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  • dexamethasone then test?

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    Old 10-21-2003, 07:29 PM   #1
    Divermon
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    Post dexamethasone then test?

    Can anyone tell me what this is about...

    I have Hypothyoidism and Hashimotos thyroidosis. The Endo did a 24-hour urine collection to test for cortisol, which she then said was not normal... didn't say if it was high or low. I don't have a copy of the test results yet.

    Now she wants me to take 1mg of dexamethasone at 11 pm, then have blood drawn in the morning, between 8:30 and 9:30.

    Anyone know what that would be for?
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    Old 10-22-2003, 12:26 AM   #2
    orion
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    I believe you are being tested for Cushing's disease where blood cortisol is very high. The usual symptoms include weight gain, moon face and sleeping problems.

     
    Old 10-22-2003, 07:47 AM   #3
    Divermon
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    Thanks Orion, I appreciate your time.

    It's sooooo hard to get any info out of this Doc (something I usually fire Docs for, and I may do so here too), but since it is sometimes difficult to even get a doc to run tests, I think I'll go along with this one for a bit.

    For example, it's been a full four weeks since the blood draw and urine test in the hospital, and the Endo is just now ordering this additional test, and said in the email "everything is normal except the cortisol free" - wouldn't even say if it's high or low. But I'll get a copy, as soon as I can get over there. I'm sure I'll have to arm wrestle for it, which will be difficult, given my current fatique, yeah.
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    Old 10-23-2003, 08:59 AM   #4
    HeatherW
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    She may also be running a ACTH. Testing to see if the pituitary is having an increased response to a lack of cortisol in the blood. HEather W.

     
    Old 10-23-2003, 06:39 PM   #5
    Divermon
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    I read from a few sites on Cushings, this is one of the usual next steps to discover the reason for Cushings. Cushings is the effect of, over time, having high cortosol.

    I don't have any of the symptoms of Cushings, except the red cheek bones. I'm not sure what a moon face is... is that like, with craters in it?.... face made out of cheese?? I guess it's a "round" face.

    It's really not uncommon for people with thyroid disorders, to also have adreanal issues, but usually, I think, it's low cortisol... aka subclinical addison's, aka adreanal fatigue.

    One cause of high cortisol is depresion. Of course, having thyroid issues would depress anyone. hmmmm didn't think I was really.
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    Old 11-11-2003, 03:08 PM   #6
    Divermon
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    So, now I have the test results in hand, showing high cortisol.

    9/19/03 24 hour urine free cortisol 99.9 (4.0-50.0)
    10/29/03 Dexamethasone suppression test, 0.5 (range?)

    Clearly the suppression worked, and if I read right, this means:
    1. The whole pituitary/hypothalamus/adrenal works correctly.
    2. No pituitary tumor is suspected.
    3. No ectopic tumor is suspected.
    4. No adrenal disease is suspected.

    Which means, one of the remaining causes is suspected, ie:
    1. Alcoholism - I rarely drink at all
    2. Depression - I don't think I'm depressed
    3. Meds - I was using Flovent up several months before the tests
    4. Stress - only about every day, and certainly while in the hospital (where the urine test was taken)

    So, my question to anyone here, is, can job stress alone cause cortisol as high as that? Is that high enough to be concerned? Is it typical to have a cortisol spike that high, and not necessarily consistently high?

    I'm thinking I should do a saliva test at the four time periods of the day, to see if it's still high. Anyone know what the half-life of Dexamethasone, or how long I should wait till I do this test?

    Last edited by Divermon; 11-11-2003 at 03:09 PM.

     
    Old 11-17-2003, 10:29 AM   #7
    HeatherW
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    Have they preformed a MRI of the adrenals? I am assuming you are at Vanderbilt. (I live in TN also) I have a friend who had cushings because of a tumor of the adrenal. It would seem that that is the only test not preformed unless it has been mentioned in a previous post. What are the ACTH levels. I am just one of those people that likes to know why. I am never happy until I know why somthing has happened. Heather W.

