Another Cortisol Question

[zadok]

When taking any supplements to reduce cortisol levels (either OTC or prescription), do these prevent the adrenal glands from producing the cortisol or do they just block the release of cortisol? (i am currently taking PS) As i have read, when your body's HPA is out of wack, sometimes the adrenal glands will produce more cortisol. As it does this it 'robs' from other essential processes like dopamine/test/seratonin production. So my question is: by taking cortisol reducing sups, do they just restict the effects of high cortisol, or do they actually stop the adrenal glands wanting to produce so much cortisol, and so allowing the other processes to return to the normal state?

Bit of a complicated question, but pls comment if you have any idea about this

Thanks

 

[zadok]

Got anything to say Larry?

 

[zadok]

HeadDoc, anyone?

 

[HeadDoc]

great questions. I don't know and will have to take a look. I'll go thru J. Wilson's Adrenal Fatique and see if he has any answers.

 

[stat1951]

Got anything to say Larry?

OK, here's my "two cents worth"... most OTC supps that actually have an anti-cortisol effect do so in actually inhibiting the production of cortisol. This would include things such as higher dose PS, magnolia bark extract (main ingredient in Relora), Holy Basil, etc. BTW, it is also my two cents worth that the OTC supps are only gonig to work in conditions where the cortisol elevation is (a) mild to moderate, (b) by nature short-term - as in following extended training or really hard exercising, etc., and (c) if the HPA Axis is NOT dysfunctional...

One OTC supplement that is often claimed to "lower cortisol" actually does not lower cortisol at all, but does have a "buffering effect" on "some" of the negatives of elevated cortisol is DHEA.

Most meds that actually lower cortisol levels do so by inhibiting the production of cortisol. Some of the very strong ones have some quite severe side effects - especially if taken long term. A medication that I am familiar with which has demonstrated control of highly elevated cortisol is the AD medication Remeron. Also has some highly sedative effects and will put weight on many people as another side effect.

Interestingly there's a medication that reduces cortisol levels by rapidly metabolizing the cortisol out of the body (as well as inhibiting its production to start with to some degree), and that medication is Dilantin (or PHT). I find it interesting that some anti aging authorities are starting to recommend very low dose Dilantin as an anti agiing "supplement". We are talking range of 25 - 100 mg per day in that anti aging supplementation use (and Behavior / Psychological use of Dilantin also is usually done in the range of 50 - 200 mg daily). I have seen one study - in epileptic males - where Dilantin use raised SHBG levels and raised E2 and Total T levels while lowering Free T levels. It appeared (as I recall, it's been a while since I saw that study) that the changes were not that significant... and also that the doses used in treating epileptics are considerably higher than those used in anti aging regimens. Doses in epileptic control are in the 400 - 600 mg and even higher ranges. So this effect with SHBG / E2 / Total T / Free T may very well be dose relaterd also. Anyway, Dilantin - which at lower doses is remarkably free of side effects - is sufficiently good at cortisol control that one has to stop taking it before having any serious cortisol testing done! See:

http://www.healthatoz.com/healthatoz/Atoz/ency/cortisol_tests.jsp
Drugs that may cause decreased levels include androgens, aminoglutethimide, betamethasone, and other steroid medications, danazol, lithium, levodopa, metyrapone and phenytoin (Dilantin).

http://www.webmd.com/hw/health_guide_atoz/hw6227.asp

But, yes, you are absolutely right - when your body's HPA is out of wack, sometimes the adrenal glands will produce more cortisol. As it does this it 'robs' from other essential processes like dopamine/test/seratonin production. In fact, hypercortisolism is a recognized caused of hypogonadism ( can show you the referencing links - but also tell you that hypercortisolism was what caused not only my hypogonadism, but my very abrupt and sudden hypogonadism).

