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What Do My Lab Test Reports Indicate?
Question: Namasthe Doctor,
I am 32 years old male and I have been experiencing increased chest fat / tenderness from past 4 months. I have reduced my weight from 80 in 2014 September to 68 in 2015 November. My height is 160 cms. I have proactively went for blood tests and after consulting the doctor in my hometown, i got to know it is diagnosed as Late onset CAH. Just to add, i had precocious puberty at the age of 9 or 10. I have attached latest reports for your reference.
I have visited 2 endocrinologists in my hometown for treatment of CAH and unfortunately none of them have given me a clear picture.
1st Doctor Feedback: (Endocrinologist)
1. Diagnosed my health condition as "Late onset CAH". Although my cortisol and testosterone levels are normal, the female hormones 17-OH Progesterone and Estrogen are extremely high. I have gone for re-test of cortisol, 17-OHP, Aldostenedione and a new test called "plasma Renin activity" after taking an injection for stimulating hormones. After reviewing the results he has confirmed it as CAH due to probable lacking of 21 hydroxylase enzyme in my adrenal glands. Fortunately, there is no TART (testicular adrenal rest tumor) as i went through ultrasound scanning of testes although testicular size is a bit low. Unfortunately, my semen analysis test was confirmed for "Oligospermia" (moderate).
As a co-incidence, i got to know that my 3rd sister(100% blind) was diagnosed with late onset CAH in her teenage (20 years ago). Now, she is aged 35 years. My parents are less educated and didn't know this terminology. My parents are relatives to each other and married in 1973. The doctor has looked into my sister reports and then informed me about the problem. She is using wysolone tablet from almost her teenage. Finally, the doctor advised me to start taking wysolone 2.5 mg daily and all my problems such as extreme female hormone levels, borderline hypothyroidism, facial swelling, chest and abdominal fat will reduce completely in 3-6 months. However, i have preferred to take opinion from another doctor.
2nd Doctor Feedback: (Senior Endocrinologist) (The medical professor of 1st doctor)
The 2nd doctor has advised me not to use "Wysolone" as he says that it might be a problem of excess body fat and not CAH. The excess body fat contributes to high levels of estrogen and 17 OH progesterone. However, i am not at all convinced.
My current health issues are :
1) Chest Fat / Tissue - My doctor says it is "Lipomastia" and probably not Gyecomastia
2) Borderline hypothroidism - Facial Swelling, White hair, Anxiety & Difficulty in reducing abdominal fat through exercise
3) Oligspermia & CAH
I am completely confused and depressed with these unhealthy medical conditions. Is there any treatment for Late onset CAH in adult male & Borderline Hypothyroidism? If so, can i become 100% healthy ever in my life i.e., balanced hormones, perfect thyroid & healthy sperm? I do not want to experiment with wysolone tablet as there are many side effects. The 2nd doctor informed me that it is used only for females. I plan to get married next year only if there is a reliable treatment solution for my health issues. Btw, i do not smoke or drink and no BP & Diabetes.
I am waiting for your expert answer.
I am 32 years old male and I have been experiencing increased chest fat / tenderness from past 4 months. I have reduced my weight from 80 in 2014 September to 68 in 2015 November. My height is 160 cms. I have proactively went for blood tests and after consulting the doctor in my hometown, i got to know it is diagnosed as Late onset CAH. Just to add, i had precocious puberty at the age of 9 or 10. I have attached latest reports for your reference.
I have visited 2 endocrinologists in my hometown for treatment of CAH and unfortunately none of them have given me a clear picture.
1st Doctor Feedback: (Endocrinologist)
1. Diagnosed my health condition as "Late onset CAH". Although my cortisol and testosterone levels are normal, the female hormones 17-OH Progesterone and Estrogen are extremely high. I have gone for re-test of cortisol, 17-OHP, Aldostenedione and a new test called "plasma Renin activity" after taking an injection for stimulating hormones. After reviewing the results he has confirmed it as CAH due to probable lacking of 21 hydroxylase enzyme in my adrenal glands. Fortunately, there is no TART (testicular adrenal rest tumor) as i went through ultrasound scanning of testes although testicular size is a bit low. Unfortunately, my semen analysis test was confirmed for "Oligospermia" (moderate).
