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What Does My CT Scan Report Indicate?

Posted on Wed, 5 Apr 2017

Question: hi can you please check my adrenal ct scan. I have on and off elevated cortisols but are now constantly elevated. elevated blood cortisol and midnight saliva is high. normal epinephrine and metaphrines urine and blood plasma test.

Answered by Dr. Mirjeta Guni (31 minutes later)

Brief Answer:
Some more images needed.

Detailed Answer:
Hello,
The images you attached are inconclusive. Only one of them has adrenal image and looks normal. But would be better if you attach some more.
Before doing radiological exams, a low dose dexametasone supression test is mandatory because cortisol level may increase for many reasons ( obesity, stress) but if it persists high after supression, it means that there is overproduction by adrenal or pituitary gland.
Pituitary gland tumors are the most common causes of Cushing syndrome.
So, to decide rather the radiological exams need to be done for the pituitary or adrenal, a high dose ( 8 mg) dexameatson test would help.
Please attach some more images of ct scan.
Regards,
Dr.Mirjeta

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Mirjeta Guni (47 minutes later)

I tried to add more photos.. my pituitary is normal. my symptoms are caffeine and stimulant sensitivity, vasoconstriction, insomnia, weight gain, fat face, weird acne, oily hair and skin, raynauds everywhere, tachycardia , migraines I crash at around 3pm but will stay awake all night. I have Chronic urticaria, gastritis, mgus. out of all my tests the cortisol is persistently high. could it be systemic inflammation? eg vascular urticaria? don't know why I'm so sensitive even a sip of tea I get tachycardia and vomiting 5 mins after. when I get the tremors I also have uncontrollable vomiting. of adrenals look normal can you suggest a cause? the vasoconstriction is getting severe I know get ulcers

Answered by Dr. Mirjeta Guni (6 hours later)

Brief Answer:
Chatechomaines should be checked also:

Detailed Answer:
Hello,
A small adenoma is seen at the left surrenal gland.
At these conditions i would recommend a low dose dexametasone suppression test.
If the cortisol persists over 5 mcg/dl it is probable an over secretion by the adenoma.
If it is suppressed (under 5 mcg/dl) chronic urticaria, systemic inflamation, stress, weight changes may be the cause of high cortisol .
I would recommend also to check the chatecholamines to rule out a pheochromacitoma that is manifested with tachychardia vasocontriction stimulated by caffeine ect.
Wish the information will help.
Kind regards,
Dr.Mirjeta

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Mirjeta Guni (6 hours later)

thank you! I saw the adenoma myself I just wanted confirmation . I have been tested for chatechmaines that is all normal. the only abnormal tests are my cortisol Levels. the theory could be that having higher cortisol Levels could make me more sensitive to the epinephrine in my body and it is reacting. my symptoms are cyclic. which means it's very difficult to test accurately although with my past test results and current I am pretty certain it's a functioning adenoma. I have had a prolactinoma in the past as well and that's all clear. which makes me wonder if I am susceptible to endocrine problems. I have been suffering with this problem for 5 years.! burning scalp, hair loss, weight gain, now I have hair on My abdomen, flushing and vasoconstriction, ectopic heart beats, constant fungal infections etc etc. a elevated cortisol can cause this. I have cyclic symptoms at the moment I am losing weight but the insomnia is still lingering and then I will have a silent period and then it starts up again and gets worse ans longer with each flare. it's time for this thing to go. I am happy to get iT removed

Answered by Dr. Mirjeta Guni (4 hours later)

Brief Answer:
Regarding the adenoma removal;

Detailed Answer:
Hi again,
I can understand your situation.
The symptoms of cortisol overproduction are very discrete and most of the patient suffer from years until the diagnosis is found.
The adenoma is small and it should be confirmed before intervention rather it is a functioning adenoma or incidentaloma as some preoperative and postoperative cautions should be done if it functioning adenoma (secreting cortisol tumor) to prevent adrenal insufficiency after removing the lesion.

So, you should discuss with your treating physician before making a decision.
Regards,
Dr.Mirjeta

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Above answer was peer-reviewed by : Dr. Yogesh D