Suggest treatment for high Cortisol levels in body, hypothyroidism and PCOS during pregnancy
I did some more tests. 1)cortisol 24hr in urine 72,1mcg/g CR (previous 60mcg/g CR) 2)cortisol in blood morning 40,5mg/dl (previous 38mg/dl) 3) ACTH 80,8pg/ml (previous 63,4pg/ml) After that I did high dose suppression test with dexamethasone (8mg ) and here are the results : cortisole : 2,5mg/dl acth: 1,9pg/ml I read that : If the disease is Cushing suppression > 60 % . so I definitely have Cushing
what treatment do you suggest and what pill is safe to use during pregnancy?
It is possible you have excess cortisol production in your body.
The latest guidelines suggest using a cut off of 1.8 for blood cortisol after dexamethasone suppression tests.
Now when you say High dose 8 mg dexamethasone suppression test, did you do this for 2 days ie a total of 16 mg?
Regardless, I would strongly recommend performing the midnight salivary cortisol test, at least 2 times.
This is assuming you have the usual sleep-wake cycle of going to bed at night and getting up in morning.
I have also done 1 mg dexamethasone test.
I see. Yes I noted the result of the 1 mg test too.
The 8 MG 2 DAY HIGH DOSE DEXAMETHASONE SUPPRESSION TEST (DST) is different and is supposed to be done as follows:
Again to emphasize, THIS FORMAT APPLIES TO INDIVIDUALS WHO HAVE THE TYPICAL SLEEP PATTERN OF GOING TO BED AT NIGHT AND WAKING UP IN THE MORNINGS.
IF YOU HAVE THE REVERSE PATTERN SUCH AS NIGHT SHIFTS, PLEASE LET ME KNOW SO I CAN ADVISE YOU HOW TO DO THIS TEST DIFFERENTLY.
1 FASTING IS NOT REQUIRED FOR THIS TEST
2 You will need A PRESCRIPTION FOR dexamethasone tablets.
Please make sure you take it in the right doses.
3 YOU ARE REQUIRED TO TAKE 2 MG, 4 TIMES IN A 24 HOUR PERIOD AS FOLLOWS:
9 AM, 3 PM, 9 PM, 3 AM ON DAY ONE
THEN AGAIN FROM NEXT MORNING (DAY TWO) AT 9 AM, 3 PM, 9 PM, 3 AM
THEN ON MORNING OF DAY THREE AT 9 AM YOU HAVE TO UNDERGO A BLOOD TEST FOR SERUM CORTISOL AND ACTH
4 ALSO, YOU HAVE TO COLLECT URINE IN A CONTAINER FOR 24 HOURS FROM MORNING OF DAY TWO TILL MORNING OF DAY THREE
5 THE TIMINGS FOR THIS TEST ARE CRITICAL AND SO DO NOT DEVIATE FROM THESE
So I suggest you do the midnight salivary cortisol test as well as the above HDDS test. Establishing the diagnosis of Cushings syndrome can be challenging at times.
Second follow up
The 8 mg overnight test is also one of the alternative methods.
The one I have described is the 2 day High Dose Dexamethasone Suppression test (DST). It is well described too and is useful.
But I can understand you are anxious to get started with treatment. However one needs to be certain of the diagnosis because treatment is directed there.
Furthermore, the diagnosis just does not end at Cushings syndrome. One needs to establish whether this is ACTH dependent or not.
The 2 day high dose DST will give confirmation of this, and if fond to be ACTH dependent then even though I see your MRI of the pituitary is negative, the next step is
INFERIOR PETROSAL VENOUS SINUS SAMPLING
Sometimes the 'adenoma' producing excess ACTH is found by this test and localized to one side of the pituitary. This side is then addressed during surgery.
This is a highly sophisticated test that requires considerable expertise and experience in high volume centers. It is complex and challenging so I suggest you find an academic endocrinology/ university hospital center near you with 'Interventional Neuro Radiology' services.
The preferred treatment for Cushings disease is surgery and only then medications if required.
Third follow up
As per international guidelines and best practice recommendations, Inferior Petrosal Sinus Sampling (IPSS) is a crucial next step to find which side of the pituitary has the tumor potentially to guide surgery
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