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Dr. Andrew Rynne

Family Physician

Exp 50 years

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What do these following lab reports indicate?

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Dr. Mirjeta Guni

Endocrinologist

Practicing since :2006

Answered : 2143 Questions

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Posted on Tue, 21 Mar 2017 in Thyroid Problem and Hormonal Problems
Question: Hi,
I recently got my results from my doctor and it looks as though it came up with some abnormalities. I had pituitary tumor(Cushing disease) in 2014. I get tested every year for this. My MRI came out clear but my IGF-1 was low for my blood results. IGF-1 was 138 (normal range 155-432). I just did a 24 hour urinary cortisol test and I'm waiting for the results.

1) what could this be caused by
2) what is the treatment for this
doctor
Answered by Dr. Mirjeta Guni 27 minutes later
Brief Answer:
About low IGF1 levels;

Detailed Answer:
Hello and thank you for asking!
I have gone carefully through your query.
IGF-1 is a hormone similar in molecular structure to insulin. It plays an important role in childhood growth and continues to have anabolic effects in adults.
IGF-1 is produced primarily by the liver as an endocrine hormone as well as in target tissues in a paracrine/autocrine fashion. Production is stimulated by growth hormon.
So, it reflects indirectly the growth hormone level that is produced by the pituitary gland.
Low levels mean that the pituitary gland does not produce enough after the intervention.
There are some further exams (insulin stimulation test)needed to confirm the growth hormone defficency and if confirmed and there are clinical symptoms of growth hormone deficiency (low muscle mass, fatigue, increased body fat ect) the treatment consists in growth hormone replacement therapy.

Hope the information will help.
Kind regards,
Dr.Mirjeta
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Mirjeta Guni 20 minutes later
I have been feling reallg fatigued lately especially in during exercise. Its hard to determine with my weight because i am purposely gaining weight because I am an athlete.

Are my levels low enough to have a significant effect on my body compositon/energy/
doctor
Answered by Dr. Mirjeta Guni 12 minutes later
Brief Answer:
Insulin stimulation test is more accurate:

Detailed Answer:
Welcome back!
The levels are not too low but to make a diagnosis of growth hormone deficiency is needed insulin stimulation test.
If after stimulation the levels persist low and you have the symptoms of growth hormone deficiency, treatment is recommended.
It can not be judged only by a single IgF1 test. It guides rather stimulation test is needed or not.
Regards,
Dr.Mirjeta
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Mirjeta Guni 7 minutes later
My doctor had me do a 24 hour free with cartinine.

Was this the right choice to make?

doctor
Answered by Dr. Mirjeta Guni 9 minutes later
Brief Answer:
Please specify what hormone to check:

Detailed Answer:
Would you please specify better what your treating physician suggested?
Did you mean to recheck IgF1 after 24 hours free of carnitine?
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Mirjeta Guni 44 minutes later
I believe we are checking for cortisol. Im not sure the details of it but i attached the lab orders from the doctor.
doctor
Answered by Dr. Mirjeta Guni 7 hours later
Brief Answer:
Your treating physician suggested to check cortisol level.

Detailed Answer:
Hi again,
The doctor suggested to check the cortisol level in urine to exclude a recurrence of the Cushing.
Regards,
Dr.Mirjeta
Above answer was peer-reviewed by : Dr. Remy Koshy
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