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Forum Name: Endocrinology Topics

Question: Possible Adrenal Hyperplasia???


 scb - Thu Jul 05, 2007 8:19 pm

Hello, I am a 29-year-old female that has been searching for a diagnosis for about 4 years now. I weight 146 and am 5ft tall. (No other family members known to have the same problem as described below, only family dx known is hypothyroidism and thyroid cancer)
A brief description of my problems:
60 pound weight gain in last 4 years (most of which was within 1 years time), headaches, extreme fatigue, panic disorder (started within the last 4 years), infertility, abnormal menstrual cycles (long cycles, short cycles, missing cycles), hirsuitism (onset at age 10-12).
Recently, I started seeing an endocrinologist, for what I thought might be a thyroid problem. The doctor sent me for numerous labs; here is a rundown of labs in the past 3 months:
NORMAL RESULTS
TSH 1.34,FreeT4 .80,Total T3 164,Antithyroglob. <20,Thyro Recept AB <0.3
FSH 5.7 (day 21 of cycle),Testost, Total 67,Testost, Free 1.4,Andostenedione 183
Prolactin (norm don’t have #)

ABNORMAL RESULTS
LH 27.5 (day 21 of cycle),17- Hydropregnenelone 739 ng/dl,DHEA-S 2124 ng/dl
CRP, Cardiac 7.31

I have had a u/s abdomen/pelvis, CT scan abdomen/pelvis, MRI brain
The u/s only showed a prominent ovary
The CT scan showed no adrenal masses, but did show a very small cyst on the ovary
The MRI showed a pituitary micro adenoma less than 2mm ( I was told that it wasn’t big enough to classify?)

I had a dexamethazone suppression test that lowered my cortisol to 0.9, ACTH plasma to <5, and DHEA SO4 to 140. (I was told this was supposed to be the outcome)

I just had a ACTH stimulation test on Monday, and am still awaiting some results. I do have the a.m. (baseline) cortisol 16.6ug/dl, ACTH plasma 24 pg/ml, DHEA SO4 249, with a pending Androstendione .
The labs after injection are ACTH plasma 12pg/ml, DHEA SO4 250ug/dl with a pending Cortisol, and Androstendione.

The doctor seems to think that I have Congenital Adrenal Hyperplasia, with a slight possibility of PCOS in addition. The ACTH test was supposed to give us an answer; I was told that if the levels were raised, then it was a dx of CAH. My question is based on what you see here, did the levels rise enough to prove that, and if not what could the diagnoses be? If not CAH why would my DHEA level be 2124ng/dl in a normal range of 162-995 (I was told that he had never seen a level that high before)?
Thank you for any and all help/info on this matter.
Sincerely,
SCB
 Dr. Chan Lowe - Sat Jul 14, 2007 4:30 pm

User avatar The endocrinology behind CAH is complicated as there are many different defects of several enzymes in the pathway that can lead to CAH. I am most familiar with the types that present in childhood.

Your DHEA level is quite high. Your doctorl may want ot look for an adrenal tumor as well (not necessarily cancer). I would recommend you have your 17-alpha-hydroxyprogesterone level tested if it has not been. This test is helpful in defining if CAH is present.

Your LH/FSH ratio is very suggestive of PCOS. PCOS itself can account for many of your symptoms. I am simply not familiar enough with these labs to be able to comment much further.

Continued follow up with your doctor is important. You may also want to see a gynecologist regarding the PCOS issue.

Best wishes.
 scb - Sat Jul 14, 2007 8:17 pm

Thanks you for your time and suggestions. I will be following with the doctor next week. Hopefully, a diagnoses can be made.

Thanks again

scb

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