Help With Symptoms - Low DHEA

[drkatzjr]

I am 34/Can you help me?

I recently received some new blood work back indicating the (3) following low items:

Free  and Total Testosterone   -slightly low

DHEA-S  -  Markedly low     76      (194-590)


Tests Pending:   Cortisol, ATCH, antiadrenal antibodies, aldosterone, PTH, Intact
Angiotensin-Convering Enzyme

Lab History:

over 10 years

TSH suppressed (0.09)
T4  Normal, but always borderline low
T3  Normal. but always borderline high
Normal CBC w/ differentials
Normal Metabolic panel  - some labs have flagged low potassium and low magnesium

Current  Dx  Subclinical Hyperthyroidism  (untreated)

Symptoms:  Excessive fatigue, very low libido, malaise, mild vague pain in LRQ.

CT Scans w/ contrast of abdomen and pelvis:  Normal - Unremarkable. ****

What is the significance of my markedly low DHEA-S level, given that I don't
have some of those other tests back yet. (tests mentioned above)  pending tests

If ---anyone---- who knows anything about low DHEA-S , I could really use ---any-- feedback.
    

[rumpled]

Weird re iodine scan!
Low testosterone and low TSH  .... that can be suppressed by elevated cortisol. Is the doc going to do more testing - or what?

[drkatzjr]

T3 is normal.  Dx is subclinical  hyperthyroidism  (LOW TSH, all else normal, including antibody tests.  Only strange fact:  Iodine Uptake Scan displayed low uptake at 5.3% which was stated by radiologist as "HYPO" of all things!

Now the abnormality to add to the equation is low Testosterone (FREE AND TOTAL) and profoundly suppressed DHEA-S

[rumpled]

But no Free T3...
Stable weight but no loss I would be more inclined actually to lean toward hypercortisolism than hypocortisolism - given that most with Addison's lose and those with Cushing's are all over the place (cortisol is wild!) but there are no absolutes on either side.
I had low BP with both high and low cortisol. Normally that is a sign only of low. It takes a lot of testing and an expert doctor.
A CT should rule things out - but alas - they can be read wrong. Was the MRI done where you had contrast given while you were in the machine - or were you pulled out? If pulled out, it was not a proper pituitary MRI.

[drkatzjr]

ps.. sorry...forgot to answer one of your questions, free thyroid:  normal

[drkatzjr]

Thanks for responding.  I am still waiting for the tests that I mentioned.

In terms of weight changes:  I would say my weight has been very stable.

In terms of the MRI of the Brain with focus on the pituitary, I am not sure concerning your questions.  It was read by a radiologist whose specialty is  neuro-radiology.  

On a different note, I would assume that the CT W/ Contrast
of my abdomen and pelvis would rule out -----major---- problems?
(which both were normal)

[rumpled]

What about your free thyroids - is that what you mean by active thyroid?

Has your weight gone up or down? How is your blood pressure? Your doc has pretty much tested everything I suggest except renin - but got aldosterone which is half of the loop.

Imaging as I said before can be iffy- was your pituitary MRI dynamic? Did a pituitary surgeon review the film? Radiologists can miss them as well as a smaller tumor can fall between the 3mm slices.

My adrenals were enlarged when removed - but showed up as normal both before and after removal on several reports. Yes - even after. I am not the only one either.

I prefer to respond on the forum - otherwise I get way too many PMs - and no information is out there to help anyone else. Being a patient myself I only visit once maybe twice a day since I am busy. Please be patient!

[drkatzjr]

Thanks for your comment.  I too was leaning toward some type of adrenal issue.  My active thyroid  t4 and t3 are normal, never been suppressed.

[rumpled]

Low DHEA-s can indicate an issue with the pituitary or adrenal insufficiency.

Low potassium is also another indication that something is going on, but usually it would spike, not drop, but I also drop - but usually sodium and potassium drop at the same time.

Cushing's often suppresses the thyroid and testosterone.

So based on this - I cannot tell if you have low or high cortisol - given the symptoms overlap a lot.

Imaging can be misleading - the lesions and the glands are tiny!