Your body recognizes that the need for apppropriate levels of cortisol is extremely vital. With insufficient levels of cortisol you will die quite rapidly. So if your HPA Axis feedback is dysfunctional, then your cortisol production will become excessive (and in some cases secretion will become constant instead of cyclical or will be cyclical but normal cycle times will be off, etc.).

I would normally like to post a number of links on this topic for more in-depth review on your part, but unfortunately I am accessing via a computer at NIH Hospital and not my home computer (with all of those bookmarked links at fingertip reach). I am here for a two week "visit" for some extensive testing and studies to see if they can (a) figure out what my adrenal gland tumor is up to, (b) specifically see if the adrenal gland tumor might be responsible for my hypercortisolism, and / or (c) see if they can find out what - if anything else - might be causing my hypercortisolism.

If still interested in about 1 1/2 weeks, give me a PM and I can send (or post) some of those involved links. Also might do a search through this Mens Health forum at MESO on "cortisol".

Larry

P.S. Here's a couple quick links (on Dilantin) that I found right off the bat:

http://www.antiaging-systems.com/a2z/phenytoin.htm
(Actually the doses they quote for epileptic use are quite low with many epilepsy patients on does twice that level).

http://www.lef.org/anti-aging/chap11.html

And this is simply an excellent overall article (from right here at NIH):

http://www.nih.gov/news/pr/sep2002/nichd-09.htm

 

[ikho1967]

Just how high is your cortisol?

There can be many causes of slightly elevated cortisol, but as the poster above... Are you from the Cushing's board too my friend??? I'll be curious to hear how your NIH visit turns out. My $$$ is on Cushing's if this is who I think it is...

OP, have you had any cortisol testing? I had pituitary Cushing's (cyclic)... It can cause hypogonadism. There are specific tests that will tell you if you have a testicular problem or hypothalmic/pituitary... Have you had them?

They are at a minimum LH, FSH and total testosterone six weeks off replacements or before replacements...

 

[stat1951]

There can be many causes of slightly elevated cortisol, but as the poster above... Are you from the Cushing's board too my friend??? I'll be curious to hear how your NIH visit turns out. My $$$ is on Cushing's if this is who I think it is...

Yes, my friend, I am also on the Cushing's Support Board. My cortisol levels have ranged from 5+ normal mximum range (first two 24hr UFCs taken) too mainly 1.5 to 2.5 normal maximum (about 90% of my UFC tests). When I was on Remeron (five months), I had cortisol suppressed to high normal ranges.. for example one test was a 97.8 in a reference range of 20 - 100 (two months earlier it was a 222). Even though on Remeron for five months, none of physical symptoms - except insomnia - went away. Anxiety improved some, but that was about it. Insomnia immediately came back when Remeron was stopped.

I'm sure I'll post something on one of the Boards (or both) when I get my summaries back. I'd like to take your money, but the head research doctor here (who I spoke to Friday for quite a while) is already "leaning" toward the same conclusion that my specialist Endo back home (it's a major world-reknown medical center) was gradually coming to... that the adrenal gland tumor is "a fatty-tissue lesion that is not only benign, but biologically inactive and not causing your hypercortisolism", nor that it was Cushing's Disease or Cushing's Syndrome from other causes.

He hastened to add that he has not seen test results from my stay here other than to view CT Scan frim first day but has done extensive review of all Labs and reports from prior testing - but that he was "impressed" with levels of advanced testing and specific tests done prior to my coming here.

So it will be interesting to see what their final determinatrion is.

I have so far done some very extensive testing here. Pretty much all day long, day after day. And on the week-ends when there's no one here for the more active tests, they have you doing 24-hr UFC tests both days.

Larry

 

[ikho1967]

Hey Larry. :.)

I truly wish you the best and think you're in great hands. But just to let you know, my 24 hour urines never went over 1.5 X normal, but my ACTH went to 129 (others elevated too) while serum cortisol was slighly elevated--so something else producing ACTH and negative feedback loop was off... Along with elevated midnight serums, 49.5 am serum cortisol, etc.

