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Medical Forum / General / Cardiology / May 2007

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PCOS/hyper-insulinemia/metabolic syndrome x

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PetShopQueen007 - 28 May 2007 05:13 GMT
since its been proven that i have this condition, and probably have
since i was born (hence why i was having the same symptoms and hair
growth and other things even before i ever started having a period),
and how 90% of my problems are probably caused by this... i had a few
questions.

they say that those with PCOS have the free-circulating insulin that
can cause a fatty buildup and arterial problems, etc. i have a high
insulin, but not sure for how long. all i know is from the time i was
diagnosed with it (1996)... and have never once had high (bad)
cholesterol or any of that.  my good cholesterol is also perfect and
has always been perfect.

now, being 25 and active and a fairly healthy diet for all my life and
everything.. *could* it be possible that this has accumulated in my
arteries and even in my heart and this is whats causing my heart
strain?

on my EKG's its consistently shown non-specific st-t waves... but echo
always showed no signs of ischemia. could this be a blockage in my
heart arteries? could such a blockage be causing the tachycardia and
right heart strain (specifically), though?

i spoke to my doctor on the phone the other day and he says that all
of this should just be addressed with the endocrinologist and that
this is most likely all just hormonal. okay, yeah i know that, but
hormones causing this by themselves, without a blockage?
everyone keeps saying, that st-t waves can be very common in a
perfectly normal, healthy heart and might not mean anything at all.
but... it just doesnt seem right.
could they be being caused by the tachycardia and strain?

how can they be so sure there isnt a blockage causing this based on
the echo? i dont get it.

supposedly, though.. i had two EKG's show a significant decrease in
the st-t waves or to the point of really not even being there. it made
no sense what the doctor was referring to. he couldnt seem to make up
his mind if they were there or not. what the hell?!
again, im just gonna switch to another cardiologist in the same
practice.

im wondering if that fall i had just knocked some sh.t out of wack
that was in my arteries anyway (fat or insulin-causing blockages), and
not particularly a clot/PE.

either way,  underliningly, its all gotta do with this PCOS sh.t.

if say, there is a blockage in my heart... at this stage, couldnt they
do something about it?
Andrew B. Chung, MD/PhD - 28 May 2007 08:26 GMT
> since its been proven that i have this condition, and probably have
> since i was born (hence why i was having the same symptoms and hair
[quoted text clipped - 13 lines]
> arteries and even in my heart and this is whats causing my heart
> strain?

>From your clinical history, occlusive coronary disease is not
suspected.

> on my EKG's its consistently shown non-specific st-t waves... but echo
> always showed no signs of ischemia. could this be a blockage in my
> heart arteries? could such a blockage be causing the tachycardia and
> right heart strain (specifically), though?

Your clinical picture is more consistent with recurrent subacute PEs.

> i spoke to my doctor on the phone the other day and he says that all
> of this should just be addressed with the endocrinologist and that
> this is most likely all just hormonal. okay, yeah i know that, but
> hormones causing this by themselves, without a blockage?

With recurrent subacute PEs.

> everyone keeps saying, that st-t waves can be very common in a
> perfectly normal, healthy heart and might not mean anything at all.
> but... it just doesnt seem right.
> could they be being caused by the tachycardia and strain?

By recurrent subacute PEs.

> how can they be so sure there isnt a blockage causing this based on
> the echo? i dont get it.

Your clinical history goes against the idea of occlusive coronary
disease.

> supposedly, though.. i had two EKG's show a significant decrease in
> the st-t waves or to the point of really not even being there. it made
[quoted text clipped - 11 lines]
> if say, there is a blockage in my heart... at this stage, couldnt they
> do something about it?

You would not have passed the stress tests if you had occlusive
coronary disease.

Meanwhile, you would be wise to have your doctor(s) supervise your
eating less down to the right amount thereby becoming hungrier to lose
all the visceral adipose tissue (VAT) that is causing your metabolic
syndrome (MetS):

http://HeartMDPhD.com/HolySpirit/overweight.asp

May GOD bless you in HIS mighty way making you hungrier than ever.

