low

-The 24 hour urine cortisol was high
I think that this certainly justifies more testing of the adrenal axis in particular. Something does not seem right to me in this part of the testing

-Your Hematocrits and Hemoglobins are consistantly a little high. I would rec that Polycythemia family of conditions be ruled out.

-Lh and fsh are at the post puberty level and your testosterone in mid-range
So your sex hormones are probably good.

-Chloride 100 (102-109) Can be elevated with hyperthyrpoidism

-Glucose 65 (70-105) A little low, don't really know why but do you get hypoglycemia?

-Ferritin 55 (29-248) could be iron deficiency anemia, have to look at (MCV) the Red blood cell to see, *also I'm making a mental flag because you've been running these slightly high hematocrits and Hemoglobins.

Thyroid
-T4 free  1.21  (.7- 1.24)
tsh 1.13   (.32- 4.05)
Could actually be that you are hyperthyroid, could explain the low chloride and glucose
-You may be hyperthyroid but it does not look like it is pituitary in nature? I don't know enough about this but so other people think that other tests should be done?

-Somatomedin c  267  (127- 424) This is what is used to check your Growth Hormone levels

Horselip
765439 tn?1292964014
thanks horselip ;)
765439 tn?1292964014
thanks as well
596605 tn?1369950227
Two comments-
One a correction to something i said above low chloride can mean hyperthyroidism
and #2 You did not have a stim test right? What do you mean Rumpled about normal result on the dex test?
765439 tn?1292964014
i didnt think  i had a stim test, but figured sicne  i dont know what all the tests mean, rumpled might have thought  i did, and i trust her more than myself ha
Avatar universal
COMMUNITY LEADER
If you suppress on dex, that is a normal result. So that may, in the doc's eyes, wipe out the abnormal UFC. If you do some research though, that test is kinda iffy to some docs, and golden to most - some use it as a test of location, some use it as a test of exclusion. Columbia obviously used it as a test of exclusion. I failed all dex tests (low dow, high dose, etc.) and still was Cushingoid - I know lots of people in that boat.

From what I see, it does not appear there is a stim test here.

As for the low chloride - I have that constantly. I was told it was not low enough to be a factor. This is from a website:"Decreased levels of blood chloride (called hypochloremia) occur with any disorder that causes low blood sodium. Hypochloremia also occurs with prolonged vomiting or gastric suction, emphysema or other chronic lung diseases (causing respiratory acidosis), and with loss of acid from the body (called metabolic alkalosis)."

I can make mistakes - I am far from perfect!
765439 tn?1292964014
i went to my primary doc today...who is the only doctor  i love....
and she reccomended me to call the rare disease clinic at nih...she said the cortisol looks high to her....and she agrees small tumors can cause problems.

shes a very caring doc....but obviously as a primary there's not much she can do
765439 tn?1292964014
when  say you failed all dex tests does that mean you had a noral result..or an abnormal one? aka did you supress or not? im guessing you supressed.

i just wish i could get into the rare disease clinic. i think they have the best shot at helping me.....plus theyre in maryland so its not far.
Avatar universal
COMMUNITY LEADER
When I say I failed, I mean I also suppressed so I had a normal result (although some were abnormally low). Even on dex-CRH which is a NIH gold standard test. NIH may not take you based on the dex - they are proponents, sadly, of the test. I tried to get in there too. But if your doc sends in all your stuff, you may be able to get in.
Avatar universal
COMMUNITY LEADER
This just came out:
"High Prevalence of Normal Tests Assessing Hypercortisolism in Subjects with Mild and Episodic Cushing's Syndrome Suggests that the Paradigm for Diagnosis and Exclusion of Cushing's Syndrome Requires Multiple Testing.