I'm coming along well post surgery... most symptoms gone or greatly improved... I'm off my high bp meds and bp is normal... off salt tabs, (I had orthostatic intolerance when in a low) nearly-there diabetes (1 point away) --glucose now going down..., off 80mgs of Nexium (40 is upper limit suggested)... I had multiple stomach ulcers and was in the top tier of the worst cases my GI doc had seen... Lost 36 pounds so far and counting, face not like a balloon anymore... no longer red/flushing, no more hot flashes, no more edema... on and on... really good stuff... ... I have nodules on my left adrenal gland, but it is most likely from adrenal hyperplasia caused by the overstimulation from the pituitary gland.

Also, NIH is great, but conservative... they often watch cyclics over time. I was cyclic, but the disease was progressing in my body like a full blown. I bled too much during the first surgery (had to stop) and got a provoked clot from my picc line (because I was also clotting too much) from the Cushing's.

Hope you don't have Cushing's... it is a nasty disease... But I"m still betting... lol

 

[stat1951]

Thanks much!



As a side note, I have not had any elevated ACTH levels.

I also do not express the normal phsyical manifestations of Cushing's (severe torso weight gain, moonface, red face, buffalo hump, etc.). In fact, if you list out the "main" Cushing's "visual symptom" charactertistics (Rounding of the face or "moon face", Facial redness facial plethora, Hump on back of neck, Weight gain around the belly with thinner arms and legs, Purple stretch marks, Facial hair growth - in women, Acne, Muscle weakness, Thin skin and Easy bruising), I have exactly "none" of those! If you include the other common symtoms (Bone thinning, Recurrent infections, Sleep disturbances,
Fatigue, High blood pressure, and Diabetes mellitus), I have severe insomnia and some mild fatigue. When you include mood disorders, somewhat of a majority of Cushing's tend to have depression rather than anxiety - and my problem has always been severe anxiety with hardly any depression.

As to my BP levels, if anything, I will have more borderline low BP reading than borderline high ones (had a couple early last week that were like 144/84, etc - but also a couple that were like 98/59 - and never have had any outright high BP levels. My "normal" BP tends to be around 120/60 with a pulse in low 60s... in fact, they just took it here about 10 minutes ago and it was 125/72 with pulse of 67.

As to my glucose levels, well they have snuck up some, but we're talking just a little bit, from a (fasting) level of around high 80s to low 90s to a level of around 100 - 107.

I also became severely hypogonadal, which can be caused by any form of hypercortisolism - Cushing's or otherwise.

My other symptoms included severe tinnitus developing, sharp stining pains to extremities and also somewhat cold hands/lower arms and severely painfully icy cold feet/lower legs. None of those generally "mainstream" Cushing's symptoms.

Also, the tests here have included and/or will be including bone density scan, CT Scans, MRIs, GNRH Test, multiple midnight serums draws (all non elevated - in fact quite low - of the ones that results have returned anyway), posture test, mixed meal test, ACTH tests (multiple), glucagon test, two AVP tests, multiple (on-going 24-hr UFCs) and low dose Dex suppression tests and high dose Dex suppression tests... (plus they provide coordinated follow-up with you through your established Endo for up to five years afterwards).

I hate to think that that this is a "conservative approach". What additional testing would a more "liberal" approach be?



Larry

 

[ikho1967]

Good stuff Larry...

No, no...I didn't mean to imply they are conservative in testing... their testing is awesome!! I often try to get people to go there if they are full blown Cushing's or have something mimicing it potentially, like Adult Growth Hormone Deficiency etc. I've just heard their stance on cyclic Cushing's so far is they acknowledge it, but watch it over time. This is not a choice I could have made... I was really sick even though my numbers weren't blow em away. That's all I"m saying...

