Desperate to know what these results mean

[CFS_for_19_years]

New or worsened high blood pressure no

This makes having Cushing's less likely.

Pink or purple stretch marks (striae) on the skin of the abdomen, thighs, breasts and arms yes but as far as I understand this could also be due to her vegan diet.

Some of these images show severe stretch marks, but at least you can get an idea of what to look for:
https://www.google.com/search?q=cushing's stretch marks&source=lnms&tbm=isch&sa=X&ei=DFNnVJ67MefuigKs_oD4Cw&ved=0CAgQ_AUoAQ&biw=1200&bih=572

When I was getting worked up for Cushing's I read a ton of articles and wanted to determine as much as I could prior to receiving my lab results. One test you can do at home is a measurement of waist-to-hip ratio. Here's the paper:

Body Composition and Metabolic Features in Women with Adrenal Incidentaloma or Cushing’s Syndrome
http://press.endocrine.org/doi/full/10.1210/jcem.86.11.8059

For the sake of understanding the article and table: THE ADRENAL INCIDENTALOMA (AI) is an adrenal mass discovered accident when getting imaging studies for another reason.

Scroll down to Table 1 where it says

Table 1. Anthropometric and clinical features in women with CS, women with adrenal incidentaloma (AI), and healthy control (C) women

Click on the table to the left of that description.

Table 1. Anthropometric and clinical features in women with CS, women with adrenal incidentaloma (AI), and healthy control (C) women

Look for the line where it says WHR, which is an abbreviation for waist-to-hip ratio.
Women with CS (Cushing's syndrome) had a WHR of 0.90 ± 0.01.
Women with adrenal incidentaloma (AI) had a WHR of 0.88 ± 0.02.
Healthy control women (C) had a WHR of 0.77 ± 0.001.

Abdominal fat distribution is a strong feature of Cushing's syndrome. When I measured my own WHR I think it was around 0.75 and I felt some relief.[/quote]

 

[CantThink]

When she last visited the endocrinologist last year, I asked him if she could be suffering from Cushing's. She has many symptoms although she misses a number of vital ones.

The trouble is that these symptoms are part of many disorders and not specifically to Cushin's

As for adult CAH the same applies, yes certain aspects she has, loss of hair, hirsutism and trouble with her monthly cycle as well, but masculin features such as deepening of voice or change in genitals growth ...she has one breast larger (about one or two cup sizes) than the other (I know.. nothing to do with genitals, but it just made me think...) One would be an A size and the other a C. This started when she developed breasts. But possibly totally unrelated. Just had did quick google search and can't find a connection. Not a lot on the reason why this happens, just that estrogen might be the cause.

L_avender

It's not so much that I or other members think she has either of these conditions, more so that when diagnosing PCOS they should be excluded. It's like when diagnosing M.E. - other diagnoses have to be excluded in order to confirm the diagnosis of M.E. As you said, unfortunately a lot of endocrine problems mimic each other with common symptoms, and then it is down to more specific ones that suggest one condition over another.

If she has low vitamin D3 that will not help her bones/teeth (speaking from experience) so definitely worth keeping that supplemented.

The vitamin B12 and D3, selenium and iron are all really important factors in the thyroid function.

 

[Jonathan Edwards]

This is a normal hemoglobin. What's throwing you off is the units of measure. In the US, hemoglobin is reported in gm/dl, not mmol/l. I didn't have to get out my calculator and do the math for this, as I could see that her hematocrit of 41%, is perfectly fine as are her erythrocyte (RBC) levels.

A good rule of thumb when estimating hematology values goes like this: RBC x 3 = hemoglobin; hemoglobin x 3 = hematocrit. Example: RBC's are 5. Multiply x 3, you'll get a hemoglobin of 15. Multiply the hemoglobin of 15 x 3 and you'll get a hematocrit of 45. This is only useful for the units of measurement used in the US. It won't work when hemoglobin is reported in mmol/l.

I thought this was odd and am still puzzled because 8.4mmol/L seems to be 50% haemoglobin (Hb is 64kD) - which would be as solid as a bar of soap. I find it difficult to believe that the actual Hb concentration is much more than 5% at most (i.e. 12% in red cells). The trouble is without knowing what these concentration figures mean we cannot interpret the haematocrit, which is a volume per volume measure that does not indicate a measure of Hb (She could be hypochromic.) All in all I suspect this really is a normal Dutch value though. (Maybe they are using the single chain molecular mass of 16kD but even that seems high.)