Summary

Many Endocrinologists believe that a single determination of eucortisolism or a single demonstration of appropriate suppression to dexamethasone excluded Cushing's syndrome, except in what was previously thought to be the rare patient with episodic or periodic Cushing's syndrome. We hypothesize that episodic Cushing's syndrome is relatively common and a single test assessing hypercortisolism may not be sufficient to accurately rule out or diagnose Cushing's syndrome and retrospectively examined the number of normal and abnormal tests assessing hypercortisolism performed on multiple occasions in 66 patients found to have mild and/or episodic Cushing's syndrome compared to a similar group of 54 patients evaluated for, but determined not to have Cushing's syndrome. We found that 65 of the 66 patients with Cushing's syndrome had at least one normal test of cortisol status and most patients had several normal tests. The probability of having Cushing's syndrome when one test was negative was 92% for 23:00 h salivary cortisol, 88% for 24-h UFC, 86% for 24-h 17OHS, and 54% for nighttime plasma cortisol. These results demonstrated that episodic hypercortisolism is highly prevalent in subjects with mild Cushing's syndrome and no single test was effective in conclusively diagnosing or excluding the condition. Rather, the paradigm for the diagnosis should be a careful history and physical examination and in those patients in whom mild Cushing's syndrome/disease is strongly suspected, multiple tests assessing hypercortisolism should be performed on subsequent occasions, especially when the patient is experiencing signs and symptoms of short-term hypercortisolism.
Affiliation

Division of Endocrinology, Metabolism, and Molecular Medicine, Charles Drew University of Medicine and Science, Los Angeles, CA, USA.
Journal Details

Name: Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme
ISSN: 1439-4286"
765439 tn?1292964014
yeah, i dont consider that a new finding...jsut another finding that has been known by the community butt aken ages to figure out by the medicalsystem....im sure YOU knew this already -_-.

btw that's horrible that you were denied by nih.....i cant think of a peerson who could have had a more mutally beneficial case with them. youd make a great lab rat....lolo
Avatar universal
COMMUNITY LEADER
It is newly published, at least.
Yeah, I would be a great rat except they only want them with one thing wrong.
596605 tn?1369950227
You only have one things worng- Your endocrine system :-)
Horsey
Avatar universal
COMMUNITY LEADER
Hey! I"ll put that down on the app next time! Good one!
765439 tn?1292964014

by horselip
, Nov 19, 2010 11:39AM
Two comments-
One a correction to something i said above low chloride can mean hyperthyroidism
and #2 You did not have a stim test right? What do you mean Rumpled about normal result on the dex test?


yeah thats what  iwas wondering originally.
765439 tn?1292964014
is it possible for prolactin t0 be TOO low?
as a male im glad its low but is my level too low for a 21 yr old male
765439 tn?1292964014
ive eard that cortisol could e too low(which shocked me..i thought cortisol was bad) but this begged the question about the possibility of prolactin
Avatar universal
COMMUNITY LEADER
I found this:
"Levels of prolactin that are below normal are not usually treated but may be indicative of a more general hypopituitarism. Low levels may also be caused by drugs such as dopamine, levodopa, and ergot alkaloid derivatives."
But since you are male, it is really not going to effect you so much that I can figure out - re periods etc. but when my prolactin was high, it really effected my mind a lot.

Low cortisol is deadly.
765439 tn?1292964014
yeah  i think ill take it  as a positive that cortisol is low. high testosterone low end of normal cortisol and low prolactin makes a strong man

haha just messing around ;)
765439 tn?1292964014
what do you know!!!!!!!!!!

i was just looking at some old labs from feb 2009....and there is an AM cortisol test...20.7(4-22.0)


and wow my cholesteral has gotten a lot worse due to bad eating.......
it was 60 back then and now its 193(maybe higher now) hdl went down ldl went up tryglicerides went up 20


but yeah is the above cortisol high or is it fine cause its in range...take into account my current tests are high
Avatar universal
COMMUNITY LEADER
The first test is fine. What time was the test?
Cortisol goes up and down in normal people and it is a very time dependent test.
You can be normal then and high now - the doc should take the changes into consideration.
765439 tn?1292964014
it was an am test,so im assuming it was 8am? it was 2 years ago, and icant even remember what  i ate last night anymore


but is that result really fine? with my history isnt a number that is that high in the normal range still suspicious? i mean the range goes from 4-22 and i was 20.7 almost 21!

not to mention i always feel SO bad in the morning.

i dont see thart doctor anymore...ive been going to a new primary for a few months whos great.

Avatar universal
COMMUNITY LEADER
The time of the test should be on the lab slip.
Usually when you are high, one feels a lot better - cortisol is an anti-inflammatory and covers a lot of symptoms - hence why it is given as a medication for  a lot of stuff. Food does not effect it. Some docs may look at it as borderline but most will not.
765439 tn?1292964014
ok i made a mistake these labs were from april 20,2010.....which i guess makes my cholesteral raise even worse ha

but anyway, it says NONE next to ''collected''
but next to reported it says 12:45......those stupid techs didnt record a collected time -_-
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