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Re: PCOS: ATCH (Dr. Futterweit please)

From: Walter Futterweit, MD, FACE,FACP (anonymous@obgyn.net)
Sat, 29 Dec 2007 13:23:27 -0600 (CST)

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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