Maybe that will change with protocol in the future... They are also conservative in that they use the higher diagnostic numbers too... 7.5 and above on serums, where as my doc uses 5 and above as suspicious. But he makes you go through hoops to get 3 "diagnositic" tests in 3 categories... So he's looking for much higher than 5... but that is enough to keep testing... Ie tons of tests over a period of time until he has a rock solid case.. Pretty brutal actually... ... So he is conservative too, but just in a different way... (I like conservative... don't get me wrong... I was a pain in the butt about making sure Cushing's was the correct diagnosis, so I understand all your researching. You were very impressive!

If your midnight serums aren't turning up, then you probably don't have Cushing's unless it is ectopic... I've heard ectopic may not impact diurinal rhythm. What threw me was I thought you had like a 6 times normal (of course I have no memory thanks to Cushing's... LOL) and most of the literature says anything over 3 or 4 times normal (depending on the paper you consult) differentiates from pseudo.

All my serums were elevated--my only consistant test. That seems a good indicator for mild/early/cyclic disease... But my friends had readings of like 3 and 4 on one night and 12 and 20 the next (they do midnight and then 12:30am draws there... to see if relaxing makes the levels go down or not...). So range is so variable...

Either way, you have some great information and I think sharing information is power, so I hope you come back to the Cush site. I believe if someone doesn't have Cushing's, but something similar and gets resolution, that will help someone else... whether they are reading this today... or 5 years from now in a search.

I wish you the best Larry... high cortisol is devastating no matter where it comes from--you're 100% correct there. I had very bad anxiety (not me *at all*) once my levels started coming up at year 2... mostly at night, as this is when it would rise real good.

Hope you get a great resolution... Fascinating stuff, isnt' it? For example, Tberry having no elevated urines at all to speak of, but her adrenal tumor staining for ACTH... Others with adrenal Cushing's have the highest urines... in the thousands. Such a strange disease indeed.

Another friend who had high serums, but marginal urines just lateralized on her CSS in the 16 thousands!!!!

Finally, on the ACTH... only 50% of full blowns ever get an ACTH caught out of range and then it is only a modest increase. I was lucky that my ACTH's where very up for being caught.

Whatever your outcome, you're a fascinating case! Please keep us updated.

 

[zadok]

Larry has heard my story before but basically, I have basically buggered myself with steroids. My last free test level was 57 (range:49-140nmol/L). i have basically no sex drive and weight fluctuates a lot. One particularily horrible symtom which no one can diagnose is the condition of my genitals. When i wake in the morning everything is ok. but within 5 minutes my testicals/scrotum shrinks up to my body, like so tight its painful. My penis also shrinks down to very small, sometimes no shaft at all. Slowly through-out the day my penis becomes more normal and my scrotum drops a bit. Although by the end of the day it is better it is never anywhere near what it should be. Also if i do sport or anything physically stressful these symtoms are worsened.
Since i have started TRT (7 weeks now) this problem has only got worse. My libido is now also absolutely nothing. All blood results ok (including E2), except 24hr cortisol which is 280 (range 40-240nmol/24hr). My endo doesnt know whats wrong with me. she says that amount of cortisol alone could not be causing these symtoms.

I remember you saying before Larry that when you stated TRT your ED was basically cured, mine has got worse. Not sure whether Cortisol is the culprit or not. I have tried large doses of PS. i think i have noticed small improvement in sex drive and also some weight gain, but genitals still the same.

I am beginning to thing my problem is more to do with the brain, dopamine/seratonin, etc?

I have been like this for more than a year now. When will it end.....

 

[ikho1967]

Wow... that's rough

That's some tough stuff... Have you tried a doc who specializes in athletes that abuse steroids... If you'd like to find one you could go to pub med and try searches...

Here's one I started:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed

Type in the anabolic steroid abuse (if this is what happened) and things like gonadal changes, gonadal atrophy, etc.

Once you find an entry that hits, get the names of the researchers. Then google their names and see where they are... Search on their physician profiles and email them with this question. I bet you'll get an answer eventually.

