Endocrinologists....

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Beer Jew
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Endocrinologists....

Post by Beer Jew » Mon Mar 21, 2016 7:49 pm

A family member (female, mid 20's), just got blood results back.

This is all that was stated on the letter, and as a non-medical family, none of us have any idea what it means.

"Biochemical results have shown an ACTH of 11.3 ng/L coupled with a cortisol level of 614 nmol/L (on the oral contraceptive pill). Liver function tests were normal. Thyroid function tests were entirely normal at 2.52 with a TSH of 2.52 and a T4 of 16.6. IGF-1 was also normal at 23.4. Iron studies, B12 and folate were entirely normal. Her Vitamin D was sub-optimal at 59 nmol/L. ANA was negative at less than 20. Full blood cell count showed normal Hb and white cell count with platelets of 401. Glucose was 4.5.

She had an ultrasound of her abdomen showing possible small liver haemangioma which was a well-defined, hypoechoic solid lesion in the right lobar segment measuring not larger than 6mm.

In light of her results, I would be grateful if you could initiate Vitamin D 1000 units to be taken daily."

Does she need to be worried?

Symptoms that prompted the blood test were depression, mood swings, high stress, bad reactions to stress, significant weight gain, reflux, sugar cravings and a number of other issues.

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terra
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Re: Endocrinologists....

Post by terra » Mon Mar 21, 2016 11:56 pm

Not my area.
Guessing the scan was to rule out abnormal adrenal mass or ovary cysts (Cushings synd, PCOS etc) and the liver was an incidental finding?

If so, and on the scant info, simply trialing a comprehensive lifestyle overhaul and changing to an alternate contraceptive pill may be helpful?

Side effects of certain brand contraceptive pill can be extreme when taken by certain patients. It's a question for patients in this demograph if they've have sudden symptom changes as described. Had two patients who had recently changed to this brand:
http://www.rxlist.com/yasmin-side-effec ... center.htm changing brands helped. Yasmin was popular a while ago and resulted in a few horror stories, although one patient liked the breast swelling side effect...

Sorry to not be of more help.
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Beer Jew
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Re: Endocrinologists....

Post by Beer Jew » Mon Mar 21, 2016 11:59 pm

Thanks Terra. You said;

"If so, and on the scant info, simply trialing a comprehensive lifestyle overhaul"

To combat what though? I don't really know what those results are showing. The best I've managed to come up with is low ACTH and high Cortisol, but to be honest I don't really know what that would mean...

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baffled
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Re: Endocrinologists....

Post by baffled » Tue Mar 22, 2016 1:42 am

I'd bet her doctor would have an answer.

I'm not a doctor, not giving advice, and just spent a minute or so copying and pasting into Google to see what came up. I think this may have some stuff on the liver lesion.

http://radiopaedia.org/articles/hyperec ... er-lesions

and

http://radiopaedia.org/articles/hepatic-haemangioma-3


I'm not sure what any of that meant, but just going bit by bit on Google makes it look pretty ho-hum.

Not sure how you guys do it in Englandistan, but over here you'll usually get a call from your doctor to come in and talk if there's something nasty going on.
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TerryB
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Re: Endocrinologists....

Post by TerryB » Tue Mar 22, 2016 4:22 am

She sounds fat. How fat is she?

Labs are fine. She could be psychotic though. Does she fine you interesting?
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baffled
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Re: Endocrinologists....

Post by baffled » Tue Mar 22, 2016 6:21 am

Well, he did say this is for a woman, so psychotic is a given.
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Re: Endocrinologists....

Post by terra » Wed Mar 23, 2016 8:31 am

Beer Jew wrote:Thanks Terra. You said;

"If so, and on the scant info, simply trialing a comprehensive lifestyle overhaul"

To combat what though? I don't really know what those results are showing. The best I've managed to come up with is low ACTH and high Cortisol, but to be honest I don't really know what that would mean...
Note, I also said 'Not my area'.

I'm Guessing they heard her story, looked her over and thought "hormones out of wack". So did bloods to find out which ones and where along the chain the problem might be. When cortisol goes up ACTH goes down due to the feedback loop, which seems to be working for her, so they may have taken this and eliminated the pituitary from the equation.

They then may have looked at the adrenals for reason behind the high cortisol. Whilst there they'd also look at the ovaries/uterus because the history could also point to ovarian/uterine cysts etc - even though she's at the young end for it.

Which leads to 'scant info' comment as you'd want to look at all the reproductive hormones, SHBG etc... High estrogen can cause the cortisol to go up, which, along with some of the physical changes is why she might want to look at alternative contraception brands/types.

A liver haemangioma in not normally a drama, especially one that small, hence me saying probably just an incidental finding.

It looks like they wanted to rule out any sinister pathology and they're happy that they've done so. If you are in the UK then you have access to public health, so get a second or third opinion. Assuming you have a copy of the scans and blood tests (always get a copy of these things) take them. The Vit D might help (esp in UK) but remember that some MDs only consider, "Is there a diagnosis" and if so "What do I need to prescribe to treat that symptom". Try a GOOD naturopath who deals with young women's health or a more holistic MD.

In complementary medicine terms she may be said to have 'early stage adrenal fatigue', where the cortisol spikes before falling in later stages. I don't use that term as I look at things differently.
In the absence of sinisters, the described symptoms can occur when the system's strategies to compensate for stress are being confused, and the resources are subsequently overloaded. The persons body is saying, "something has to change".

None of this is medical advice. Get a second/third opinion if you are concerned. Good luck with it.
What lies behind us and what lies before us are tiny matters compared to what lies within us.
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Beer Jew
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Re: Endocrinologists....

Post by Beer Jew » Wed Mar 23, 2016 4:10 pm

Thanks Terra.

As wonderful as a public health system is, it's not user friendly, and the woman in question (my wife) is finding it incredibly difficult to navigate her way through.

Rather than having a central doctor or point of contact, she is shunted from specialist to specialist, who do tests and then only get in contact if need be. She is called into appointments on a weekly basis, all of which are during work time, meaning some are missed, and the system breaks down.

The GPs are next to useless - they act purely as gatekeepers with no specialist knowledge.

She's been given a 24 hour urine test, and a sleep test. Further blood tests also need to be done. They will all be analysed by different specialists, and no one brings it all together for the patient, helping them to understand the results/implications.

I'm looking for a doctor who will be capable of looking at her in a very much holistic way. I'm convinced and have been for a while that all her issues stem from a single cause, and I've always thought that high cortisol/messed up thyroids might be to blame.

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WildGorillaMan
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Re: Endocrinologists....

Post by WildGorillaMan » Wed Mar 23, 2016 5:22 pm

That's frustrating, BJ. I can empathize.

From my limited experience with endos, unless your problem is a pathological, gonna-kill-you-sooner-than-later one, they tick the boxes, and close your case. They're more interested in whether or not your levels conform to the "normal range" rather than how you feel or any subjective symptoms.

As frustrating as it is you and she are probably going to have to keep jumping through hoops until you find the right doctor.
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TerryB
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Re: Endocrinologists....

Post by TerryB » Wed Mar 23, 2016 10:01 pm

Beer Jew wrote:Thanks Terra.
Oh, OK. Well fuck you too!!!
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Beer Jew
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Re: Endocrinologists....

Post by Beer Jew » Wed Mar 23, 2016 11:12 pm

TerryB wrote:
Beer Jew wrote:Thanks Terra.
Oh, OK. Well fuck you too!!!
I know right? What a dick.

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