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    Old 07-14-2005, 08:49 PM   #1
    van7771
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    Labs, Help Me Understand?

    I have been experiencing the following symptoms: headaches, lightheaded and dizzy, nausea at times, stomach issues, cant gain muscle and feel real week at times, cant concentrate, muscle aches,agitated, no motivation, chills, oral temp is around 94-95.0 F. My symptoms continue to get worse. I had half of my throid memoved several years ago, the other half has a nodule that isnt cancerous. My docor has done the following tests and cant figure out whats wrong with me. Could anybody let me know if they see anything abnormal.

    Normal
    Renin, Plasma Acitvity: .2 (.4-4.5)
    ACTH, Plasma 427 (5.0-60.0)
    11-Doexycortisol, Serum 6662 (20-130)
    11-Deoxycortisol, Serum LC/MS/MS 7074 (119 or less)
    ACTH Stimulation;
    Cortisol Baselin: 22.6 (4-22)
    30 minutes 28.1
    60 minutes 29.0
    Testosterone 257 (241-827)

    Prolactin: 37.2 (2.0-18.0)

    Alot of these tests look out of range to me, but not sure what to do. The Prolactin Test was just done this past week and this test is also out of range, not sure what this test is.
    l am male and 27 years old, my testosterone for my age doesnt look right either.

    TSH 1.32 (.40-5.5)
    T4 Free 1.2 (.80-1.8)
    T-3 Free 317 (230-420)

    I also have a strange sensation in my throat around my thyroid that hasnt been removed.
    Any help would be very much appreciated.
    Thanks:

     
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    Old 07-14-2005, 09:16 PM   #2
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    Re: Labs, Help Me Understand?

    Have you ever been tested for the thyroid antibodies? TPO and anti-TG's? Those can cause a whole host of symptoms even if you labs are in range.

    When they took your thyroid out did they indicate if you have autoimmune thyroid problems?

    Karen

     
    Old 07-15-2005, 05:41 AM   #3
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    Re: Labs, Help Me Understand?

    I agree with you on the testosterone level--that looks pretty low. Have you done any research on the internet? You probably can find what levels you need to be at to feel healthy.
    Carrie

     
    Old 07-15-2005, 06:17 AM   #4
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    Re: Labs, Help Me Understand?

    Hi again Van. I responded to one of your earlier posts too, and I'll say the same thing again: a lot of your tests are WAY out of range. ACTH, the cortisol precursors (11-deoxycortisol), and prolactin are very high. And yes, testosterone is a little low. There is definitely something VERY wrong and if your current doctor (I hope you're seeing an endocrinologist) doesn't think so, find a new doctor now! If you have not yet had a pituitary MRI, get one (although I think you said you had one already and it was normal, right??) I can't believe any doctor would leave you in the lurch with no answers, after seeing results like these. I mean, your 11-deoxycortisol is FIFTY TIMES the normal upper limit. Call your doctor right now and demand some answers; you definitely deserve that much. If your current doc is in over his head and doesn't know what's going on, have him/her refer you to someone who does.

     
    Old 07-15-2005, 06:55 AM   #5
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    Re: Labs, Help Me Understand?

    That looks a lot like Cushings to me:

    Condition ACTH Cortisol
    Cushing's disease High High
    Adrenal tumor (Cushing's syndrome) Low High
    ACTH made outside the pituitary gland High High
    Addison's disease High Low
    Hypopituitarism Low Low

    That was supposed to be a chart above...you get it though? When ACTH and Cortisol are both high, it is indicative of Cushings or a tumor somewhere typically. Have you ever had a pituitary MRI? All thoise things that are HIGH for you arre originated by the hypothalamus or pituitary. Prolactin, ACTH, testsosterone - all regulated by the pituitary. You might want to get that checked. Might be a small tumor on their pumping out lots of extra hormone.

    Also, Im 35 and my testosterone was only 247. Doc told me it should be around 700-800 for a guy my age.

    Last edited by nastyhashi; 07-15-2005 at 08:00 AM.

     
    Old 07-15-2005, 02:47 PM   #6
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    Re: Labs, Help Me Understand?

    Thanks for all your replies:

    I have had an MRI of my Brain and they say it looks okay, there is a small abnormality, but according to the doctor its nothing to worry about.
    I know something is wrong just wish l could find someone who can help.
    What other bood work can be done to try and find the problems l am having, like pituitary blood work?
    Nastyhashi:
    What did your doctor do about your low testosterone?
    Thanks:

    VAN

     
    Old 07-15-2005, 04:01 PM   #7
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    Re: Labs, Help Me Understand?

    Quote:
    there is a small abnormality, but according to the doctor its nothing to worry about
    Aha! See another doctor. Find someone who is a pituitary specialist. Sometimes a "small abnormality" can cause BIG problems. ACTH-secreting tumors are often very small; in fact half the time they don't even show up on an MRI. Any doctor worth his salt would take a "small abnormality" very seriously when it occurred together with your incredibly high ACTH.

    Another pituitary hormone you might want to get tested is IGF-1. This is a measure of growth hormone, which you may be deficient in.

    There is such a thing as testosterone gel, which is sometimes prescribed for low testosterone. But you obviously have more going on than just low testosterone and I'd be surprised if testosterone replacement would alleviate your symptoms.

