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Re: PCOS: ATCH (Dr. Futterweit please)
From: mjak (anonymous@obgyn.net)
Sat, 29 Dec 2007 17:36:56 -0600 (CST)
Thank you Dr. Futtterwiet for your helpful and quick response to my
question.
I am currently seeing an Endo at NYU but she is stumped as is my local
Endo who sent me to NYC. I have had some of the tests you have
mentioned but not all. have had catscans of both pituitary and adrenal
both normal except adrenal glands looked somewhat atrophic. DHEAS and
Testosterone are both elevated. My ACTH is elevated but my 24 hour
cortisol has actually been low normal. It just came back at 8. I had
an adrenal stim test done which showed I had no aldostrone at all but
cortisol seemed okay. I have not had any plasma cortisol testing except
years ago and I recall that was elevated at the time. I do have the
physical apperance of Cushings. I was evaluated by Dr New at Mt. Sinai
for CAH and found to be a carrier but not affected. This week my doctor
has me doing a midnight salivary cortisol. Since last spring I have
been very unwell and am getting frantic with the lack of progress I am
making toward a diagnosis and regaining my health. I just checked your
website and see you list adrenal disorders as an area of specialty. Are
you taking new patients?
--
mjak
At Sat, 29 Dec 2007, Walter Futterweit, MD, FACE,FACP wrote:
>
>An elevated ACTH level 4-5x normal range is very significant and
>suggestive of
>Cushing's syndrome. Polycystic ovaries may occur on ultrasound with
>Cushing's syndrome. The following must be done.
> Get an expert endocrinologist and the folloiwng must be obtained.
>1) a plasma cortisol and DHEAS
>2) a 24 hour urine collection for urine free cortisol and creatinine.
>3) an overnight suppression test taking 1mg of dexamethasone with a
>snack
>before bedtime. The next morning, fasting, get a plasma cortisol
>(should be less than 3ug%), and another ACTH level which should be
>suppressed.
> If the above are abnormal it is likely to be Cushing's syndrome:
>Imaging of the pituitary gland with gadolinium as well as a CT scan of
>the adrenals (or MRI) are needed. Sometimes extopic ACTH producing
>tumors may be found in the chest and other sites.
> By all means address these results to me, and I will respond.
>Best wishes,
>Dr.Futterweit
>
>At Sat, 29 Dec 2007, mjak wrote:
>>
>>I have been diagnosed with PCOS for over ten years. I have all the
>>symptoms few periods, facial hair, insulin resistance ect.. . I
>>recently found out I have significantly elevated ACTH levels. The
>>doctors repeated the tests 3 times and the levels are are about 4 or 5 x
>>the cut off. I have been tested for everything from CAH to Cushings and
>>still no diagnosis. My question is could the elevated ACTH just be a
>>manifestation of the PCOS or is this deffinitly indicitive of someting
>>else? Thank you for your opinion.
>>
>>--
>>mjak
>>
>--
>Walter Futterweit, MD, FACP, FACE
>Clinical Professor of Medicine, Division of Endocrinology
>Mount Sinai School of Medicine, New York, NY 10029
>http://www.aacehost.com/pages/page.php?r=716
>
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