Elevated cortisol level- what does it mean?

  1. I will try to be brief here: I went to the endocrinologist and had an extensive workup done for polycystic ovarian syndrome because I am fat, hairy, have bad skin and have a mom and sister with PCOS. The doctor kept scheduling me six weeks in advance and would always schedule me for afternoon appointments when I had worked all night the night before so I had to reschedule my appointment three times (to avoid sleep deprivation induced auto accidents), after which his receptionist informed me that I was no longer his patient. I had no idea there was an upper limit on the number of times you could reschedule an appointment, but I digress...
    Anyway, my lab results were sent to my but now I have no doc to help me interpret them. All appear normal, except my 24 hours urinary cortisol level, which is WAY elevated. A normal result is supposed to be 105 or less; mine is 693! Aside from an adrenal tumor, what could cause this? And moreover, what the hell do I do to fix it? I have an appointment with another endo doc next month, but meanwhile I am stressing over this. Anyone shed any light for me? Thanks in advance!
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  2. 19 Comments

  3. by   manna
    http://stress.about.com/cs/cortisol/a/cortstress.htm

    Good luck with the new endo. Hope you get to the root of your problems soon!
    Last edit by manna on Dec 16, '04
  4. by   lsyorke
    Are you taking any medications???
  5. by   mitchsmom
    I don't know much about this and you may have already thought about it, but remember that cortisol waxes and wanes... peaking in the morning and dropping a lot by the evening (I think like 90%).. and I think sometimes it is out of whack for night shift workers. I only noticed it b/c you mentioned night shift in your post.
    Hope it turns out well

    edit: Couldn't help looking a little more:
    My book lists tumors (adenomas and carcinomas), adrenal hyperplasia, and therapeutic use of glucocorticoids (steroids) as causes of increased cortisol secretion. It also says that additional lab findings may include: > blood glucose, >WBC, > lymphocyte count, > Na+, < serum Ca+, < serum K+ levels. It describes more detailed testing if Cushing's disease is suspected: 24 hr urine, radiographic studies, dexamethasone suppression tests.
    A bunch of info on Cushing's syndrome for you:
    http://www.emedicine.com/emerg/topic117.htm
    http://www.emedicine.com/med/topic48...~differentials
    Last edit by mitchsmom on Dec 17, '04
  6. by   jaimealmostRN
    Just remember, your doctor is there for YOU, not vice versa. Tell them your scheduling needs, insist on an AM apt if thats what works for you. I got this from "laboratory tests and diagnostic procedures" 3rd ed., by chernecky and berger. Increased urine cortisol can be amenorrhea, cushing syndrome, hyperthyroid, lung ca, pituitary tumor, pregnancy, stress and the drug corticotropin.....so see your NP or dr.
  7. by   vwgirl
    Quote from lsyorke
    Are you taking any medications???
    I am, but I checked them out and none of them should interfere with this test. As far as my doctor being there for me (which someone else posted), the doc who ordered this test refuses to have anything else to do with me at this point because I had to reschedule three times, and will not discuss the results with me. I am retaining tons of water in my hands; I guess I will just have to wait till January till the new endo can see me.
  8. by   jaimealmostRN
    What I meant is that when you go see your new dr. they should be there for you, thats one criteria that I would insist on before chosing them as my specialist or PCP. But if your hands are swelling and you don't feel well, then PLEASE go to the ED!!! If posible, go to a university ED that has endos. in house so you can get to the bottom of this!
  9. by   jetta1
    Sounds like you may have polycystic ovaries or PCOS.
  10. by   SarasotaRN2b
    [font=Comic Sans MS]Okay, my question is this...if your "former" doctor ordered this test and received the results, don't they have some responsibility? I don't know, but I feel that the endocrinologist at least has the responsibility of going over the results even if they decide not to continue care.
    [font=Comic Sans MS]
    [font=Comic Sans MS]Take care and I hope that it is as one of the posters suggests just a fluctuation between doing the test night and day.

    Quote from vwgirl
    I will try to be brief here: I went to the endocrinologist and had an extensive workup done for polycystic ovarian syndrome because I am fat, hairy, have bad skin and have a mom and sister with PCOS. The doctor kept scheduling me six weeks in advance and would always schedule me for afternoon appointments when I had worked all night the night before so I had to reschedule my appointment three times (to avoid sleep deprivation induced auto accidents), after which his receptionist informed me that I was no longer his patient. I had no idea there was an upper limit on the number of times you could reschedule an appointment, but I digress...
    Anyway, my lab results were sent to my but now I have no doc to help me interpret them. All appear normal, except my 24 hours urinary cortisol level, which is WAY elevated. A normal result is supposed to be 105 or less; mine is 693! Aside from an adrenal tumor, what could cause this? And moreover, what the hell do I do to fix it? I have an appointment with another endo doc next month, but meanwhile I am stressing over this. Anyone shed any light for me? Thanks in advance!
  11. by   jsn43210
    Quote from vwgirl
    Anyway, my lab results were sent to my but now I have no doc to help me interpret them. All appear normal, except my 24 hours urinary cortisol level, which is WAY elevated. A normal result is supposed to be 105 or less; mine is 693!
    The first thing to do would be have it retested.
  12. by   jsn43210
    If it is still high, the differential would be:


    - pregnancy, ACTH-secreting tumor, Cushing's syn., pituitary tumor
  13. by   ?burntout
    I think I would have the test repeated.

    I also wanted to give you a website with lots of good information on PCOS:
    PCOS FAQS
  14. by   BamaRN
    you may have cushings. its caused by pituitary tumor, adrenal tumor, some meds - corticosteroids. the s/s you listed are all s/s of cushings also may have HTN, hyperglycemia, depression, fatigue etc. i would definately go to another doctor and have more tests ran.

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