Why does your doctor even think you have this high a level of cortisol? Cortisol does suppress LH and thus testosterone production. Possibly your HPA axis is whacked from the 'roids... This takes up to a year to reverse I believe... and I saw a case study where it didn't.

How long have you stopped "the buggering"? lol

Or could you have Cushing's? That is the other question.

 

[ikho1967]

Hey Larry... could you help a girl out? :.)

You're a *very* smart guy. Could you do me a favor. My boyfriend has secondary hypogonadism... Mind looking at his test results? I posted a few days ago under my name ikho1967 in the men's health forum (here).

We're going to a couple of great docs, but like you, I like to know everything... (Just like you!)

Two things puzzle me the most... his really low SHBG and his jump in TSH... I'm thinking these are clues. Could hypothyroidism alone suppress this much. I know Cushing's can suppress too. I have been resisiting Cushing's and hope his undetectable ACTH is a lab error and not us about to find out he has adrenal Cushing's. (Also <10 sounds funny as a range. I had a 7 after that 129... pit was shut down between cycles...

Although, if you have to have Cushing's, adrenal's better than pituitary in my book. Cure more likely and less reoccurance.

Thanks and hope all is well Larry.. I'm so curious to hear your latest test results.

 

[stat1951]

You're a *very* smart guy. Could you do me a favor. My boyfriend has secondary hypogonadism... Mind looking at his test results? I posted a few days ago under my name ikho1967 in the men's health forum (here). We're going to a couple of great docs, but like you, I like to know everything... (Just like you!) Two things puzzle me the most... his really low SHBG and his jump in TSH... I'm thinking these are clues. Could hypothyroidism alone suppress this much. I know Cushing's can suppress too. I have been resisiting Cushing's and hope his undetectable ACTH is a lab error and not us about to find out he has adrenal Cushing's. (Also <10 sounds funny as a range. I had a 7 after that 129... pit was shut down between cycles... Although, if you have to have Cushing's, adrenal's better than pituitary in my book. Cure more likely and less reoccurance. Thanks and hope all is well Larry.. I'm so curious to hear your latest test results.

Here's the results that I saw posted (assuming them to be the ones that you're talking about):

He's 36 years old.

Baseline: While on 5 grams Androgel

TSH 6.28 (.35-5.50)***
Free T4 1.3 (.8-2.0)
FSH 4.0 (1.4-18.1)
LH 2.76 (1.5-9.3)
Total Testosterone 302 (280-1100)

All testing at 9am, 6 plus weeks off Androgel

9am serum cortisol 21.46 (4.3-22.4)
ACTH <10 (undetectable) (10-60)
FSH 3.3 (1.4-18.1)
LH 2.30 (1.5-9.3)
SHBG 7.6 (10-60)
Estradiol, serum 24.74
Free Testosterone 6.2 (9-30)
Total Testosterone 168 (240-950)
bioavailable "T" 113 (72-240-950)

TSH 10.04
Prolactin 3.9 (1.5-9.3)
IFG1` 148 (109-280something)

Boy those are some tough ones to decipher. The hypogonadism is an obvious. The bioavalable T is low normal at best and total T and free T are definitely sub normal. Is that serum E2 reading a "24.74", and if so what range? Also was that test being done by the ultra sensitive assay method? Assuming it was and that the Labs ranges are the normal 10 - 50 or 10 - 60 type range, his E2 is good... but kind of meaningless with low T levels.

TSH is obviously elevated and Free T4 could - for his individual case - be low. No T3 test taken? T3 is the more active form of the Thy hormones (body basically uses T$ as a storage resorvoir aand converts it to T3 for active purposes as I understand it), so T4 could be borderline low and T# absolutely low. And hypothyroidism can have an effect on hypogonadal state.

