Brief Answer: Cause might be ulcer or H.Pylori. Detailed Answer: Hi, I have gone through your query. Your Daughter has has High cholesterol level, High ESR and CRP. Cause for High Cholesterol level include: * Hereditary * Obesity * Diet High ESR and CRP levels indicate any type of inflammation. Level of DHEAs may be high due to increased level of Cholesterol. Now coming to Symptoms. Your daughter has poor appetite with nausea, and stomach pain after eating. This is usually seen when there is H. Pylori infection in stomach or GERD (Gastro esophageal Reflux Disease) or Ulcers in stomach or all together. From the test results and symptoms, it is most probably H.Pylori infection, that is why your treating doctor has advised Urea Breath Test (can detect H.PYLORI). But chances of ulcers or GERD cannot be neglected. And an Upper GI endoscopy with or without biopsy is also advised. Now coming to your question. Yes, these can cause low appetite and hence poor health. You have to consult an endocrinologist and gastroenterologist as further treatment( Like Pravastatin for lowering cholesterol, Antibiotics if H.Pylori, Iron Supplement for anemia) can be started after clinical examination and few more investigations. In the meantime following can be done: * Avoid spicy and Junk food. * Healthy diet(low in total or saturated fat) at 3-4 hours interval. * Regular exercise. * Proton Pump Inhibitors like pantoprazole with Domperidone can be taken daily before breakfast. Hope I have answered your query. If you have any further questions I will be happy to help.

---

Brief Answer: 24 hour cortisol urine test is reliable. Detailed Answer: Hi, Thanks for the follow up. Sorry for mistaking Cortisol with cholesterol. My bad. Please ignore all related to cholesterol in my previous post. Cortisol level rises during early morning and is lowest in early phase of sleep. Your daughter's cortisol level at 8 am is high and a cortisol test is done to find problems of the pituitary gland or adrenal glands, such as making too much hormone, which happens in Cushing's syndrome. Normally Cortisol levels increase in body in following conditions: *Stress *Trauma *sleep deprivation *caffeine *Burn *prolonged exercise *Alcohol consumption For diagnosis of the disease, 24 hours cortisol urine test is more reliable than blood test at particular time. This is also preferred over Dexamethasone suppression test but both show same result. You are concerned about 465 ml of urine in 24 hours for test. Test needs any amount of urine voided in 24 hours. It is advised to drink plenty of fluid before test to prevent dehydration. Don't worry about a single test. She may require series of urine or blood test once endocrinologist is consulted. If high levels are found, she has to go for a CT scan of adrenal gland or MRI of pituitary gland. If you do not have any clarifications, you can close the discussion and rate the answer. Wish her good health.

---