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What Causes Elevated ESR Levels?
Question: ESR 70 ANA 1:160 C-RP 12. I know these are inflammatory markers, but i dont have arthritis. I do have subluxation of thumb joints. And i did have my pituitary gland removed 17 months ago due to abnormal ACTH cells. I do have pretty bad fatigue i just cant shake. I did have drug induced lupus 12 months ago, but have been fine since. What other things can raise these levels?
Brief Answer:
Autoimmune and other conditions as following...
Detailed Answer:
Hi,
I have gone through your tests reports and understood your concerns.
Based on what you are reporting, I can give the following opinion, however, it should be better to have the reference range of your lab for a more specific opinion:
1. Your ESR is very high and is indicating for possible inflammation or infection inside your body.
2. Your CRP is also slightly above the normal range (upper 10) which is also confirming that there is a type of inflammation or infection inside your body
3. Your ANA titer is quite high and is suggesting:
- that you might be still having problem with drug induced lupus; please take note that it will take a few days to months after the withdrawal of the causative drug for the symptoms to subside including the ANA titer
- you might be having liver/kidney problems; therefore, I advise to run further tests to further evaluate them: complete blood count (to exclude anemia); kidney function tests (blood urea nitrogen -BUN and creatinine); liver function tests; urine analysis
4. Being fatigue is commonly happening after pituitary surgery. However, I need to know:
- the type of abnormal cells noted at that time (adenoma?) or other types of invasive tumors? (the full biopsy report is needed to understand your current situation
- anemia and other blood electrolytes imbalance can also cause fatigue; checking their levels can help further
- the presence of an autoimmune problem inside your body can also be another cause; the tests advised above will help determine the right problem and the best treatment strategy.
All the best!
Dr.Sejdini
Autoimmune and other conditions as following...
Detailed Answer:
Hi,
I have gone through your tests reports and understood your concerns.
Based on what you are reporting, I can give the following opinion, however, it should be better to have the reference range of your lab for a more specific opinion:
1. Your ESR is very high and is indicating for possible inflammation or infection inside your body.
2. Your CRP is also slightly above the normal range (upper 10) which is also confirming that there is a type of inflammation or infection inside your body
3. Your ANA titer is quite high and is suggesting:
- that you might be still having problem with drug induced lupus; please take note that it will take a few days to months after the withdrawal of the causative drug for the symptoms to subside including the ANA titer
- you might be having liver/kidney problems; therefore, I advise to run further tests to further evaluate them: complete blood count (to exclude anemia); kidney function tests (blood urea nitrogen -BUN and creatinine); liver function tests; urine analysis
4. Being fatigue is commonly happening after pituitary surgery. However, I need to know:
- the type of abnormal cells noted at that time (adenoma?) or other types of invasive tumors? (the full biopsy report is needed to understand your current situation
- anemia and other blood electrolytes imbalance can also cause fatigue; checking their levels can help further
- the presence of an autoimmune problem inside your body can also be another cause; the tests advised above will help determine the right problem and the best treatment strategy.
All the best!
Dr.Sejdini
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your response.
Reference ranges are as follows...
ESR <20
ANA < 1:80
C-RP <10
The drug induced lupus was a year ago. Would that still be a factor now?
I do have abnormal liver function would that cause The above results?
I will put All results out of range. If Test is not here then it was normal. I have had most tests done.
ALT :62 (<35 )
AST :74 (<35 )
ALP: 138 (30 - 115 )
GGT: 174 (<40 )
Anion gap :23 (8-16)
eGFR :83 ( >90 )
Globulin :38 ( 25-35)
chloride : 95 (98-107)
Potassium : 3.5 ( 3.5- 7.2 ) Only put this on in as its on the low end of normal
FBC
WCC 12.6 (2.0-11.0 )
lymphocytes : 4.8 ( 1.0-4.0)
cortisol: 1299( 119-618 )
ACTH : 79 ( 7.2-63.3)
LH : 3.9 (7.7-59 )
prolactin :85 ( 102-496)
midnight saliva cortisol :52( <9)
24hr urine: 489 (<150)
Creatinine :6.8 (7-14)
clearance: 2.1 (2.6-20 )
serum :77 (44-80) Upper range of normal
Vitamin D : 20 ( 75-300 )that's nmol/L ( I have been on Vit D supplements for 9 months. I was taking 5000IU daily as my levels were 13nmol/l
After 3 months my Endocrinologist dropped me back to 2000IU per day as he said 5000IU is too high.My levels were 37 when he dropped back the dose.
20 is my current result.
I don't have anaemia. My Hb is always around 12. I recently got my Doctor to check Vitamin B12 and folate studies, which were all normal. Something Good :)
Kidney function : In my most recent hospitalization i was put on IV fluids for renal insufficiency. I'm not entirely sure of the circumstance for this as doctor didn't explain much.
But i was drinking around 2 to 3 liters per day so i wasn't dehydrated.
I was not given biopsy report following surgery however i was told i had Overabundance and Hyperplasia of the ACTH cells diffuse through out the whole gland???