     
    Old 11-17-2003, 06:36 PM   #8
    Divermon
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    Well, hello from Nashville, Heather. I think you have to be that way. I don't know how else to make sure the right things happen.

    I was at my first appointment with the Endo, and my BP was 168/120 (I'm usually 120/80 or so), so she admitted me to the Baptist Hospitcal cardiac ICU for observation. I am Hypothyroid, and not sure if eposodic high BP is normal, But hypo does some odd things.

    So the Endo did an MRI of the renal artery, and to look for mass on the adrenals. That was all ok. So she did the 24-hour urine collection for cortisol. That was 99.9 (4.0-50.0). 50 days later, she decides to do the Dex test. The only reason I know the outcome of that is that I had my GP do it, and fax it to the Endo. I'd still be in the dark, if the Endo did the test. Of course, that was 3 weeks ago, and haven't heard anything from the Endo.

    I don't believe ACTH was ever tested.

    So I'm trying to figure out what this all means. And who knows, maybe some day I'll hear from the Endo even.

     
    Old 01-21-2004, 07:50 PM   #9
    Divermon
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    Re: dexamethasone then test?

    Though I'd take a pass at this thread again ......

    I'm working, trying to get my Hypothyroidism under control. It is said that generally if a change in thyroid med make you feel worse, before better.... to at least suspect adrenal insufficiency.

    Now in my case, I've only had the one cortisol test (except for the follow-up dex test), which came back high, 99 ( 4.0-50.0 ), and there was certainly a lot of stress at that time. Does that pretty much mean that I cannot have adrenal insufficiency issues, because obviously I can produce cortisol?

    Can I have such a high reading one day, and still have insufficiency the rest of the time?

    By the way.... as expected, I never heard from the Endo-from-Hell again.

     
    Old 01-22-2004, 07:55 AM   #10
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    Re: dexamethasone then test?

    Divermom,
    I copied some values from a chart I found describing lab results on cortisol.
    Cortisol {total, plasma}

    US value gm/dL
    8 AM 5 - 25
    8 PM 2 - 9
    SI value g/L
    8 AM 138 - 690
    8 PM 55 - 248
    Corticotropin {ACTH} levels normally fluctuate in a diurnal pattern with early morning levels being 40-50% greater then late evening levels. Loss of diurnal pattern is often seen in patients with Cushing's syndrome. Cortisol secretion does not change with age.

    THis is the list of things that can cause high readings.

    adrenal hyperplasia {congenital}
    adrenal neoplasm
    cancer {adrenal}
    cancer {lung}
    Cushing's disease
    depression
    ectopic ACTH syndrome
    hepatic disease
    hyperthyroidism
    obesity

    hypoglycemia
    pregnancy
    smoking
    stress

    DRUGS:
    alcohol
    amphetamines
    corticotropin
    cortisone
    estrogen
    hydrocortisone
    interferon
    mepacrine
    methoxamine
    metoclopramide
    naloxone
    oral contraceptives
    quinacrine
    spironolactone
    vasopressin


    Moon face is something that happens when there is too much cortisol from either natural sources or from medications. Your face will become very round n appearance and it will loose some definition. Have you seen pictures of Jerry Lewis when he was really sick? That is moon faced. He had it really bad though. I hope that some of this might help you find what your looking for. Just so you know, If your cortisol levels are high, you will feel really crappy. Just like you would if you have no cortisol. HeatherW.

     
    Old 01-22-2004, 02:44 PM   #11
    Divermon
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    Re: dexamethasone then test?

    Thanks HeatherW.

    I think the dex test pretty much ruled out the list of secondary causes that secrete ACTH, such as cancers, because the dex successfuly suppresed the cortisol production. But I'll never get that out of this Endo.

    Maybe I should get the 4x per day saliva test done, and see for myself. Does anyone know where I can order that?

     
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