Cushings ? in a 15 yr old

[andijess]

My 15 year old daughter has the following stuff going on.  

Depression of over one year  --taking lots of meds, but still depressed
thyroid problem taking 75 mcg levothyroid
wt. gain of 50 lbs in one year (most of it in her trunk)
feels hungry all the time, even when she just ate
feels like she is "weak" (used to be a comtetitive gymnast, but cant do much anymore)
tired all the time, but has trouble going to sleep, but then sleeps 15 hours a day
stretch marks (purple pink) all over on her thighs, arms, tummy, chest
thick body hair on her thighs, stomach, and even on her chest.
some hair on her face
complaints of headaches,  pushes on her eyeballs to feel better.
more sprains and strains when she is just walking and they take longer to heal

Her psychiatrist just changed, and he was alarmed, but her pediatric endo guy said it's probably just "pseudo cushings" and had us do a two pill at 11pm, and blood test in am to rule out cushings, but I've been reading that this may not be the best rule out test.  

What else should I ask for/do.  Does this sound like cushings to you ?

[1jitterbug]

You  might want to ask the doctor to check her B-12 level too.
Low B-12 can cause many of the symptoms you mentioned.

[Deanna L Aftab Guy, MD]

work on the insulin resistance and consider the same calorie diet but work with the dietician to modify its contents-more protein, less simple carb and more fiber and water.
Have them get the urine to rule out the cushings altogether

[andijess]

Hmmm.  She stopped growing a year ago.  I am 5'3" and her dad is 5' 7", and she is only 5'1" - so I don't know if she should be taller.  I know that her doctors think she eats too much, but she sticks to a 1500 cal diet, and exercises 5 to 6 days weekly.  Until all of this, she was very muscular (as a gymnast should be) but has lost so much muscle in the last few months, that she has had to stop competition...She watches her diet, and has worked with a dietician when she was in training.  

Something just isn't "right".......

[Deanna L Aftab Guy, MD]

Cushing's is rare, especially in a child who is growing height wise just fine, rapid weight gain and large weight gain definitely make the picture hard to interpret as this too adds stretch marks that are pink, usually Cushings vascular marks are violet and bright over the abdomen. Her blood sugars would be elevated but again rapid weight gain and type 2 diabetes are also a risk. So I would start with your pediatric endocrinologist, 3 separate 24 hr urine collections for free cortisol may help, in patients with depression there is a slightly higher cortisol level so it has to be interpreted accordingly. The next test is a dex suppression test which she is doing, dexamethasone will suppress the pituitary from making acth as a feedback loop mechanism, when we give a dose at midnight, then we would expect a low level of cortisol if the system is working, if however the level is high we tend to think that the feedback is off like something is driving the adrenals to work harder to make extra cortisol, like a tumor.
The urine test is also helpful as a screening to see if the level in the blood is overall too much and then we would look for the location.
Don't do the urine test though during the dex suppression test.
I would tend to think that believe it or not she has a component of insulin resistance, on top of depression and probably not eating all that she should to keep a healthy weight and on top of probably not moving her body as much as she should, if the Cushing's is ruled out, I would discuss with your peds endo about insulin resistance and see a dietician and find an exercise or health wellness program that is safe for her abilities and something that she actually will like, hopefully this will gear up her metabolism and make it easier for her to maintain a healthy weight.

[andijess]

Add to previous post.... she has elevated (mildly) prolactin, acth (50) and cortisol(24).