That's all i know.
I guess the main question i have/ or concern is. Is it ok to wait 4 months to see my Endocrinologist with so many results out of range. They don't seem Concerned.
Should i not be concerned? I feel like something should be done and 4 months is a long time to wait. But I'm just the patient what do i know.
See :) I'm frustrated and don't know whats right or not right.
Sorry for such a long post :)
PS : For LFT I dont drink alcohol at all. I do have diabetes. And i have been told i have a fatty liver.
Reference ranges are as follows...
ESR <20
ANA < 1:80
C-RP <10
The drug induced lupus was a year ago. Would that still be a factor now?
I do have abnormal liver function would that cause The above results?
I will put All results out of range. If Test is not here then it was normal. I have had most tests done.
ALT :62 (<35 )
AST :74 (<35 )
ALP: 138 (30 - 115 )
GGT: 174 (<40 )
Anion gap :23 (8-16)
eGFR :83 ( >90 )
Globulin :38 ( 25-35)
chloride : 95 (98-107)
Potassium : 3.5 ( 3.5- 7.2 ) Only put this on in as its on the low end of normal
FBC
WCC 12.6 (2.0-11.0 )
lymphocytes : 4.8 ( 1.0-4.0)
cortisol: 1299( 119-618 )
ACTH : 79 ( 7.2-63.3)
LH : 3.9 (7.7-59 )
prolactin :85 ( 102-496)
midnight saliva cortisol :52( <9)
24hr urine: 489 (<150)
Creatinine :6.8 (7-14)
clearance: 2.1 (2.6-20 )
serum :77 (44-80) Upper range of normal
Vitamin D : 20 ( 75-300 )that's nmol/L ( I have been on Vit D supplements for 9 months. I was taking 5000IU daily as my levels were 13nmol/l
After 3 months my Endocrinologist dropped me back to 2000IU per day as he said 5000IU is too high.My levels were 37 when he dropped back the dose.
20 is my current result.
I don't have anaemia. My Hb is always around 12. I recently got my Doctor to check Vitamin B12 and folate studies, which were all normal. Something Good :)
Kidney function : In my most recent hospitalization i was put on IV fluids for renal insufficiency. I'm not entirely sure of the circumstance for this as doctor didn't explain much.
But i was drinking around 2 to 3 liters per day so i wasn't dehydrated.
I was not given biopsy report following surgery however i was told i had Overabundance and Hyperplasia of the ACTH cells diffuse through out the whole gland???
That's all i know.
I guess the main question i have/ or concern is. Is it ok to wait 4 months to see my Endocrinologist with so many results out of range. They don't seem Concerned.
Should i not be concerned? I feel like something should be done and 4 months is a long time to wait. But I'm just the patient what do i know.
See :) I'm frustrated and don't know whats right or not right.
Sorry for such a long post :)
PS : For LFT I dont drink alcohol at all. I do have diabetes. And i have been told i have a fatty liver.
Brief Answer:
detailed below
Detailed Answer:
Hi back my dear,
Thank you for providing additional information.
1. From the New reports, I can see that your liver function tests were out of range. As you do not drink alcohol, all that is explained by fatty liver. Diabetes is often associated with fatty liver.
As your liver is inflamed and fatty, such changes will also be reflected in increased ANA or CRP as in your case.
2. Your kidney function tests were also found out of range. This also will give increased CRP or ESR.
3. At the end, there are various factors causing increased inflammation indicators in your case.
With regards to your concern whether you should be an emergency case or not, I can say as following :
- comparison of actual blood tests reports with previous tests is needed
- your actual health problems do also matter (symptoms you might have currently )
- if doctors have visited and advised to see the endocrinologist after 4 months, I believe that is for following up. Meanwhile, your doctor might have prescribed some medicine to improve your health problems.
Diet and lifestyle changes are also important.
In case, you'll have severe health symptoms like fever, mood changes etc, then should go to ER for immediate evaluation and treatment.
Hope it was of help!
Dr.Sejdini
detailed below
Detailed Answer:
Hi back my dear,
Thank you for providing additional information.
1. From the New reports, I can see that your liver function tests were out of range. As you do not drink alcohol, all that is explained by fatty liver. Diabetes is often associated with fatty liver.
As your liver is inflamed and fatty, such changes will also be reflected in increased ANA or CRP as in your case.
2. Your kidney function tests were also found out of range. This also will give increased CRP or ESR.
3. At the end, there are various factors causing increased inflammation indicators in your case.
With regards to your concern whether you should be an emergency case or not, I can say as following :
- comparison of actual blood tests reports with previous tests is needed
- your actual health problems do also matter (symptoms you might have currently )
- if doctors have visited and advised to see the endocrinologist after 4 months, I believe that is for following up. Meanwhile, your doctor might have prescribed some medicine to improve your health problems.
Diet and lifestyle changes are also important.
In case, you'll have severe health symptoms like fever, mood changes etc, then should go to ER for immediate evaluation and treatment.
Hope it was of help!
Dr.Sejdini
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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