BTW, did you know that elevated cortisol levels can strongly inhibit the conversion of T3 to T4? (Eventually hypercortisolism can also affect the thyroid directly, causing a lessend production of T4/T3 entirely)

Now hypercortisolism (whatever version, CD, CS, EC or PC) can outright cause hypogonadism - and cause it in a hurry. So his ACTH reading definitely rates an "alert status"... has he had a 24-hr UFC done or did I miss that result some where (I am NOT a fan of serum tests for determining one's overall cortisol levels - they are good for taking a snapshot picture of what your blood levels of cortisol are right at that moment, but that's about it)?

If there is hypercortisolism then your cause for hypogonadism - especially at his age - is right there.

I would go on a full court press here.

I would do a strong round of full Cushing's related tersting (specifically a series of 24-hr UFCs - like 3 in a 2 week time period, combined with a Late Night Salivary Cortisol test each night that a 24-hr UFC is being done). If initial testing shows any hint of a Cushings situation then obviously more detailed testing in that direction would be required.

At same time would have a full thyroid panel done, not only to specifically include Free T3 as well as Free T4, but also testing that check for antibodies indicating that one's own immune systyem could be attacking the thyroid gland.

His Endo might want to try a series of something like with Clomid to see if the HPT Axis of your boyfriend can be re-started (I am NOT an expert in that area, so a more generalized posting on main Board might surely be in order)... I believe there is a "Clomid Test" as it is called which will signal whether that "re-starting" is possible or not.

Of course unless the root problem (hypercortisolism? hyothyroidism?) is addressed then that might be a moot point at this stage of the game.

The Endo would need to decide if such a "re-start" of the HPA Axis is likely - and if not, then a decision to go on full-scale TRT needs to be made. If that decision is an affirmative one, then would look at insisting with your Endo (or finding another one) who will closely follow Dr. Crisler's protocol.

Yes, if one HAS to go into a tumor-induced Cushing's situation, the adrenal gland version is the "better" way to go...

Larry

P.S. Maybe one of the more well-versed experts in primary versus secondary and what levels of what results point which direction could jump in here...

 

[stat1951]

P.S. #2 It also appears that his IGF-1 levels are somewhat on the lower side. Not "sub normal" but not near to being in optimal ranges either. Lower IGF-1 levels often accompany hypercortisolis.

That's another one of those things that has so puzzling to the Endos in my case... my IGF-1 levels have been slightly elevated / high normal throughout whatever this is that's going on. So while I have hypercortisolism quite definitely, my IGF-1 levels have been that of a 25 - 35 year old...

 

[stat1951]

That's some tough stuff... Have you tried a doc who specializes in athletes that abuse steroids... If you'd like to find one you could go to pub med and try searches...

Here's one I started:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed

Type in the anabolic steroid abuse (if this is what happened) and things like gonadal changes, gonadal atrophy, etc. Once you find an entry that hits, get the names of the researchers. Then google their names and see where they are... Search on their physician profiles and email them with this question. I bet you'll get an answer eventually.

Why does your doctor even think you have this high a level of cortisol? Cortisol does suppress LH and thus testosterone production. Possibly your HPA axis is whacked from the 'roids... This takes up to a year to reverse I believe... and I saw a case study where it didn't.

How long have you stopped "the buggering"? lol

Or could you have Cushing's? That is the other question.

In checking PubMed (I believe that you may have to register to access it), my briefest "quickie" search turned up one case study involving steroid usage and cortisol problems. That study was actually a report of a situation involving ONE horse - and it found that post steroid use resulted in adrenal gland insufficiency (i.e., too LITTLE cortisol) rather than hypercortisolism.

J Am Vet Med Assoc. 1993 Oct 15;203(8):1166-9. Related Articles, Links

Comment in: J Am Vet Med Assoc. 1994 Feb 1;204(3):329-30.

Adrenal insufficiency associated with long-term anabolic steroid administration in a horse.

Dowling PM, Williams MA, Clark TP.

Department of Large Animal Surgery and Medicine, College of Veterinary Medicine, Auburn University, AL 36849-5522.

