Posted by 4WD on May 19, 2005, at 15:33:06
In reply to Re: Urine Test to Measure Neurotransmitter Levels? » Larry Hoover, posted by Elroy on May 18, 2005, at 20:36:38
> Yes, weird, isn't it?
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> Now with Cushing's, it is understood that the elevated levels will return as a tumor on the pituitary gland or in the adrenal gland is "forcing" the cortisol production. And with Cushing's (whatever variant), the daily cycle or rythym of secretion is greatly disturbed (so that excess secretion occurs late at night also). But with Pseudo Cushings (which includes everything else that result in high cortisol), that daily cycle is maintained.
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> In fact, that is the main test to differentiate between Cushings and Pseudo Cushings. It's the Late Night Salivary Cortisol Test. You spit into a test tube between 11 PM and Midnite and they analyze it to see if your levels are high or not (like around 100 or higher - usually much higher). I have had about seven of those done and my ranges have been anywhere from 13 to 40.
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> And yes, with multiple Dex Suppression tests done, I have always suppressed - and then reverted to elevated cortisol following said test!
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> But then that's not unusual in many "psychotic depression cases" (see the various studies done with the RU486 therapy and addressing "psychotic depression").
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> In those cases, the patient had highly elevated (but non Cushings) cortisol levels and were either cured following RU486 therapy OR previously unsuccessful anti-depression therapies rapidly were successful... (btw, the definition of psychotic depression seems pretty clearly to fit what I refer to as my "severe anxiety problem").
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> So it seems obvious that in these cases, the HPA Axis has malfunctioned or somehow become dysfunctional and needs to be "re-set", no???
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> And note that these are all therapies involving very short-term application of the RU486. Usually in the range of 4 to 7 days. RU486 - which was originally developed (France, I believe) as an anti-cortisol med for Cushing's patients (ones who couldn't have surgical intervention for some reason, etc.) - can have some nasty side effects if taken over a period of time, but I don't recall any of these studies or trials where subjects developed adverse side effects of any nature simply because the therapy protocol is conducted over such a short time period.
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> Also, in one "informal" experiment that I did (i.e., w/out endo knowing about it), I found that aggressive supplementation with OTC anti-cortisol supps clearly brought the cortisol levels down. I'm not sure of the exact figures, but prior to starting those supps, my cortisol levels were in the range of 250 - 300 (with the reference range being 20 - 100). The next two tests were then around 150 *after about three weeks of supps) and the one after that around 110 (after about another months of supps). I then stopped the OTC supps - for about 3 weeks - and my next test (the last one done) was something like 243.
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> So taking anti cortisol supps (aggressive doses) seems to be a good thing, except one notes that my levels went right back up when the supps were stopped. So it doesn't appear that this strategy of OTC anti-cortisol supps is "re-setting" the HPA Axis.... That's kind of one of the reasons why I thought that a short-term (say two weeks) of aggressive supplementation with licorice might be in order to see if it would duplicate the effects of the RU486 protocol (but then it seems to me that in the studies that I've seen, the RU486 drove the cortisol levels WAY down and that was what "re-set" the HPA Axis... it seems that the licorice injestion would have the opposite effect of raising cortisol levels quite a bit (and back last September my levels were almost 600 and that didn't "re-set anything so simply raising my own cortisol levels doesn't seem to be a logical answer)...
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> Or is it that the aggressive OTC anti-cortisol supp protocol needs to be continued - possibly for several months - before the HPA Axis would normalize?
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> Or is it that the severe anxiety (or psychotic depression?) is causing the elevated cortisol as a simple "side effect" and the cortisol problem will naturally correct once the anxiety (or whatever) problem clears?
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> Elroy
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> P.S. Thanks for the link. Will forward to my endo. Not sure it will do any good, tho... He's primarily a Cushings specialist, so once he determined that this isn't Cushings and is "Pseudo Cushings", his level of interest clearly waned. I finally did talk him into letting me send him some stuff on the RU486 therapy so with any luck at all.....
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> > > Yes, as part of ongoing testing have had a few dexamethasone suppression tests. Have always suppressed. Anywhere from moderately to significantly. Last dex suppression test was a result of a 1.2 ug/DL.
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> > Eh? What?
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> > How on earth is it that synthetic glucocorticoid suppresses your cortisol, whereas your native cortisol itself does not? Post dexamethasone, was your cortisol still above range?
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> > Lar
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> > P.S. I found an interesting study that shows that mifepristone can act as either a full agonist or a full antagonist, due to differences in GR-receptor density (and coupling proteins). Explains how some people get that "paradoxical response" thing going.
> >
> > http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14636830
> >
> > Lar
This is fascinating to me. I also have highly elevated cortisol levels (along with a small pituitary tumor). My dexamethasone suppression test was "borderline." Metanephrines were normal although normetanephrine was high normal.My next test is the corticotropin releasing hormone deal where you get injected with a drug and then blood is drawn periodically afterward. I believe this is supposed to rule out Cushings?
The reason this is so important to me is that my formerly treatable depression has become treatment resistant in the last few years. I have also begun to have uncontrollable fear or terror in the mornings upon waking. It lasts most of the day and goes away spontaneously at night.
My endoc. doesn't think the tumor is causing the problems but obviously something is going on. I don't know what other tests to ask for - I need to know what tests might conclusively reveal an endocrine problem causing depression/anxiety. I thought of just asking him to test for anything that could possibly be causing this but they tend to take you more seriously if you are well informed when you go in.
Any advice would be much appreciated.
Marsha
poster:4WD
thread:493827
URL: http://www.dr-bob.org/babble/20050516/msgs/499972.html