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Dr. Chip
Dr. Chip, Doctor (MD)
Category: Health
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Experience:  Over 20 yrs of Family Practice
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I have an adrenal adenoma and have classic symptoms of Cushings.

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I have an adrenal adenoma and have classic symptoms of Cushings. My ATCH and 24 hour UFC were in the normal range. My abnormal labs: IgG Qn Serum of 589, ANA direct was positive and Anti Dna (DS) Ab Qn was 13. Do any of the lab results support Cushings syndrom? If not Cushings, what type of conditions might these lab results indicate? Cathy Zanowski
Hi--can you first tell me what your symptoms are that make you suspect Cushing's?
Customer: replied 3 years ago.

60 pound weight gain within 14 months ( all weight is in my trunk- arms, legs, hands all very skinny), about 6 years ago, easily bruised skin, leg and arm weakness, abdominal pain, upper back pain, tired, sleep problems, headaches, buffalo hump, people no longer recognize me as I changed my facial looks so considerably

Did you have your thyroid function tested?
Customer: replied 3 years ago.

several times within last 5 years- all normal. Another symptom is heat intolerance

Do you know what you TSH level is?
Customer: replied 3 years ago.

TSH of 1.810 lab range 0.450-4.500

OK--did you have a 24 hour free cortisol urine test?
Customer: replied 3 years ago.

yes, most recent tes was 29 with a reference range of 0-50


I also had a ACTH Plasma with a score of 37.5 ((reference range wa 7.2-63.3) This blood test was taken between 1030-1045 am- I later heard that I was supposed to have this blood work taken earlier-

And I assume you've seen an endocrinologist, and, if so, he had no thoughts as to what's going on?
Customer: replied 3 years ago.

I saw an endocrinologist 6 months ago and she said that she could tell by looking at me that I did not have Cushings. I pushed her for lab work and both ATCH and 24 hour urine came back within normal range. I changed to a new internal med doc who did a wide bevy of tests, including the CT of the abdomen (where they found the .9 mm adrenal adenoma). This md is in a practice by himself and just became sick- some sort of cancer and is out for an extended period of time. His NP is wonderful, but suggested that we just watch the adrenal tumor and wait 6 months and could not explain the lab values. Meanwhile, I am feeling worse on a daily basis

OK--sorry for all the questions but I assume your glucose and cholesterol levels are normal? And have you been trying any kind of diet for the weight gain?
Customer: replied 3 years ago.

Cholesterol slightly elevated- no medication. I was diagnosed with DM 4 years ago- I take metformin and last AIC is 6.0

And about the diet?
Customer: replied 3 years ago.

I have tried everything. I did not gain wt on atkins but did not lose on anything

OK--and we can continue after this. I don't see anything from what you've told me that points to Cushing's and the adrenal tumor is probably nonfunctioning. You sound as though you may either have metabolic syndrome or another inflammatory problem like early lupus. I'd have you see a rheumatologist and put you on a nutrient dense diet of fresh green and leafy veggies and fruits, nuts, coconut milk, tofu or tempeh, and nor more than three servings per week of lean meats, poultry and fish.
Customer: replied 3 years ago.

I think that we got off track. Can you please explain the abnormal labs from my initial question?. Does the positive ANA and the score on the anti dna- can it mean something other than Lupus? Is the score as high as the scores people with Lupus have? What do the other abnormal labs mean? Thanks, XXXXX XXXXX

Well, the labs you've had so far don't necessarily indicate an autoimmune disorder like lupus but further more specific testing needs to be done by a rheumatologist. The abnormal labs as they now stand may not necessarily indicate any disorder.
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