PCOS Messages for January, 2002: Re: For Belle

Re: For Belle - PCOS tests

From: Belle (anonymous@obgyn.net)
Tue, 15 Jan 2002 13:43:04 -0600 (CST)

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Alright Anne, let's see what we can do. Your goal is to get the proper diagnosis so you can develop a plan for better health, right? You have *not* been diagnosed with PCOS?

This is a hard post to write because there is no way I can know all of the specifics of your situation and because you have a couple of symptoms that are not related to PCOS or are related to another condition.

First off, even late onset CAH is usually detected in childhood. In females, it generally prohibits the development of breasts and prevents the beginning of menstration. I read your post to mean that you are *beginning* to develop indications of virilization and that you are already an adult. I am not very concerned about CAH *if* that it the case. I do not think that 17-OHP is necessary unless there is something else going on.

On to the PCOS questions, I need to tell you that I am not very familiar with the UK's National Health System. I can only give you opinions from the point of view of the States. I do not know of any reason why you *should* use the same lab as before. If you have the records from your earlier tests, they could be used as a comparison when you are tested again. In reality, far more weight will be placed on the results of the newer test results since they should give a snapshot of your health at this time, regardless of what was occuring in the past.

The diagnosis of PCOS can be difficult. The tests that you are having repeated are very good pieces of the puzzle. Because we have trouble with lipids, that is also a good test. I am curious about the insulin test. Is it a fasting insulin test or are you going to have a glucose tolerance test with insulin levels as well? I would assume that your SHBG is low based on your symptoms. I do like the idea of DHEA-S being tested.

Based on what you have said, AN, male pattern baldness, unwanted hair, anovulation, you certainly could have PCOS.

Now, the other symptoms, yours may be unusual but it is normal for one's voice to deepen with age, unless it is dramatic, I would not be concerned about that. I am concerned about your statement that you backbone and ribs have grown, how did you come to that conclusion. Is there a possibility that you are developing an enlarged area on your back that makes it appear as though your collar bone is more prominent. Have you been tested for Cushing's. The symptoms are very similar. http://world.std.com/~csrf/factsheet.html There are different tests listed here, have you had any of those. I would recommend testing your Cortisol levels.

To sum up: I can not think of a reason why you should have to use the same lab. The tests that you are having repeated are great, consider asking for DHEA-S and cortisol levels.

Please get back to me with the answers. I would like to follow what is going on with you.

At Tue, 15 Jan 2002, anne wrote: >
>Please help me - I need to repeat some of the PCOS tests I originally
>had over 2 years ago. I have been untreated since then- long story- and
>my problems have worsened considerably. Anyway, I've moved recently
>since seeing the proper specialist i.e the R.E for the first time and I
>want to know if I should get these tests done at the same labs as the
>first lot even if I later have to change hospitals. The repeat tests are FSH, LH,
>oestradiol, testosterone, prolactin and something I can't read! I'm also
>getting insulin, lipids etc done. I've had progesterone done before and
>didn't ovulate and TSH and had PCO on ultrasound.
>
>Also do you think I should push for further tests? i.e DHEAS,
>androstenedione, free or bioavailable test, 17-OHP, and maybe SHBG? at
>least. And how do they know for sure I don't have late onset CAH as
>well? I'm in the UK on the NHS and I can't help think they need to keep
>costs down so haven't done that many tests. I know I'm whining again
>but I'm worried- I have had manifestations of PCOS for many years now
>and I think it is getting pretty darned severe. I have lots of
>hyperandrogenic symptoms and IR symptoms including AN-despite changing
>diet recently. I am kind of worried about 'virilisation' symptoms as
>well now. I have been losing hair for a couple of years in a mostly
>male pattern but it has only become a lot more noticeable and sped up
>recently- in the last few months-in the last few weeks even. Also in
>the last few months my ribcage/back has grown and collar bone sticks out
>more. Also I have a lot more fine hair growth all over the place as
>well as hirsutism and a deepening voice- although my voice I think has
>been gradually deepening over the years. Also some weight gain and more
>AN I think. Still have same size breasts though so I suppose that's
>something. not sure about clitoris-keep forgetting to check! Anyway, in
>view of these symptoms-which were not present or noted at my initial
>exam, and in view of the fact that I really want to waste no more time
>and treat this agressively and be sure I've been diagnosed correctly NOW
>should I push for more tests? The other problem is that they apparently
>don't offer private tests at my practise so I can't say here's some
>money, please do these tests too?
>SO what do you think? Where should I get the tests done, and what should
>I get done?
>Thank you
>
>--
>anne
>

-- Hope this helps,

Belle

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