Adrenal insufficiency was diagnosed in a 9-year-old American Quarter Horse gelding that had received monthly injections of stanozolol for 8 years. After the injections were abruptly discontinued, the horse developed anorexia, lethargy, weight loss, and bilateral forelimb lameness. Secondary hypoadrenocorticism was diagnosed on the basis of clinical signs, lack of high endogenous plasma ACTH concentration, and lack of cortisol response to administration of ACTH. Because the medical history did not include glucocorticoid administration, the cause was determined to be excessive administration of an anabolic steroid. Treatment consisted of physiologic glucocorticoid replacement for 9 months until adrenal function returned. Findings in this horse indicate that anabolic steroids influence the hypothalamic-pituitary axis in horses.

Publication Types: Case Reports

PMID: 8244866 [PubMed - indexed for MEDLINE]

No real directly related to THE cortisol question, but did find this interesting study:

Endocrine alterations in the aging male.

Elmlinger MW, Dengler T, Weinstock C, Kuehnel W.

University Hospital, Pediatric Endocrinology Section, Tuebingen, Germany. elmlinger@med.uni-tuebingen.de

The recent increase in the elderly population, current health trends and awareness of age-related changes in the male endocrine system, have led to discussions about the role of the hormonal changes in the aging process in males. Better prevention and treatment of suboptimal health status and age-related diseases in aging men are based on an improved understanding of aging, particularly of the significance of age-associated hormonal changes. The aims of this study were 1) to evaluate the age dependence of the serum concentrations of the following important hormonal parameters in adult males using the IMMULITE 1 automated assay system (DPC, Los Angeles): testosterone, dehydro-epiandrosterone sulfate (DHEAS), estradiol (E2), sex hormone binding globulin (SHBG), lutropin (LH), follitropin (FSH), cortisol, prolactin, thyroid stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4) and the growth hormone-dependent parameters insulin-like growth factor (IGF-I) and IGF-binding protein-3 (IGFBP-3) and 2) to derive the following parameters: calculated free testosterone (cFT), ratio of calculated free testosterone to total testosterone (% cFT) and free androgen index (FAI). We found a significant decrease between the 21-30-year age group and the > 70-year age group for total testosterone (-42.4%), FAI (-65.5%), cFT (-60.0%), % cFT (-30.0%), DHEAS (-71.9%), E2 (-35.4%), TSH (-23.6%), IGF-I (-40.3%) and IGFBP-3 (-26.5%). Since the decreases in the FAI and cFT were greater than that of total testosterone and because these derived parameters reflect the biologically active fraction of testosterone, FAI and cFT are better markers for androgen deficiency in males. In contrast, a significant increase with age was observed for SHBG (+61.2%), LH (+40.0%), FSH (+98.3%) and cortisol (+54.2%). No significant alterations with age were observed for prolactin, fT3 and fT4. The study demonstrates that determining complete profiles of the androgenic, gonadotropic, adrenocortical, thyroid, pituitary and growth hormone/IGF endocrine axes in middle-aged and elderly men may be helpful in obtaining a correct clinical diagnosis for various hormonal disorders.

Clin Chem Lab Med. 2003 Jul;41(7):934-41.

Larry

 

[stat1951]

1. RE: or have something mimicing it potentially, like Adult Growth Hormone Deficiency etc....

2. RE: ...their stance on cyclic Cushing's

3. RE: Pretty brutal actually...

4. RE: You were very impressive!

5: RE: If your midnight serums aren't turning up, then you probably don't have Cushing's unless it is ectopic...

6. RE: I've heard ectopic may not impact diurinal rhythm.

7. RE: What threw me was I thought you had like a 6 times normal...

8. RE: ...most of the literature says anything over 3 or 4 times normal (depending on the paper you consult) differentiates from pseudo.

9. RE: I think sharing information is power, so I hope you come back to the Cush site...

10. RE: .. high cortisol is devastating no matter where it comes from--you're 100% correct there.

11. RE: Such a strange disease indeed.

12: RE: Whatever your outcome, you're a fascinating case! Please keep us updated.