     
    Old 07-15-2005, 06:14 PM   #8
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    Re: Labs, Help Me Understand?

    I agree with above. I don't think those labs take an expert to see something is pretty wrong and in my opinion, a lot of that leads to pituitary or other tumor. Don't want to scare you though so it could be anything and Im obviously no doctor.

    I've done some research on this for my own knowledge and problems and have found that high ACTH and high Cortisol can be indicative of a tumor either on the pituitary or elsewhere, typically on the lungs or around the adrenals. I don't want to scare you but it needs to be considered so you get the correct help. I know there are other tests that can be done and a contrast MRI should be able to show something. Like poster above said, a tiny little tumor the size of a sesame seed on your pituitary can be pumping out additional hormone on its own.

    I heard of some stuff called Adro-Gel, which is just testosterone replacement for that problem but becasue they are all connected, I would get the pituitary issue looked into first.

     
    Old 07-15-2005, 07:21 PM   #9
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    Re: Labs, Help Me Understand?

    Your stim test is virtually flat. The baseline Cortisol is "normal" (most healthy people run between 16 and 24 mcg/dL), but the 30 minute should be at least 7 points higher than the baseline, and the 60 minutes should be at least (minimum) 11 points higher - but preferably double the baseline. Some docs consider adrenal fatigue if the 60 minute isn't at least 35.

     
    Old 07-15-2005, 07:34 PM   #10
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    Re: Labs, Help Me Understand?

    Whoops! I accidentally posted before I was finished. Anyway, as I was saying, your ACTH Stim test looks totally flat. The whole purpose of giving the test is to stimulate your adrenals to produce cortisol, and yours didn't increase production hardly at all! Your 60 minute looks just like your 30 minute. It could be that you have adequate adrenal reserves, which might explain the results within the reference range, but what happens when those reserves run out, and your adrenals aren't doing such a hot job of producing more?

    I would really want to know why your adrenals seem so sluggish.

     
    Old 07-16-2005, 03:46 PM   #11
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    Re: Labs, Help Me Understand?

    I am on my second endo and l think l need to go to a pituitary specialist?

    VAN

    Last edited by van7771; 07-16-2005 at 03:48 PM.

     
    Old 07-16-2005, 03:47 PM   #12
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    Re: Labs, Help Me Understand?

    Thanks for all you replies, l have a few questions on what was said.

    If l have had an MRI done and they cant see a tumor how do you find the tumor if its real small and the MRI cant pick it out?

    My last doctor put me on synthroid, florinef and cortef, all these drugs made me feel alot worse. The cortef almost drove me crazy all my symptoms intesified by like 20 times on the cortef. The amount of cortef l took was so small my doctor said 99% of people wouldnt even know they took it. I guess l am the 1%, that would tell me that something isnt right with either my pituitary or my adrenal glands. But l am not sure where to go from here. What tests should l ask for, someone above said an IgF-1 test l think, what else?

    VAN

     
    Old 07-16-2005, 04:36 PM   #13
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    Re: Labs, Help Me Understand?

    You really need to see a pituitary specialist. A regular Endo probably won't be good enough. I am sure there are more extensive scans that can be done if needed to find a tumor if there is one or perhaps it has grown real recently. When did you have the last MRI? Was it with contrast? The contrast helps a lot. Also, I would get a physical copy of the NRI and bring it to a pituitary doc for him to look at. I would think a lot of radiologists dont see too many pit tumors and they can be really small. They can also give drugs in some cases, laser radiation and a host of other solutions but you gotta find the right doc. Read up on cushings and pituitary microadenoma on the net. You can even find MRI scans online of actual pit tumors versus normal scans. Theres a lot of info there if you search correctly.

     
    Old 07-17-2005, 11:51 AM   #14
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    Re: Labs, Help Me Understand?

    Yep, I second what nastyhashi said. Get your actual MRI films and bring them with you when you see a pituitary specialist.

    It IS possible that your pituitary is not the culprit here (although the "abnormality" on the MRI and the high prolactin make me suspicious that it is pituitary.) One thing to keep in mind, is that usually ACTH-secreting pituitary tumors don't cause levels quite as high as yours. WHen ACTH is that high, it's often coming from a tumor elsewhere in the body (usually lung.) But a pituitary endocrinologist will know what tests to run to be able to determine whether it is a pituitary source or not. Probably a good first test to have is a dexamethasone suppression test. This is where you take dexamethasone at 11pm and then have blood taken for cortisol testing the next morning. There are high-dose and low-dose versions of this test, and I think the high-dose one can help distiguish the source of excess ACTH.

    The presence of a tumor can be confirmed through extensive blood testing even when it can't be seen on MRI.

    Yikes, why would your doc put you on Cortef when your cortisol is already at the top of the range? No wonder your symptoms got worse!

     
    Old 07-21-2005, 07:11 PM   #15
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    Re: Labs, Help Me Understand?

    I have heard that an ectopic tumor can casue alot of whats going on with me, not usre if anybody has any comments about that.
    My MRI was performed with contrast, but if there is a tumor in the lungs or adrenal glands they wouldnt catch it without some type of a scan. Any comments would be appreciated.

    Thanks:

    VAN

     
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