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What Does This Salivary Cortisol Level Indicate?
Question: what does this mean: cortisol,f,ug/24hr,u 66 0-50 ug/24 hr ( Urine)
hemoglobin a1c 6.4 4.8-5.6
The last two test were done with dexamethasone testing.
salivary cortisol, ms <0.010
cortisol 0.7 2.3-19.4 ug/dL
Salivary Cortisol, MS <0.010 ug/dL (this test was done 3 days later without dexamethasone at 8pm
Please advise, doctor thinks I may have cushing - I have a lot of the symptoms, my shape is changing, along with my face.
hemoglobin a1c 6.4 4.8-5.6
The last two test were done with dexamethasone testing.
salivary cortisol, ms <0.010
cortisol 0.7 2.3-19.4 ug/dL
Salivary Cortisol, MS <0.010 ug/dL (this test was done 3 days later without dexamethasone at 8pm
Please advise, doctor thinks I may have cushing - I have a lot of the symptoms, my shape is changing, along with my face.
Brief Answer:
Cushings
Detailed Answer:
Cushings disease, many a time, is a tricky condition to diagnose and manage. Typically it requires an experienced endocrinologist to handle this.
There are several tests to screen for it and confirm the diagnosis.
You have had a few of those tests done.
The salivary cortisol is not elevated so that is negative. However the value of the test is when it is done at bedtime. There is no standard way of interpreting the test when dexamethasone is given. Looks like you had this test with and without dexamethasone the previous night.
The 24 hour urinary cortisol is mildly high. This however requires a simultaneous urine creatinine measurement to ensure adequacy of the urine sample.
The A1c is in the pre diabetic range.
The blood cortisol result of 0.7 seems to be after taking dexamethasone the previous night. It is negative for Cushings too.
But the standard recommendation is to take dexamethasone at midnight rather than 8 pm.
Standard guidelines by authoritative bodies recommend a combination of tests to screen for Cushings.
Cushings
Detailed Answer:
Cushings disease, many a time, is a tricky condition to diagnose and manage. Typically it requires an experienced endocrinologist to handle this.
There are several tests to screen for it and confirm the diagnosis.
You have had a few of those tests done.
The salivary cortisol is not elevated so that is negative. However the value of the test is when it is done at bedtime. There is no standard way of interpreting the test when dexamethasone is given. Looks like you had this test with and without dexamethasone the previous night.
The 24 hour urinary cortisol is mildly high. This however requires a simultaneous urine creatinine measurement to ensure adequacy of the urine sample.
The A1c is in the pre diabetic range.
The blood cortisol result of 0.7 seems to be after taking dexamethasone the previous night. It is negative for Cushings too.
But the standard recommendation is to take dexamethasone at midnight rather than 8 pm.
Standard guidelines by authoritative bodies recommend a combination of tests to screen for Cushings.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
What other followup test should I have. Or should I just ask for a CT test to determine what is going on.
I have been feeling bad for the past 5 years, weight gain of 50 pounds all in my stomach area, starting to get a hump in my upper back, always tired, no energy, muscles hurt, bruising, cuts take long time to heal, low back pain, red cheeks, more facial hair than before, more upper thigh hair on my legs.
I am seeing a Endocrinologist or should I see a specialist for this Please advise.
I have been feeling bad for the past 5 years, weight gain of 50 pounds all in my stomach area, starting to get a hump in my upper back, always tired, no energy, muscles hurt, bruising, cuts take long time to heal, low back pain, red cheeks, more facial hair than before, more upper thigh hair on my legs.
I am seeing a Endocrinologist or should I see a specialist for this Please advise.
Brief Answer:
Follow up
Detailed Answer:
It is good to note that you are seeing an Endocrinologist.
One cardinal rule in general in Endocrinology and particularly applicable in the context of making the diagnosis of Cushings disease is to first determine whether or not there is truly an excess of cortisol in the body.
The combination of tests as explained above are to be deployed systematically to make correct judgements on this matter. Often, the tests can have results that are not clear cut and that is why this condition is challenging to diagnose.
When I see a patient like you in my practice I order 3 screening tests depending on how likely the diagnosis based upon a thorough in-person assessment.
1 Midnight Salivary cortisol
2 24 hour urine free cortisol with creatinine (provided the kidney function is normal)
3 One milligram overnight dexamethasone suppression test
If at least 2 of the above 3 tests are positive I proceed to the second round of tests which include different types of tests. One example is the 48 hour High dose (8 mg) Dexamethasone Suppression test.
Follow up
Detailed Answer:
It is good to note that you are seeing an Endocrinologist.
One cardinal rule in general in Endocrinology and particularly applicable in the context of making the diagnosis of Cushings disease is to first determine whether or not there is truly an excess of cortisol in the body.
The combination of tests as explained above are to be deployed systematically to make correct judgements on this matter. Often, the tests can have results that are not clear cut and that is why this condition is challenging to diagnose.
When I see a patient like you in my practice I order 3 screening tests depending on how likely the diagnosis based upon a thorough in-person assessment.
1 Midnight Salivary cortisol
2 24 hour urine free cortisol with creatinine (provided the kidney function is normal)
3 One milligram overnight dexamethasone suppression test
If at least 2 of the above 3 tests are positive I proceed to the second round of tests which include different types of tests. One example is the 48 hour High dose (8 mg) Dexamethasone Suppression test.
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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