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What Does My MRI Scan Test Report Indicate?
Question: I was investigated for Polycystic ovaries/ Cushings in my 20's due to body shape/ round face/ hirsutes and higher than normal androgens. Result- no need to treat although out of norms.
Used oral contraceptives/ dianette etc for years- then Mirena for 9 yrs. Currently using HRT- Elleste conti.
Now aged 53. Have developed more pronounced Cushingoid features- XXXXXXX hump, even rounder face, still hirsute, central body weight gain, fat pad around clavicle and have problems with nerve entrapment /stenosis/ disc herniation at various levels cervical, one large herniation t10/11 and various s1/ l5- evidenced by MRI. Multiple joint pains, knees, forefoot, ankle wrist.
Given course prednisone to help with spinal issues- can't believe how much this has lifted overwhelming fatigue/brainfog and lethargy/chronic pain/improved acne/ reduced greasy hair etc. Feel more "normal " than for many years. Glad I have the good results but steroids intended as short course. It seems like a paradox as why would steroids help if I have sub clinical Cushings then why would steroids help so much ? Seeing GP next week- what tests might be appropriate please ? Any ideas why this might be and what the possible diagnostic scenarios are ?
Used oral contraceptives/ dianette etc for years- then Mirena for 9 yrs. Currently using HRT- Elleste conti.
Now aged 53. Have developed more pronounced Cushingoid features- XXXXXXX hump, even rounder face, still hirsute, central body weight gain, fat pad around clavicle and have problems with nerve entrapment /stenosis/ disc herniation at various levels cervical, one large herniation t10/11 and various s1/ l5- evidenced by MRI. Multiple joint pains, knees, forefoot, ankle wrist.
Given course prednisone to help with spinal issues- can't believe how much this has lifted overwhelming fatigue/brainfog and lethargy/chronic pain/improved acne/ reduced greasy hair etc. Feel more "normal " than for many years. Glad I have the good results but steroids intended as short course. It seems like a paradox as why would steroids help if I have sub clinical Cushings then why would steroids help so much ? Seeing GP next week- what tests might be appropriate please ? Any ideas why this might be and what the possible diagnostic scenarios are ?
Brief Answer:
Investigate for non classical CAH
Detailed Answer:
Hi,
Welcome to HCM. I have gone through the question and understand your concerns.
One rare condition mimicking Polycystic ovarian disease that improve drastically with steroid intake is non classical congenital adrenal hyperplasia (NCCAH). Here your adrenal gland is producing less steroids and instead excess androgens (male hormones). When you take steroids this steroid deficiency is corrected and excess androgen production will be stopped.
You should consult an endocrinologist if possible. After stopping the steroids and HRT for 2 weeks we usuall do some blood tests like 8 am cortisol. 17 hydroxy progesterone, DHEAS and testosterone. If results are suggestive of NCCAH, we do stimulation tests to confirm it. Low dose maintenance steroids can improve symptoms in NCCAH.
Hope I have answered your questions. If you have any further queries I will be happy to help you
Regards,
Dr Ajish TP [MD,DM]
Consultant Endocrinologist
Investigate for non classical CAH
Detailed Answer:
Hi,
Welcome to HCM. I have gone through the question and understand your concerns.
One rare condition mimicking Polycystic ovarian disease that improve drastically with steroid intake is non classical congenital adrenal hyperplasia (NCCAH). Here your adrenal gland is producing less steroids and instead excess androgens (male hormones). When you take steroids this steroid deficiency is corrected and excess androgen production will be stopped.
You should consult an endocrinologist if possible. After stopping the steroids and HRT for 2 weeks we usuall do some blood tests like 8 am cortisol. 17 hydroxy progesterone, DHEAS and testosterone. If results are suggestive of NCCAH, we do stimulation tests to confirm it. Low dose maintenance steroids can improve symptoms in NCCAH.
Hope I have answered your questions. If you have any further queries I will be happy to help you
Regards,
Dr Ajish TP [MD,DM]
Consultant Endocrinologist
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for the prompt reply. I was thinking along the same lines from some recent reading ..but can't understand how I would be showing signs of excess steroids via the definite cushingoid type features - if the steroid level was low as in NCCAH ? or am I over simplyfying and you could end up with too much of one type of steroid but the other is not produced or converted.
Am totally convinced there is an endocrine cause to the general fatigue and your reply has given me encouragement to push for a referral or at least some bloods from the GP that will help decide which way we go from here.
GP also indicated that my spinal problems were unususl for someone of my age who had not done a lot of manual labour. Is this commonly associated with the endocrine issues you suspect ? Thanks
Am totally convinced there is an endocrine cause to the general fatigue and your reply has given me encouragement to push for a referral or at least some bloods from the GP that will help decide which way we go from here.
GP also indicated that my spinal problems were unususl for someone of my age who had not done a lot of manual labour. Is this commonly associated with the endocrine issues you suspect ? Thanks
Brief Answer:
See detailed answer
Detailed Answer:
Hi,
Obesity, round face and hump are not specific signs of cortisol excess. We have to support it with lab reports. You have to do a 8 am cortisol, 24 hour urine free cortisol, overnight and low dose dexamethasone suppression tests to confirm or rule out Cushing's syndrome.
This diagnosis of Cushing's syndrome is less likely in your presentation considering your long duration of symptoms. Any way you have to rule out that.
Spine problems may be related to osteoporosis. I think we should do a bone densitometry scan to assess it. Osteoporosis in usually not associated with PCOS or NCCAH, but is associated with Cushings.
You should undergo hormonal tests as these steroid hormones are pulsatile and results done initially may not be always correct. Cortisol excess / deficiency can be suggested and preliminary tests for NCCAH can be done with help of GP. Further tests need a help of endocrinologist. Please stop all medications, steroids, HRT etc at least for 2 weeks before the tests or it will complicate the results.
Wishing you good health.
Regards
Dr Ajish TP
See detailed answer
Detailed Answer:
Hi,
Obesity, round face and hump are not specific signs of cortisol excess. We have to support it with lab reports. You have to do a 8 am cortisol, 24 hour urine free cortisol, overnight and low dose dexamethasone suppression tests to confirm or rule out Cushing's syndrome.
This diagnosis of Cushing's syndrome is less likely in your presentation considering your long duration of symptoms. Any way you have to rule out that.
Spine problems may be related to osteoporosis. I think we should do a bone densitometry scan to assess it. Osteoporosis in usually not associated with PCOS or NCCAH, but is associated with Cushings.
You should undergo hormonal tests as these steroid hormones are pulsatile and results done initially may not be always correct. Cortisol excess / deficiency can be suggested and preliminary tests for NCCAH can be done with help of GP. Further tests need a help of endocrinologist. Please stop all medications, steroids, HRT etc at least for 2 weeks before the tests or it will complicate the results.
Wishing you good health.
Regards
Dr Ajish TP
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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