Prayerfully in Jesus' awesome love,

Andrew <><
--
Andrew B. Chung, MD/PhD
http://EmoryCardiology.com

"Unlike the 2PD-OMER Approach, weight loss diets can't be combined
with well-balanced diets."
http://HeartMDPhD.com/Love/TheTruth
PetShopQueen007 - 28 May 2007 17:53 GMT
hopefully you are right and its something like this, that's
'correctable'.

well, im setting up with a new endocrinologist/gyno (like the other
doctor i had who was very knowledged in PCOS, etc and seemed to be
very up to date on it all...), and hopefully i can find out where
everything stands as far as hormonal levels and all of that go, and
work out a good system plan to go along with what im already doing.

another thing... is it normal... for someone's blood pressure (with my
physical characteristics) to go from 120/80 to say 105/70 and even
96/70? all within a week, each time at the doctor's, its been either
of these. 96 seems a bit low to me, too. even day by day it'll be like
this or even within a few hrs time. fluctuates about around those
intervals all the time. in fact, i think its always kind of been like
that. though, in the past, my doctor's never really mentioned it.. but
when they did or i asked....

so, i dont think these fluctuations have much to do with the day or
time of day, or what i ate, etc. since it can change within a matter
of minutes to an hour, really.

and on my right arm, the BP is usually higher than the left. right
would be 120/70 and the left 105/70, or something like that. the
doctors never really.. clarify anything for me about this when i asked
about it.
Andrew B. Chung, MD/PhD - 28 May 2007 17:58 GMT
The endothelial dysfunction associated with metabolic syndrome (MetS)
can lead to blood pressure (BP) variability and arterial spasm (left
vs right arm BP differences) as you describe.

May GOD bless you in HIS mighty way as you lose your VAT making you
hungrier than ever.

Prayerfully in Jesus' awesome love,

Andrew <><
--
Andrew B. Chung, MD/PhD
http://EmoryCardiology.com

"Unlike the 2PD-OMER Approach, weight loss diets can't be combined
with well-balanced diets."
http://HeartMDPhD.com/Love/TheTruth

> hopefully you are right and its something like this, that's
> 'correctable'.
[quoted text clipped - 22 lines]
> doctors never really.. clarify anything for me about this when i asked
> about it.
PetShopQueen007 - 29 May 2007 12:11 GMT
On May 28, 12:58 pm, "Andrew B. Chung, MD/PhD"
<heartd...@emorycardiology.com> wrote:
> The endothelial dysfunction associated with metabolic syndrome (MetS)
> can lead to blood pressure (BP) variability and arterial spasm (left
> vs right arm BP differences) as you describe.

can this be corrected/reversed?

like i said.. a year ago, i dont recall ANY of this vascular stuff
happening. not even in november. this stuff started exactly the week
all this heart stuff started happening, and the fall, period... etc.

as for strange blood pressure fluctuations.. thats been going on for a
while (since early 2005) and the feeling of just getting off an
elevator.. and SOB since at least later 2004, early 2005.

my mom was saying today she first remembered me complaining about all
of this about 2-3 months after stopping the birth control pill
completely... and yeah, i remember feeling very strange/different
after that.

i dont think this is PH at all now. all this other sh.t is related and
obviously is.. i mean it all fits the pattern.
but still.. PCOS/mets x causing it all out of the blue like that? at
least the vascular? it was my understanding that  most of these types
of problems develop over a period of time.. usually years.. decades.
but so suddenly like this? id think id have had at least 'some'
vascular sympyoms prior to this. i swear to god, i cant think of
anything prior to december, as far as that goes.  i just remember 2
days after that fall and the onset of this other thing.. coming home
from work, and it was very cold out..and i wasnt wearing any gloves or
anything and driving home. my hands wer elike ice (takes forever the
heat to work in that car and besides. its just a 10 minute drive
home), but when i got inside the house.. the warming reaction in my
hands and fingers was really strange. i cant explain it. id never
really had it happen like that before, except many years ago, playing
around in the snow as a kid and almost getting frostbite and tossing
my hands under really hot water, which wasnt exactly a good idea, LOL>
but yeah it felt extreme like that and they felt pretty strange the
rest of the night. so much so, i mentioned something to my mom. they
looked a normal color and the capillary refill seemed normal. just the
feeling.. like the nerves.. or something. but they never responded in
this extreme type of way before. of course when the fingers warm up
from the cold, you're gonna feel stuff like that, but this was way
different.    and throghout my life, ive been very known to have some
of the best circulation and veins..
but within a matter of a couple weeks.. they even started looking all
different. not just little areas here and there.. im talking about
widespread vein appearance changes. they dont 'look' as strong and
healthy as they did before.
for the first time in my life that week, i was feeling like i had all
my blood drained and fingers going numb for no reason and toes. even
my face. that really scared me. then 3 weeks or so later.. a lot of
that subsided and my fingers and everything seemed somewhat back to
normal. i wasnt having any problem doing anything, but i still noticed
a difference. it was like my body was changing before my eyes, for
some unknown reason. and not just seieng i, but you just feel like ..
inside everythings just not working right. even feeling like sh.t all
the time from my auto-immune problems and the PCOS.. id never felt
this way before. this was soemthing o a whole other new category and
even despite feeling 'sick' before all that, i still felt 'healthy'
and 'together'... and strong.

