For those w/confirmed Cushing's dx: what were your cortisol levels post-dexamethasone suppression?
I (37F) have been investigating some endocrine issues for the past few weeks, and I'm wondering: for those of you who have confirmed Cushing's diagnoses, what were your cortisol levels after you took the dexamethasone suppression test?
Mine is 2.0, and I know the threshold for a positive test is 1.7/1.8. I'm just trying to determine if that's high enough for most endocrinologists to take seriously as a potential Cushing's indicator, or just one of those "higher end of normal that can be explained by other things" situations. Because the endo who ordered the lab work (after laughing at me for asking for it) just said that under 5 is "fine," and then blocked me from contacting her or her nurse on MyChart.
Based on all the research I can find, I'm pretty sure she's full of it, but I'm curious to see just how full.
Now, I should mention that the only reason I even looked into Cushing's in the first place was because I was discussing some symptoms with a good friend of mine (I'll get to the symptoms soon), who had pituitary Cushing's, and he said that even though doctors would be skeptical, it might be a good idea to get my cortisol levels checked just in case.
Turns out my blood cortisol was unignorably high--36 ug/dL in the morning and 13.1 in the afternoon--and all of my other lab work so far has been consistent with pituitary Cushing's:
- high fasting blood glucose and triglycerides on 3 different CMPs (two in February, one two weeks ago). This is what initially confused me because these have never been issues in the past, and the rest of my cholesterol levels are normal, as well as my A1C (diabetes runs in my family)
- BP either in or constantly flirting with stage 1 hypertension (which I know doctors tend to ignore because it's not flaggable on its own, but I've had a very low baseline my whole life that's historically topped out at like 100/61.)
- testosterone so low it didn't even register (it says <2.5), and, while I'm not sure if this matters, that blood was drawn the same morning as the post-dexamethasone suppression cortisol test
- normal thyroid panel, so unlikely to be a thyroid issue
- normal DHEA sulfate levels, and no abnormalities detected on a February MRI of my adrenal glands (the MRI was for something else but the adrenals were included), so almost certainly not an adrenal issue
Then there are the symptoms I'm experiencing:
- constant, and I mean 24/7/365, fatigue and muscle weakness. No matter what I do or how much I sleep (and I'm not a great sleeper), while also feeling like I cannot relax, like my whole body is a clenched fist. I'm autistic and have struggled with fibromyalgia in the past, so I'm no stranger to micromanaging my energy, but it's gotten much worse and less predictable over the last two years (probably longer, but in 2020-21 it would've been reasonable to chalk it up to the Unprecedented Times™), and even though I've been getting great physical therapy three times a week since the end of March, it's getting harder and harder to maintain enough of a baseline to do normal activities. It's gone from being "tough but manageable with advance notice and planning" to feeling like I can't make ANY plans anymore.
- constantly feeling dehydrated and urinating very frequently (been experiencing that for over two years now, but chalked it up to getting older)
- feeling warm most of the time and having noticeable difficulty with temperature regulation (I live in NYC and I did not turn my radiator on once during the winter--I only noticed it might be colder than I thought when I saw my cats routinely attaching themselves to the hot water pipe)
- also feeling OVERLY sensitive to heat (I love doing hot yoga, but recently I've been unable to do it because my skin feels like it's burning and the floor and my mat feel like high-noon concrete on the summer's hottest day).
- abrupt and unexplained weight gain of at least 15 pounds in the last year, which has also been the MOST physically active and nutritionally sound year I've had in a while (I'm 5'1 and weighed in yesterday at 130 pounds.)
- weight gain is disproportionately prominent in my face and my breasts--less so around my waist, which I know is the stereotypical area for Cushing's, but I do notice a consistent "swollen" feeling around my waist (something like water retention, but not quite), I've read that Cushing's weight gain can also be concentrated in the chest, and well...I've gone up two cup sizes in the last year.
- bizarrely slow wound healing--I scratched my hand on a paper clip over two months ago, didn't even draw blood, and it still hasn't faded
- episodes of blurry vision that I can't really explain (which apparently is a key indicator of a pituitary tumor)
Luckily I got my PCP to sign off on the saliva and urinary tests that this doctor SAID she would order anyway IF the labs she ordered indicated Cushing's, and I'll probably have those results by Monday. But I'm doing all this so I can get a pituitary MRI to know for sure, and I doubt my insurance will cover it unless the order comes from an endocrinologist. So to have this person ignore ALL of that information and then BLOCK ME after I did exactly what she ordered...like? How many more times do I have to have lab work prove me right before an endocrinologist takes me seriously enough to merit a pituitary MRI?
Sorry this kinda turned into a rant, but I really do want to gather some data about other people's post-dex suppression cortisol levels.