 

[Helen]

Hi Helen,

Thank you so much for sharing this info.

In the last tests (Jun/Jul 2014) this was the outcome of the ferritine and iron (blood):
Ferritine 22 ------ ------ ng/ml 16 - 280 (so within the range but very low)
Iron 23.5 ------ ------ μmol/l 14.0 - 36.0 (normal)
Iron measured in 24 hr urine was:
Iron------ <5 ------ μg/24u <= 1200 (low)

ENDOCRINOLOGY IN URINE (the total picture)
T3 ------ 691 ------ pmol/24u 800 - 1800
T4 ------ 1937 ------ pmol/24u 1800 - 3000
T3 % average ref.value------ 53.2 ------ %
T4 % average ref.value------ 80.7 ------ %
T3/T4 ratio ------ 0.36 ------ ratio 0.63 - 1.00
Reverse T3 ------ 62 ------ pmol/24u 46 - 130
T3/RT3 ratio ------ 11.1 ------ ratio 10.0 - 20.0
TSH (u) ------ 19 ------ μU/24u 14 - 60
Cortisol (u) ------ 82 ------ nmol/24u 58 - 248
2-OH-Oestron (E1) ------ 4.5 ------ μg/24u 1.9 - 15.8
4-OH Oestron ------ 7.9 ------ μg/24u 4.4 - 18.7
16-OH-Oestron ------ 3.4 ------ μg/24u 1.7 - 5.8

Vitamine B12 >997 ------ ------ ng/l 540 - 2702 (blood)
Baring in mind that in the preceding six months she had B12 injections every week for 10 weeks and then every month. So this result might not give a true picture of her deficiency as I understand B12 suppletion in any shape of form stays in your body for quite some time.

I am glad you found a knowledgeable doctor. CanI ask you what you mean by: "optimal, and not only suboptimal, treatment"?

L_avender

Yes, after getting B12 injections you would probably have pretty high serum B12 levels. I still think you should go further with your research of a B12 deficiency. A B12 deficiency might impact the level of iron and the iron level will impact the thyroid...so all deficiencies should be treated.

Experienced B12 doctors that I know don´t trust available tests if negative and prefer to let people with a suspected B12 defiecience get a trial of treatment. About the hormone tests, I am unfortunately not used to see the tests in urine, only blood.

The answer to your last question is that hypothyroidism is too often treated based on the TSH value and not on symptoms from the thyroid. I found an endocrinologist that was willing to let me try T3 treatment to start with wich gave the first positive change and then dessicated thyroid (NatureThroid) that made a real change. The morning temperature is for many a good indicator of the metabolism (36.8-37 C according to experienced thyroid doctors. But there are lots of other signs and symptoms to look for).

About B12 treatment an optimal treatment is the right kind of cobalamine and in enough high doses and enough frequent. It took me some years of trial and errors to find out that, also together with a doctor with huge experience from B12 treatment. And also B12 should be combined with folate as you surely know from this forum.

 

[CFS_for_19_years]

I thought this was odd and am still puzzled because 8.4mmol/L seems to be 50% haemoglobin (Hb is 64kD) - which would be as solid as a bar of soap. I find it difficult to believe that the actual Hb concentration is much more than 5% at most (i.e. 12% in red cells). The trouble is without knowing what these concentration figures mean we cannot interpret the haematocrit, which is a volume per volume measure that does not indicate a measure of Hb (She could be hypochromic.) All in all I suspect this really is a normal Dutch value though. (Maybe they are using the single chain molecular mass of 16kD but even that seems high.)

You just confused me more so I'm not going to argue with you other than on this one point: you said she could be hypochromic. Looking back at her indices, her MCH (mean cell hemoglobin) is 1840 amol. It would take me forever to work out the conversion factors to US units, if in fact they need any conversion at all (my mind's gone blank) - having that information would indicate whether she's hypochromic or not. Here's a wikipage about converting MCH units:
http://en.wikipedia.org/wiki/Mean_corpuscular_hemoglobin

Her MCV of 88 puts her in the normal range for mean cell volume.