one thing that came back to me was.. back in high school.. after
having a really really bad flu and a bad period.. (may 2000), and id
had an odd episode upon waking up, of really ow blood pressure..
definite blue coloring in my face and around my lips. felt like i was
gonna pass out. id NEVER felt that way in my life. i felt like id been
drugged. i got up that morning to go to school and felt really..
really washed out and strange. not just from the flu.
i jump in the shower.. and i start seeing spots and my arms had a blue
tint to them. i thought.. oh its just the flu.. (how stupid was
that?!?!) and like my heart was trying to over-compromise for the lack
of a freekin blood flow, and id currently had been on amoxicillin for
the flu, and i dont recall taking any of my cold meds that morning...
maybe the night before.. a regular sudafed... but anyways, i felt like
sh.t and i couldnt take off from school.
so later that morning, im sitting in class.. blow my nose and all of
the sudden i feel this hot rush in what feels like my stomach and it
progresses and feels like im about to combust from within. started
sweating and like my skin was burning... i turned blood red and felt
it move all the way to my head, heart racing, skin tingling,.. like
some really, really acute.. fever rush. i felt like i needed to get
some water, right away but couldnt get up. id had my head down on the
desk and refused to even move. after about 5 mins, it subsided and i
thought i was gonna vomit, but nothing happened. and the rest of the
day, everyone said i looked drunk and totally washed out. i went to
the nurse and they refused to even send me home, but... something was
NOT right. i felt kinda better after this little 'attack', but still
felt like id been thru a war inside my body. needless to say, after
that i stopped taking the antibiotic and th sudafed, just in case.
tho, id never ever had a reaction like that to either drug before. so,
i dont think thats what that was.

there'd been a couple other odd little things from before i was on the
pill, but ive mentioned those already. but, those were all tied into
around when i had my period.

im wondering.. if, like i was saying before.. that my vascular and
nervous system are reacting to some strange chemical or hormonal
imbalance.. more of an acute type.

as for my leg.. that things acting up like hell the last day or two.
not sure if its from the heat or what. started hurting and 'itching'
kind of inside and outside and started looking swollen again (though
the pouchy thing never goes away), and i was walking around lastnight
and looked down at my leg and see a little knot in the vein next to my
leg bone, and it looked like a faint bruise... and i touched it and i
could feel it. felt like my moms messed up vein bulges. freaked me
out. id never had that before either. its been feeling more odd.. ever
since i had my period a week and a half or so ago.. but this knot
thing really creeped me out.

i just dont know how the heck to bring allt his up to the doctors..
my current one, i think.. believes im a quack now.
i dont even know where to begin with what tests would need to be done,
theres just too many to be done.. and the doctors wont bring it up
themselves, so i have to, and when i do, they act like there is no
need and start this whole fight about it. even despite the physical
evidence. god forbid a patient suggests certain things.
Andrew B. Chung, MD/PhD - 29 May 2007 12:21 GMT
> Andrew, in the Holy Spirit, boldly wrote:
> > The endothelial dysfunction associated with metabolic syndrome (MetS)
[quoted text clipped - 115 lines]
> need and start this whole fight about it. even despite the physical
> evidence. god forbid a patient suggests certain things.

It is likely what we see in you is the proverbial "straw that broke
the camel's back."

Time to get the straw (VAT) off the camel's back and wait for the
healing to occur.

GOD is the Source of all healing.

