high cortisol

[ssterns]

Hi

I recently did 24 hr urine tests and both tests came up high, 62 & 83 ug/24hr.  I am 49, male and have been overweight most of my life, 330 lbs currently.

I have always struggled with weight even though I eat very healthy, no fast food, nothing fried, etc. however, I don't get a lot of exercise, I have a desk job with long hours.  I have been trying to find out if there is a medical reason that would explain this.

I have other symptoms that point to something being out of whack:

recent total testosterone is low 338, % free 0.41%, Free 1.4ng/dl.
marginal diabetes, 115 sugar.
other thyroid tests seem normal, Free T4 0.81, HS-TSH 0.99,
general feeling of exhaustion
wake up very tired in the morning
poor sleep, 6 hrs max.
frequent urination
muscle weakness, no strength
skin problems, excema, etc
I have a lot of anxiety all the time, and stress out over minor things. Stress keeps me awake at night.

I have high colesterol, but take pravastatin 80mg, Niacin 500mg, and aspirin 320mg daily, with this, my total chol is 129, LDL 80, HDL 33, TRIG 79.  I have a hard time keeping the HDL up, can't take more niacin, I flush easily.
I had really severy astma as a child, requiring cotisone shots very often, I finally outgrew it in my late 30's.
I also have used a lot of topical cortisone creams, (triamcinolone, etc) , to treat skin conditions, and rashed in my legs, chest, and groin area over the years, I've stopped using them a year ago, I wish I had known then the risks of this.

My questions is what's next, I suppose my endo dr. might suggest an MRI/CT to check for tumors,  a salivary test, or ACTH to check for cushings.

[val1198]

How is your blood pressure?  In spite of diet and working out, I have never been able to lose the 55 lbs I gained while undiagnosed hypothyroid for at least nine years.  

I'm now on an aldosterone blocker and have lost about a lb/week since starting it.  I'm sick of being told to eat less and exercise more.  Now I hand them my charts.  Finally, my new GP said something more than thyroid was going on and sent me to an endo who diagnosed primary aldosteronism.  You can look at my charts here  
http://www.wyosip.com/Mine/wtcharts/weight1.htm

I'd say you should be worked up for Cushing's, primary aldosteronism and possibly pheochromocytoma.  Urinating all night, anxiety, metabolic disturbances are all symptoms of PA.

Could the cortisone cream use still be be affecting your urinary cortisol levels?  Ask your endo.

[Mark Lupo, M.D.]

The urine cortisol tests in that range are not specific and more testing including dexamethosone suppression testing is necessary.  The slight elevations may be due to weight and stress.  Also ask about sleep apnea.  Most of the symptoms and medical problems you mentioned boil down to weight -- despite your previous efforts to lose weight.  May be time to try behavioral modification (if available) or other more aggressive weight loss methods -- there are no medications that will be safe/effective for this problem.