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Re: PCOS: ATCH (Dr. Futterweit please)
From: Walter Futterweit, MD, FACE,FACP (anonymous@obgyn.net)
Sun, 30 Dec 2007 21:19:23 -0600 (CST)
At Sat, 29 Dec 2007, mjak wrote:
I am glad you have had some of the tests. Imaging of the pituitary even
with CT scanning, or having the best with gadolinium on MRI may miss
tiny microadenomas secreting ACTH.
Yes, there a a number of confounding results but not suprisingly you
state that you look Cushingoid.
Dr. New and I know each others for years and you made a wise decision
to see her.
Yes, I do take on new patients, and will do whatever it takes
to make a diagnosis.
Best wishes,
Dr. Futterweit
At Sat, 29 Dec 2007, mjak wrote:
>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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