May HE bless you in HIS mighty way making you hungrier than ever so
that you will lose the VAT:

http://HeartMDPhD.com/HolySpirit/overweight.asp

Prayerfully in Jesus' awesome love,

Andrew <><
--
Andrew B. Chung, MD/PhD
http://EmoryCardiology.com

"Unlike the 2PD-OMER Approach, weight loss diets can't be combined
with well-balanced diets."
http://HeartMDPhD.com/Love/TheTruth
PetShopQueen007 - 29 May 2007 23:00 GMT
as for VAT fat loss.. ive been working on that. the last few months
now, especially.. the foods ive been eating and frequency. i  hardly
eat that much lately, anyways. lol.
i'll have a tuna fish sandwich and soup for lunch and dinner..
something like fish, veggies, rice or pasta.. or a light chicken and
veggies meal. as for my mid-section (which seems to be the area for
the most VAT fat), ive always kind of been slightly more 'bloated'
around that area ever since i was little. same for my mom. within the
last few months, thats gone down quite a bit , but that might've been
due to water retention or just me losing weight overall. (losing 5
pounds can make a huge difference on me.. im very very small.)

anyways,... what type of doctor would be best for this whole thing?
the mets, possible adrenal issues, etc.. an endocrinologist? or an
endocrinologist/gyno (which is VERY hard.. to find in this area.. at
all)?

also, as far as deep vein thrombosis goes..
the deep veins to be worried about would be the ones in my calf
itself.. behind the leg?

the problem area with mine.. is off to the side.. next to the ankle
(close to the heel) and above the ankle... and goes slightly to the
area right below the calf muscle on the side. not behind on the calf
itself.
the bulgy vein is right next to the front leg bone midway on the lower
leg. about half an inch.

would this sound more like a superficial vein?
Susan - 29 May 2007 23:41 GMT
> as for VAT fat loss.. ive been working on that. the last few months
> now, especially.. the foods ive been eating and frequency. i  hardly
[quoted text clipped - 7 lines]
> due to water retention or just me losing weight overall. (losing 5
> pounds can make a huge difference on me.. im very very small.)

If you have PCOS or Cushing's, you should be eating low carb; ixnay the
iceray and astapay.  :-)

> anyways,... what type of doctor would be best for this whole thing?
> the mets, possible adrenal issues, etc.. an endocrinologist? or an
> endocrinologist/gyno (which is VERY hard.. to find in this area.. at
> all)?

Reproductive endocrinologists are at the forefront, but not all of them.
The best intervention is low carb diet, with metformin if diet alone
isn't 100% effective.

Susan
Andrew B. Chung, MD/PhD - 30 May 2007 03:50 GMT
> as for VAT fat loss.. ive been working on that. the last few months
> now, especially.. the foods ive been eating and frequency. i  hardly
[quoted text clipped - 7 lines]
> due to water retention or just me losing weight overall. (losing 5
> pounds can make a huge difference on me.. im very very small.)

The key is eating less down to the optimal amount thereby becoming
much hungrier.

As for the right diet... avoid foods that cause a reduction in
appetite.

As for the right activity... avoid doing things that cause a reduction
in appetite.

As for the right people... avoid people that cause a reduction in
appetite.

As for the right meds and supplements... avoid things that cause a
reduction in appetite.

It is when you are hungry especially when the stomach is growling that
your body is dismantling the VAT.

> anyways,... what type of doctor would be best for this whole thing?

As for the right doctor in your case... one who listens to you and
answers your questions thoughtfully so that you experience an increase
in appetite after visiting him/her :-)

> the mets, possible adrenal issues, etc.. an endocrinologist? or an
> endocrinologist/gyno (which is VERY hard.. to find in this area.. at
[quoted text clipped - 12 lines]
>
> would this sound more like a superficial vein?

Yes.  However, where there is a problem with superficial veins, it is
likely there is also a problem with the deep veins.

May GOD bless you in HIS mighty way making you hungrier than ever.

Prayerfully in Jesus' awesome love,

Andrew <><
--
Andrew B. Chung, MD/PhD
http://EmoryCardiology.com

"Unlike the 2PD-OMER Approach, weight loss diets can't be combined
with well-balanced diets."
http://HeartMDPhD.com/Love/TheTruth
Susan - 28 May 2007 20:26 GMT
> hopefully you are right and its something like this, that's
> 'correctable'.
[quoted text clipped - 17 lines]
> time of day, or what i ate, etc. since it can change within a matter
> of minutes to an hour, really.

It's normal if the person has PCOS symptoms caused by Cushing's syndrome
or disease, a common condition rarely diagnosed.  Everyone with PCOS is
supposed to be evaluated for Cushing's first.

