lots of random symptoms

[jeric]

I realize this is a thyroid board... but this is related to endocrinology... can you please help?

I'm a 20 year old female.

Here are the other symptoms I've had over the past 2 years:
Excessive hair growth (my face especially the upper lip, my breasts and abdomen, and upper thighs)
Hair loss on my scalp, anytime I run my fingers through my hair I pull stands of hair out
Weight gain (about 40 pounds in 6 months) however the weight is only in my abdomen (my wrists are still freakishly small) and I'm probably even more active than I was before.
Fatigue (I try to practice good sleep hygiene and always get at least 8 hours of sleep) and not just tired mentally physically tired. My sleep cycle is also all messed up I tend to be extremely tired between 4-9pm and most awake 11pm-2am. I usually go to bed around 2:30am and wake up at 11am.
Stretch marks (purple and white across my abdomen)
Acne, I never had really bad acne, even as a high schooler, I only had mild breakouts, now I have bad breakouts on my face and going down onto my neck

Could this be Cushing's Syndrome?

I realize that I need to see my doctor... and that if I'm right about the Cushing's a referral to an endocrinologist is in order... however my PCP doesn't have any openings until the end of June (and I will be in Spain then) and even if she were to give me a referral to the endo without seeing me I would never get into see the endo before I leave.

I guess what I would like to know is...
Do you agree with me that I could have Cushings? or am I maybe overreacting?

When I meet with the gyn's NP should I mention my thoughts on this or not because isn't not related to their specialty?
Should I call my PCP's office tell them my symptoms and ask for a referral to an endo and make an appt with the endo for when I get back from Spain (August 10th)?
Should I make an appt with my PCP for August when I get back?  
Thanks so much any advice you can give me is GREATLY appreciated.

[Mark Lupo, M.D.]

This is likely PCOS, but Cushings needs to be tested -- usually a 24 hour urine collection for urine free cortisol will detect Cushings.  Your primary could order this.

[jeric]

Yes... I'd also read that you could have PCOS w/o the cysts. I'm not 100% sure on the tests for Cushing's... but from what I've read it's not jsut a simple bloods or urine test.... some that I've seen are 24 urine free cortisol, midnight salviary cortisol and dexamethasome supression test (dose to dexamethasone is given at night and blood cortisol levels are tested in the morning). From what I've read (or what make sense to me) is that to diagnose PCOS, it's based more on  physical exam exam, presence of cysts, and hormone levels. I would think a rule out of Cushing's could also be used to diagnose PCOS... but I'm just guessing here.

I wish I could go see my dr... but she has no open appts. before I leave for Spain.

[JenB12]

Yeah I can understand what you're saying and you're right in terms of the PCOS missing a few of your symptoms, particularly the stretch mark type striations on your abdomen area. I did know that sometimes PCOS can be confused for psudo-cushing's.....

I am not 100% sure what the methods used to diagnose PCOS are exactly, it kind of seems odd to me since you can have it with out having any cysts on the overies at all! ?  I was diagnosed with PCOS in college but evidently it was a misdiganosis because i was later told by another Doctor that there was no way that i could have it. in fact all of the symptoms that i was presenting while i was in college disappeared almost instantaneously with in a year... And now, 5 years later,  it's seems i've got opposite of a lot of the problems i was having before. It's just so weird how hormones can effect everything.

I really do not know which is easier to diagnose or rule out PCOS or Cushing's i thought there WERE conclusive tests for Cushing's? but I really don't know.

I definitely don't blame you for wanting to know and for constantly thinking about it. I think that it's easy for people to say "don't worry about it until you get some test results back..." I think it would be best for you to see a Doctor as soon as you can just to give you some peace of mine regardless of if you end up having it or not.... i think knowing one way or the other will make you feel better!

[jeric]

Yes... I have been wondering if it could be PCOS... but PCOS only describes some of the symptoms... and the others could be irrelevent, however the cushing's describes all of my symptoms so exactly almost. Plus, from the research I've been doing it seems like there is no one test that can exclusivly diagnosis or exclude PCOS or Cushings... there are multiple tests and or symptoms that need to be present and then you can dx someone.

I've also found that now they are saying that Cushings should be ruled out before a dx of PCOS because they are so very simiar. In fact I've found that it seems like a lot of people who have Cushings were orginally misdiagnosed with PCOS. So I guess I would just like to rule out the cushings first before saying it's PCOS and begining treatment for that.  

I think I'm just a bit shocked to find something that described all of my symptoms sooo exactly that I can't stop thinking about it and probably won't until it's ruled out I guess... if that makes any sense?  

[JenB12]

have you ruled Poly Cystic Ovarian Syndrom? your symptoms sounds soooo much like PCOS!!!!! Did you say you're going to see your OBGYN? They would be able to rule that out for you. PCOS is pretty common and can cause the hair growth on face, chest etc. while causing hair loss on the scalp, as well as acne, fatigue and weight gain, with difficulty to lose excess weight. Obviously it is important to disscuss ALL your symptoms with your Doctors as your symptoms could be caused by a number of different things. I would not assume something like Cushing's syndrom right off the bat.

In any event. I am not a Doctor..... but any of your doctors (regardless of their specialty) should be able to point you in the right direction.... I'd try to get in to see your Doc before you leave for spain and as long as you have the time..... but there is no reason to worry yourself until you get some tests run. :)

If you can get in to see your Gynecologist, she or he can actually order some of the labs that would check some hormone levels (thyroid hormones, estrogen, testosterone, progesterone etc.) , your obgyn can be a big help in evaluating the symptoms you are describing. I know it's not an endo or an internist which might deal specifically with Cushing's and other problems of the endocrine system but i think it could be a good start for you if you can't get in to see the others until August! :) When you get a chance to see an endocrinologist you should because even if it is something like PCOS, that is still considered an endocrine disorder!

Good luck with everything... let us know what it ends up being and have fun in Spain! :)