Please select the option that best describes you:
Is it possible to have undetectable cortisol levels in secondary adrenal insufficiency?
Young, previously healthy male with normal growth presenting with two syncopal episodes. Currently, only symptom is mild fatigue. Labs showed: Cortisol undetectable with ACTH 6-8, cortisol levels did not rise with cosyntropin but aldosterone stimulated normally, low IGF1, mildly elevated prolactin, elevated TSH and low free T4 (normalized later). CBG wnl and opiate/steroid assay were negative. MRI with small pituitary. Some of my colleagues think it is interference or assay issue, others think this is true central AI.
Answer from: at Academic Institution
I agree with Dr. @Salvatori, it is very strange to see these elevated testosterone levels. And also to start thyroid replacement while trying to work through this.
I have a few clarifying questions. What work does he do? What are his hobbies/athletic interests? Do you have a testicular exam o...
Comments
at Endocrine Associates Of Connecticut
Hi Dr. @Khan thank you so much. He is now 20+, wor...
Hi Dr. @Khan thank you so much. He is now 20+, wor...
at University of Missouri School of Medicine
A germ cell tumor can cause pituitary dysfunction ...
A germ cell tumor can cause pituitary dysfunction ...
at Endocrine Associates Of Connecticut
Thank you and will write back with update.
Thank you and will write back with update.
Thank you so much. No exogenous steroid use and le...
Very strange to see such a high T level. I wonder ...
Hi, thanks for the info. I was not aware that macr...