1. That has been thought about (by the Endos) a number of times, but my IGF-1 levels are consistently on the high side, not really elevated, just in optimum ranges (as in a person 25 - 35 instead of almost 55).

2. If I have "Cushing's" (i.e., tumor induced Cushing's), there's nothing "cyclical" about it. Other than the five months that I was on the Remeron, my cortisol levels have always been elevated.

3. Yes, full range testing IS pretty brutal.

4. Thank you... I am (since my "retirement" a researcher by trade, my condition - or conditions actually - simply enhanced and focused that research)

5. To this point both late night salivary cortisol and midnite serum cortisol draws have ALL been definitely on the low side! A couple other tests have been with numbers that were "borderline" (like one of the two high-dose dex suppression tests that I took pripr to coming here) and one of three CRH tests (that I took before coming here - under my old local Endo before I switched to a specialist Endo who couldn't believe someone was still doing CRH tests, not the combined Dex/CRH test, which I have done twice, but the plain CRH Test). All other tests - including ALL of the late night draws - have indicated not being Cushing's.

6. I have heard that also... but only in a minor percentage of cases from what I've heard... maybe 10%???

7. Yes, initial testing showed a 5 - 6 times level... but all tests after that have been in the 1.5 to 2.5 range. So was that one test a Lab error (there's been probably 15 - 20 other UFCs that were consistently in the 1.5 - 2.5 x max range)?

8. Also Specialist Endo back home and Endos here point out that this "rule of thumb" is only generally true, that there are significant exceptions... especially incases of ssevere depression and severe anxiety. The ones here pointed out - interestingly - that super marathon types (whether runners, cyclists, rowers, etc.) can - temporarily - have levels over TEN times the normal max... so that "rule of thumb" isn't that "automatic" diagnosis that some on certain Boards would have one believe...

9. You are absolutely right... and I am sure that I will!

10. That's the truth!

11. Ditto

12. That I will do!

Larry

 

[ikho1967]

Wow Larry... more great stuff...

I'm running out the door. My health center appointed me to a patient advisory board and there is a meeting tonight. Then some errands...

Once I get some down time I'll come back and answer all questions because you pointed out some good stuff...

Just between you, me and the message board... his doc gave me a blank lab slip and I felt like a criminal. I wanted all the T3s and ordered Free T4, but crossed out T4 and they thought I'd crossed out the "Free" too I guess...

I felt like a criminal as I waited for the labs to be drawn... lol...

I didn't know then I needed extracted or sensitive... read that later. But I"m assuming the estradial is ok because it sure isn't binding with SHBG.

Your IGF1s are indeed puzzling...No signs of Acromegaly I take it. I heard of a patient who had both an ACTH and GH secreting tumor, but no signs of Acromegaly I think. That was a shock and the big center to go unnamed actually sort of cancelled her surgery and kind of gave her the brush off... (too complicated????). She was already diagnosed with Cushing's. I know the person who knows her if you want the details. BAck to IGF1, cortisol usually suppresses GH. It sure did mine. Things that make ya go, Hmmmmm...

To be continued...

 

[stat1951]

RE: No signs of Acromegaly I take it....

Yes. Absolutely no signs of Acromegaly.

And yes, you're right... hypercortisolism (which I definitely have - not cyclical, not episodal, but outright week-in-and-week-out hypercortisolism) just about always suppresses GH / IGF-1 levels... Yet clearly did not in my case, in fact my IGF-1 levels were high 300s - mid 400s....

And especially suppresses (very significantly) in "regular" Cushing's cases - yet interestingly, not so regularly in Pesuedo Cushing's cases.. another clue to the puzzle?

Larry

 

[androjello]

Larry,

Good job on keeping us updated. I hope everything remains excellent the remainder of your stay. And be sure to keep me up to date. For those that don't know, Larry and I share "identical" symptoms and diagnosis.