As a co-incidence, i got to know that my 3rd sister(100% blind) was diagnosed with late onset CAH in her teenage (20 years ago). Now, she is aged 35 years. My parents are less educated and didn't know this terminology. My parents are relatives to each other and married in 1973. The doctor has looked into my sister reports and then informed me about the problem. She is using wysolone tablet from almost her teenage. Finally, the doctor advised me to start taking wysolone 2.5 mg daily and all my problems such as extreme female hormone levels, borderline hypothyroidism, facial swelling, chest and abdominal fat will reduce completely in 3-6 months. However, i have preferred to take opinion from another doctor.
2nd Doctor Feedback: (Senior Endocrinologist) (The medical professor of 1st doctor)
The 2nd doctor has advised me not to use "Wysolone" as he says that it might be a problem of excess body fat and not CAH. The excess body fat contributes to high levels of estrogen and 17 OH progesterone. However, i am not at all convinced.
My current health issues are :
1) Chest Fat / Tissue - My doctor says it is "Lipomastia" and probably not Gyecomastia
2) Borderline hypothroidism - Facial Swelling, White hair, Anxiety & Difficulty in reducing abdominal fat through exercise
3) Oligspermia & CAH
I am completely confused and depressed with these unhealthy medical conditions. Is there any treatment for Late onset CAH in adult male & Borderline Hypothyroidism? If so, can i become 100% healthy ever in my life i.e., balanced hormones, perfect thyroid & healthy sperm? I do not want to experiment with wysolone tablet as there are many side effects. The 2nd doctor informed me that it is used only for females. I plan to get married next year only if there is a reliable treatment solution for my health issues. Btw, i do not smoke or drink and no BP & Diabetes.
I am waiting for your expert answer.
Brief Answer:
Need a team work
Detailed Answer:
Dear,
Good day and noted your question and reports.
It is indeed a bit confusing. Your 17 OHP levels are suggestive of CAH. Oligospermia is common in late onset CAH. I would advice you to attend a teaching hospital with a full fledged endocrine department. Since you are from XXXXXXX i would suggest endocrine departments of XXXXXXX hospital or KEM hospital. Often many brains are required to sort out these prroblems. Body fat contribute to high estrogen levels, but not 17 OHP. What was your ACTH level ( i couldn't see that in the test results). If you have oligospermia and CAH, you may respond to low dose steroids like wysolone.
You may take a small dose thyroxine for subclinical hypothyroidism.
Your case need direct examination and a panel discussion with in a group of endocriologists. I STRONGLY SUGGEST TO APPROACH A TEACHING HOSPITAL like KEM hospital or XXXXXXX hospital.
Regards
Binu
Need a team work
Detailed Answer:
Dear,
Good day and noted your question and reports.
It is indeed a bit confusing. Your 17 OHP levels are suggestive of CAH. Oligospermia is common in late onset CAH. I would advice you to attend a teaching hospital with a full fledged endocrine department. Since you are from XXXXXXX i would suggest endocrine departments of XXXXXXX hospital or KEM hospital. Often many brains are required to sort out these prroblems. Body fat contribute to high estrogen levels, but not 17 OHP. What was your ACTH level ( i couldn't see that in the test results). If you have oligospermia and CAH, you may respond to low dose steroids like wysolone.
You may take a small dose thyroxine for subclinical hypothyroidism.
Your case need direct examination and a panel discussion with in a group of endocriologists. I STRONGLY SUGGEST TO APPROACH A TEACHING HOSPITAL like KEM hospital or XXXXXXX hospital.
Regards
Binu
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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