Susan
Andrew B. Chung, MD/PhD - 28 May 2007 21:34 GMT
> > hopefully you are right and its something like this, that's
> > 'correctable'.
[quoted text clipped - 20 lines]
> It's normal if the person has PCOS symptoms caused by Cushing's syndrome
> or disease, a common condition rarely diagnosed.

Cushing's syndrome is neither normal nor common.

> Everyone with PCOS is
> supposed to be evaluated for Cushing's first.

Someone with Cushing's syndrome will likely have physical exam
findings suggestive of that diagnosis.

May GOD bless you in HIS mighty way.

Prayerfully in Jesus' awesome love,

Andrew <><
--
Andrew B. Chung, MD/PhD
http://EmoryCardiology.com

"Unlike the 2PD-OMER Approach, weight loss diets can't be combined
with well-balanced diets."
http://HeartMDPhD.com/Love/TheTruth
PetShopQueen007 - 29 May 2007 01:15 GMT
> Cushing's syndrome is neither normal nor common.

yes, its not normal or common, but i guess abnormally 'normal' with
those with PCOS../cushings.

oddly, my dog was diagnosed with cushings a couple years back.

> Someone with Cushing's syndrome will likely have physical exam
> findings suggestive of that diagnosis.

my endo back in the 90s thought i had it, until the test results.

i argued with him over the result though.. since it was 2 points above
the highest normal reading.

as for symptoms of cushings.. everyones different.

like hey,  i have PCOS... but am not overweight and can still have a
normal period (now), and havent gone into full-blown diabetes..
Andrew B. Chung, MD/PhD - 29 May 2007 02:14 GMT
> > Cushing's syndrome is neither normal nor common.
>
> yes, its not normal or common, but i guess abnormally 'normal' with
> those with PCOS../cushings.

No such thing as the latter.

> oddly, my dog was diagnosed with cushings a couple years back.
>
[quoted text clipped - 5 lines]
> i argued with him over the result though.. since it was 2 points above
> the highest normal reading.

Serum cortisol levels are highly variable.

ACTH stimulation is used to improve specificity.

> as for symptoms of cushings.. everyones different.
>
> like hey,  i have PCOS... but am not overweight

Many women aren't overweight and yet have enough VAT to cause health
problems.

> and can still have a
> normal period (now), and havent gone into full-blown diabetes..

Your health problems appear to be more vascular.

May GOD bless you in HIS mighty way.

Prayerfully in Jesus' awesome love,

Andrew <><
--
Andrew B. Chung, MD/PhD
http://EmoryCardiology.com

"Unlike the 2PD-OMER Approach, weight loss diets can't be combined
with well-balanced diets."
http://HeartMDPhD.com/Love/TheTruth
PetShopQueen007 - 29 May 2007 02:16 GMT
im going to see if they can do the 24-hour urine cortisol test. never
had that.

so, if this is my problem..causing all these symtpoms, .. cardiac and
vascular.. can they be reversed/corrected?
Susan - 29 May 2007 02:43 GMT
> im going to see if they can do the 24-hour urine cortisol test. never
> had that.
>
> so, if this is my problem..causing all these symtpoms, .. cardiac and
> vascular.. can they be reversed/corrected?

Yes, though diagnosis and treatment is variable and tricky.  A 24 hour
UFC can be helpful, but many pathology proven Cushing's patients never
have elevated test results.  Midnight salivary cortisol can be more
helpful, if positive, by showing the disrupted diurnal variation
pattern.  Cushing's tends to be cyclical, so many folks have to test
repeatedly for months or longer to catch a high result.

Here's a great resource:

http://www.cushings-help.com/intro.htm

Susan
Andrew B. Chung, MD/PhD - 29 May 2007 02:46 GMT
> im going to see if they can do the 24-hour urine cortisol test. never
> had that.
>
> so, if this is my problem..causing all these symtpoms, .. cardiac and
> vascular.. can they be reversed/corrected?

It is unlikely that your problems are arising from Cushing's syndrome.

Moreover, without an adrenal tumor, Cushing's syndrome would be
without definitive treatment.

In the interim, it would remain wise for you to lose all the visceral
adipose tissue (VAT) by eating less down to the right amount.

May GOD bless you in HIS mighty way.

