Discussions By Condition: I cannot get a diagnosis.

Strange symptoms, is it cushings?

Posted In: I cannot get a diagnosis. 6 Replies
  • Posted By: Anonymous
  • June 24, 2008
  • 02:19 AM

23 year old white female:
I have been struggling with these symptoms for 6 months
1. 60lb weight gain in 4 months- no change in eating- mostly in abdomen
2. Sweating, palpations, and dizziness
3. intermittent high blood pressure
4. Changes in eye health- went from glasses only at night driving to glasses all the time
6. Severe headaches that come on suddenly and leave just as suddenly without medicaitons.
7. Large purple striae on belly and upper arms.

I have been tested for PCOS, Hypothyroid (by TSH only (1.5)). Both negative. I also have a c-peptide of 4.7

My regular doctor is convinced it is cushings, however the last endocrinologist I saw did an AM cortisol (without supression) and it was normal.
I am so frustrated, I am only 23 and I should be having fun, instead I am miserable. Please help!!!!:confused::confused::confused:

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6 Replies:

  • PS- I am NOT PREGNANT! Checked several times.
    Anonymous 42,789 Replies Flag this Response
  • A single AM cortisol test is insufficient in diagnosing any adrenal issue. Your endo should know this. See if you can get you doctor to refer you to a different endo, one who knows something about adrenal problems. Here is a section from an article I found on Cushings on the eMedicing website: The diagnosis of Cushing syndrome due to endogenous overproduction of cortisol requires the demonstration of inappropriately high serum or urine cortisol levels (see Image 1). Currently, 4 methods are accepted for the diagnosis of Cushing syndrome: urinary free cortisol level, low-dose dexamethasone suppression test, evening serum and salivary cortisol level, and dexamethasone–corticotropin-releasing hormone test.Urinary free cortisol (UFC) determination has been widely used as an initial screening tool for Cushing syndrome because it provides measurement of cortisol over a 24-hour period. A valid result depends on adequate collection of the specimen. Urinary creatinine excretion can be used to assess the reliability of the collection. Urine free cortisol values higher than 3-4 times the upper limit of normal are highly suggestive of Cushing syndrome.2, 3 Values higher than the normal reference range but less than 3-4 times the upper limit of normal are inconclusive. Values that fall within this range may indicate pseudo–Cushing syndrome or Cushing syndrome and require further testing. Multiple collections are necessary because patients with disease may have values that fall within the normal range. Three urine free cortisol levels in the normal range exclude the diagnosis of endogenous Cushing syndrome.The rationale for the dexamethasone suppression tests is based on the normal physiology of the hypothalamic-pituitary-adrenal axis; glucocorticoids inhibit secretion of hypothalamic CRH and pituitary ACTH but do not directly affect adrenal cortisol production. Since cortisol production is controlled by ACTH, decreases in ACTH lead to decreases in plasma and urine cortisol. The overnight 1-mg dexamethasone suppression test requires administration of 1 mg of dexamethasone at 11 PM with subsequent measurement of cortisol level at 8 am.4 In healthy individuals, the serum cortisol level should be less than 2-3 mcg/dL. To enhance the sensitivity of the test, a cutoff value of less than 1.8 mcg/dL (50 nmol/L) excludes Cushing syndrome. Its ease of administration makes the 1-mg dexamethasone suppression test a widely used screening tool.Late night serum and salivary cortisol levels take advantage of the alterations in circadian rhythm of cortisol secretion in patients with Cushing syndrome. Normally, cortisol values are at their lowest level late at night.In patients with Cushing syndrome, an elevated serum cortisol at 11 PM can be an early but not definitive finding. Measuring serum cortisol levels requires hospitalization with blood samples obtained within 5-10 minutes of waking a patient and is not a practical test.Measuring salivary cortisol level has gained interest, as it is a simple and convenient way of obtaining a nighttime sample. This measurement allows patients to collect their own samples at home. With repeated measurements, levels less than 1.3 ng/mL (radioimmunoassay) or 1.5 ng/mL (competitive protein-binding assay) exclude Cushing syndrome. Less experience has been gathered for this assay, and it is expensive. Most physicians who do use this test obtain readings over several evenings to increase accuracy.The dexamethasone-CRH test is intended to distinguish patients with Cushing syndrome from those with pseudo-Cushing states. It combines a 48-hour low-dose dexamethasone suppression test with CRH stimulation. Dexamethasone (0.5 mg every 6 hours) is given 8 times starting at about 8 AM, CRH is administered intravenously 6 hours after the last dose of dexamethasone and plasma cortisol and ACTH levels are obtained at 15-minute intervals for 1 hour. A cortisol value greater than 50 nmol/L (1.4 mcg/dL) identifies Cushing syndrome. This test is reserved for patients with high clinical suspicion for Cushing syndrome but equivocal results on other diagnostic tests.Unfortunately, mild Cushing syndrome is often difficult to distinguish from normal cortisol secretion or pseudo-Cushing states. The aforementioned tests can produce both false-positive and false-negative results.Hope this helps
    Larkenn 20 Replies Flag this Response
  • Thanks, I like very much
    Anonymous 42,789 Replies Flag this Response
  • www.cushings-help.com is the best place to be for questions regarding Cushings. You sure have many of the symptoms...
    Anonymous 42,789 Replies Flag this Response
  • Thanks for your help everyone. I decided to get a second opinion with another endo.
    Anonymous 42,789 Replies Flag this Response
  • Please go to parathyroid.com and check your symptom against those given for hyperparathyroidism. Hope this leads to some help for you...it changed my life for the better.
    Anonymous 42,789 Replies Flag this Response
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