WOMENS-HEALTH Messages for April, 1997: Re: Additional hormone test results

Re: Additional hormone test results

From: Laurie (anonymous@obgyn.net)
Fri, 18 Apr 1997 10:26:03 -0500 (CDT)

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In reply to: Harvey S. Marchbein, M.D.: "Re: Additional hormone test results"

One additional test might be a 17 hydroxy-progesterone >(additional info on the adrenal).
>Good luck on this.

>*Note: Opinions expressed here are for educational purpose only.
>This information is not intended to supplant the need for you to
>consult with your physician prior to choosing therapeutic options.
>

Hi Mary, first let me congratulate you on your hard work which has paid off with signficant weight loss! That can only help your health.

Second, I think that PCO is very hard to actually define. I think your lab values are very consistent with PCO; we don't always see a 2:1 or 3:1 ratio of LH:FSH (one of my teachers used to say that "diseases don't always read the book"--in other words, classic descriptions of a process can vary from case to case). In your case, your history (irregular periods since puberty) is very suggestive, as is the fact that your problem worsened when you stopped the Pill (which was probably helping control your androgens).

Third, the reason your doctor doesn't seem concerned with the elevated DHEAS level is that we are taught that there is little danger of an adrenal tumor with DHEAS levels under 7,000-8,000 (by your units). To rule out a further adrenal problem, a couple things could be done: (1) MRI of the adrenal glands to look for a tumor, (2) an early-morning, follicular phase 17-hydroxyprogesterone level to rule out an enzyme deficiency causing a backlog of androgens, and (3) 24-hour urine collection to measure cortisol to rule out Cushing's disease or syndrome. These tests are usually based on clinical discretion.

Fourth, if you do have PCO, there is exciting new research into its causes now, and one area being investigated is the role of insulin resistance (kind of a precursor to diabetes). In your case it might be very interesting to see the results of a glucose challenge test with insulin levels. In women with PCO and elevated insulin levels, treating them with insulin-sensitizing medicines often improves their symptoms and restores normal menstrual function.

Fifth, (and finally!) an ultrasound will neither confirm nor reject a diagnosis of PCO. Up to 20% of women without PCO will have polycystic-appearing ovaries on ultrasound.

--
Laurie Lovely, MD
RE fellow, UNC-Chapel Hill

Next message: Laurie: "Re: Doctors - please respond - Breast ca and estrogen receptors"
Previous message: Deanna: "abdominal pain"
In reply to: Harvey S. Marchbein, M.D.: "Re: Additional hormone test results"

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