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What Causes High Corticosteroid Levels?

Posted on Mon, 11 Aug 2014

Question: What would cause high dopamine (905), high glucose (168, was 105 6 weeks ago), high cortisol (80.6, was 50 4 weeks ago), creatinine clearance 137, creatinine quality 2.3, creatinine urine 2.6, pth 103, thyroid peroxidase antibody 839, globulin 3.6. Octreotide scan was normal, sestamibi scan normal (except lymph node on right posterior thyroid), calcitonin normal, 5-hiaa normal, chromogranin A normal, calcium was 383 in urine 4 weeks ago, now is 245.

Answered by Dr. Shehzad Topiwala (9 hours later)

Brief Answer:
Endocrine

Detailed Answer:
There is a condition called Cushings syndrome in which high 'corticosteroids' in the body cause several problems, a high glucose being one of them. A random glucose in the human body in the normal state should not cross 140, so it would be worthwhile screening you for diabetes/ pre diabetes. A blood test called HbA1c is a good wa to screen for this. Fasting is not necessary for this test

Positive thyroid antibodies indicate the prospect of auto immune thyroid problems that often lead to a permanently under active thyroid. The best way to assess if your thyroid is fucntioning normally or not is to perform a simple non fasting blood test for TSH.

I have noted the high PTH and this can occur either due to
1) low vitamin d levels

So a blood test for 25 hydroxy vitamin D will settle this matter

2) In association with a high blood calcium

in a condition called primary hyper parathyroidism, in which over active parathyroid glands can also cause a high urine calcium

Urine calcium levels can bi=ounce around at times and must be interpreted in light of urine creatinine. Your urine creatinine seems to be on the higher side suggesting an over collection but I would like to know the range on your lab report

3 due to high phosphorus levels in blood

When I see someone like you, I typically order

Ionized calcium
Magnesium
Phosphorus

Also, ask your endocrinologist to consider ordering a screening test for Cushings syndrome. There are 3 options: blood, saliva and urine

i have noted the other results that are normal

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shehzad Topiwala (11 minutes later)

With carcinoid carcinoma in my immediate family, would it be likely that a thymic carcinoma would cause cushings and hashimotos? Phosphorus level=2.5, magnesium=2.1, 25 hydroxy vitamin D=38 ng and the urine calcium was a 24 hour test with volume=3270, with the reference range <300. Thank You!

Answered by Dr. Shehzad Topiwala (2 hours later)

Brief Answer:
Follow up

Detailed Answer:
Yes I recall your past question too.

Thymic carcinoid can rarely cause Cushings but not Hashimotos.

In light of the labs you have just shared, the urine calcium is of concern but the calcium level, preferably ionized, is missing

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shehzad Topiwala (13 hours later)

Do you think adrenal carcinoma would be more likely? Would these test numbers indicate that? Would octreoscan detect adrenal tumors or adrenocortical carcinoma? Thanks!

Answered by Dr. Shehzad Topiwala (3 hours later)

Brief Answer:
Second follow up

Detailed Answer:
The cardinal principle of endocrinology is to first prove biochemical problems. It simply means there needs to be evidence that hormones typically produced by the adrenal gland are present in excess in the blood. Tests for this include:

Tests to show excess blood cortisol (a random blood cortisol sample is not one of the tests that suffices this criterion)

DHEAS

Androstenedione

High Aldosterone levels (uncommonly)

If any one of these are significantly elevated, only then does one proceed to 'Imaging' tests like CT scan or FDG PET scan. Octreoscan is typically not useful for this type of carcinoma.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shehzad Topiwala (9 hours later)

But if someone (twin sister) has carcinoid carcinoma (pancreas, stomach, other places) would you think these numbers were significant enough to do a test for carcinoids or neuroendocrine tumors? If the random blood cortisol was not the right type of cortisol test, would the saliva test be better? My endocrinologist just ordered a saliva test and blood test for ACTH. Also, blood calcium is 9.5 but I don't know if it was ionized. Why is the octreoscan not useful for this type of carcinoma? Are they tumors too small to be seen on ocretoscan? Thanks

Answered by Dr. Shehzad Topiwala (26 hours later)

Brief Answer:
Third follow up

Detailed Answer:
1 With a twin sister being affected, I recommend genetic testing for the other twin

Yes the index of suspicion would be high for the individual whose twin sister has several carcinoids and warrant due diligence in screening for the same type of tumors

2 Saliva test for cortisol is very useful and becoming popular. It is endorsed by experts in the field

3 A calcium of 9.5 is the total value, and not ionized

4 Octreoscan can detect carcinoids

The question you asked above was for adrenocortical cancer for which octrescan is not helpful. The reason is that octreoscan is applicable to 'neuroendocrine' type of tumors. Carcinoid is a neuroendocrine tumor while adrenocortical cancer is not.

Things you are trying to comprehend are of extra ordinary complexity. A very small percentage of doctors worldwide have the special training to understand these things and manage patients who come to them.
Your attempt is rather like me trying to build a spaceship which is way beyond my expertise. So no matter how many questions I ask I will never be able to build one unless I undergo formal education and training in the subject.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shehzad Topiwala (1 hour later)

I appreciate your help and you are correct, it is really difficult to understand and learn about this illness. Thanks again.