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What Do These Cortisol Readings Indicate?
Question: I called and found out that my baseline cortisol reading was 17.4 and my suppression test cortisol was 0.6. Is this indicative of Cushing's Disease?
Brief Answer:
No
Detailed Answer:
Baseline cortisol values have little value in diagnosing Cushings disease.
The suppression test result of 0.6 is considered a pass meaning that Cushings disease is unlikely as the cut off is 1.8 mcg/dl.
Are you on any steroid type medications like prednisone, prednisolone or hydrocortisone? I ask because these tests cannot be interpreted if you are 'corticosteroid' like medications.
It would be unlikely that you are in them because otherwise your baseline cortisol would not be in the 17 range.
I am raising this point to make the distinction between Cushings disease and Cushings syndrome.
The latter can also occur in an individual who is taking high doses of steroids, while Cushings disease refers to the pituitary being the main cause of excess steroid hormone production by the adrenal glands.
Furthermore, diagnosing Cushings disease can be challenging. Suppression tests are of various kinds.
Screening tests are of 3 types and then one proceeds to confirmation tests.
An experienced endocrinologist is required to perform and interpret these tests while having the opportunity to examine the patient in person
No
Detailed Answer:
Baseline cortisol values have little value in diagnosing Cushings disease.
The suppression test result of 0.6 is considered a pass meaning that Cushings disease is unlikely as the cut off is 1.8 mcg/dl.
Are you on any steroid type medications like prednisone, prednisolone or hydrocortisone? I ask because these tests cannot be interpreted if you are 'corticosteroid' like medications.
It would be unlikely that you are in them because otherwise your baseline cortisol would not be in the 17 range.
I am raising this point to make the distinction between Cushings disease and Cushings syndrome.
The latter can also occur in an individual who is taking high doses of steroids, while Cushings disease refers to the pituitary being the main cause of excess steroid hormone production by the adrenal glands.
Furthermore, diagnosing Cushings disease can be challenging. Suppression tests are of various kinds.
Screening tests are of 3 types and then one proceeds to confirmation tests.
An experienced endocrinologist is required to perform and interpret these tests while having the opportunity to examine the patient in person
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Would you say, based on the suppression test, that my microadenoma, is difinitively not releasing hormone that affects cortisol? Is it possible for secreting microadenoma's to turn "on and off" so to speak?
Also, yes, I've been using a hydrocortisone cream for psoriasis type skin condition. What would this do to effects?
Also, yes, I've been using a hydrocortisone cream for psoriasis type skin condition. What would this do to effects?
Brief Answer:
Follow up
Detailed Answer:
1 There is no definitive in the domain of Cushings. It is very tricky condition to diagnose and manage. That is why there are half a dozen tests designed to look for this with some confidence.
A lot depends on the 'pre test probability' meaning the diagnosis relies on the likelihood of you having the condition in conjunction with the results of the test.
That is why an in person detailed examination is necessary.
Many medical conditions even in this millennium are not diagnosable 100% with a laboratory test. This is certainly true of several diseases in endocrinology, which is one of the most complex fields of medicine.
Cushings disease has been a challenge for a long time and continues to remain one.
So to summarize again: you will need to be assess thoroughly by an endocrinologist who will consider ordering one or more tests to be reasonably certain if your microadenoma is not releasing a hormone that affects cortisol.
2 Yes, cyclical Cushings disease has been well described where cortisol levels fluctuate over time, making diagnosis even more difficult
3 Yes, the hydrocortisone cream can affect levels. This would likely give high cortisol levels in the blood as hydrocortisone gets converted to cortisol in the body. However a lot depends on how much cream is being applied and to what degree it is being absorbed in the blood stream which varies from person to person. This too is hard to judge
Follow up
Detailed Answer:
1 There is no definitive in the domain of Cushings. It is very tricky condition to diagnose and manage. That is why there are half a dozen tests designed to look for this with some confidence.
A lot depends on the 'pre test probability' meaning the diagnosis relies on the likelihood of you having the condition in conjunction with the results of the test.
That is why an in person detailed examination is necessary.
Many medical conditions even in this millennium are not diagnosable 100% with a laboratory test. This is certainly true of several diseases in endocrinology, which is one of the most complex fields of medicine.
Cushings disease has been a challenge for a long time and continues to remain one.
So to summarize again: you will need to be assess thoroughly by an endocrinologist who will consider ordering one or more tests to be reasonably certain if your microadenoma is not releasing a hormone that affects cortisol.
2 Yes, cyclical Cushings disease has been well described where cortisol levels fluctuate over time, making diagnosis even more difficult
3 Yes, the hydrocortisone cream can affect levels. This would likely give high cortisol levels in the blood as hydrocortisone gets converted to cortisol in the body. However a lot depends on how much cream is being applied and to what degree it is being absorbed in the blood stream which varies from person to person. This too is hard to judge
Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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