Prayerfully in Jesus' awesome love,

Andrew <><
--
Andrew B. Chung, MD/PhD
http://EmoryCardiology.com

"Unlike the 2PD-OMER Approach, weight loss diets can't be combined
with well-balanced diets."
http://HeartMDPhD.com/Love/TheTruth
Susan - 29 May 2007 02:46 GMT
>>Cushing's syndrome is neither normal nor common.
>
[quoted text clipped - 15 lines]
> like hey,  i have PCOS... but am not overweight and can still have a
> normal period (now), and havent gone into full-blown diabetes..

I don't know who's arguing with you, clearly someone in my kill file.
Cushing's is very common, but even most endocrinologists are completely
ignorant of its true characteristics.  With 10% of type 2 DMs having it,
that's a big group.

I am slim, was very slim when I developed PCOS years ago, don't look at
all Cushingoid, yet I consistently run extremely high cortisol,
particularly at midnight.  When it's lower, I experience symptoms of
adrenal insufficiency even while running cortisol in the normal range
because my body is used to running on more.

Susan
Andrew B. Chung, MD/PhD - 29 May 2007 03:18 GMT
> >>Cushing's syndrome is neither normal nor common.
> >
[quoted text clipped - 20 lines]
> ignorant of its true characteristics.  With 10% of type 2 DMs having it,
> that's a big group.

Someone with hyperglycemia from Cushing's syndrome would neither be
diagnosed with nor treated for type-2 diabetes.  Instead, the
chronically elevated cortisol levels would be addressed.

Excerpt from Merck Manual:

Testing begins with measurement of urinary free cortisol (UFC), the
best assay for urinary excretion (normal, 20 to 100  g/24 h [55.2 to
276 nmol/24 h]). UFC is elevated > 120  g/24 h (> 331 nmol/24 h) in
all patients with Cushing's syndrome. However, many patients with UFC
elevations between 100 and 150  g/24 h (276 and 414 nmol/24 h) have
obesity, depression, or polycystic ovaries but not Cushing's syndrome.
A patient with suspected Cushing's syndrome with grossly elevated UFC
(> 4 times the upper limit of normal) almost certainly has Cushing's
syndrome. Two to 3 normal collections virtually exclude the diagnosis.
Slightly elevated levels generally necessitate further investigation.

Traditionally, further investigation is accomplished with the test, in
which 1, 1.5, or 2 mg of dexamethasone is administered po at 11 to 12
pm and plasma cortisol is measured at 8 to 9 am the next morning. In
most normal patients, this drug suppresses morning plasma cortisol to
 1.8  g/mL (  50 nmol/L), whereas patients with Cushing's syndrome
virtually always have a higher level. A more specific but equally
sensitive test is to give dexamethasone 0.5 mg po q 6 h for 2 days
(low dose). In general, a clear failure to suppress levels in response
to low-dose dexamethasone establishes the diagnosis.

Source:

http://www.merck.com/mmpe/sec12/ch153/ch153e.html#S12_CH153_T002

May GOD bless you in HIS mighty way.

Prayerfully in Jesus' awesome love,

Andrew <><
--
Andrew B. Chung, MD/PhD
http://EmoryCardiology.com

"Unlike the 2PD-OMER Approach, weight loss diets can't be combined
with well-balanced diets."
http://HeartMDPhD.com/Love/TheTruth
PetShopQueen007 - 29 May 2007 01:12 GMT
hey susan,

yeah, they checked me for Cushings back when i was first diagnosed,
but they ruled that out (then.)
however.. my cortisol was 'normal', however it was about 2 numbers
above the highest normal number interval.
my doctor then had an ultrasound done on my kidneys and adrenals to
make sure there were no tumors or any other abnormalities and
everything was supposedly normal. but as for that, i havent had that
checked since. ya better bet i'll be mentioning this again to my new
endo.
because i think something may have been 'overlooked' back then.

> > hopefully you are right and its something like this, that's
> > 'correctable'.
[quoted text clipped - 23 lines]
>
> Susan
Susan - 29 May 2007 02:48 GMT
> hey susan,
>
[quoted text clipped - 8 lines]
> endo.
> because i think something may have been 'overlooked' back then.

Check the link I provided in another post.  One test can't rule it out,
Cushing's tends to be very cyclical.  Pituitary MRI read by one of a few
expert neurosurgeons, plus abdominal C-T scan of the adrenals, along
with extensive hormone testing using 24 hour UFCs and salivary cortisols
would be more useful.

Susan
 
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