Dear Ahmed,
Thank you for that reference. After consultation with Gill Rumsby at
UCL I think our next step will be to request 24 hour urine steroid
profiling.
Thank you
Fiona
On 11/29/12, Waise, Ahmed <[log in to unmask]> wrote:
> There is some evidence these patients may have subtle steroid hormone
> changes not identified by the usual testing and more detailed analysis of
> adrenocortical hormone is required . See
>
>
> Clin Endocrinol Metab. 2011 Dec;96(12):3775-84. Epub 2011 Sep 14.
> Urine steroid metabolomics as a biomarker tool for detecting malignancy in
> adrenal tumors.
> Arlt W, Biehl M, Taylor AE, Hahner S, Libé R, Hughes BA, Schneider P, Smith
> DJ, Stiekema H, Krone N, Porfiri E, Opocher G, Bertherat J, Mantero F,
> Allolio B, Terzolo M, Nightingale P, Shackleton CH, Bertagna X, Fassnacht M,
> Stewart PM.
> SourceCentre for Endocrinology, Diabetes, and Metabolism, School of Clinical
> and Experimental Medicine, University of Birmingham, Birmingham B15 2TT,
> United Kingdom. [log in to unmask]
>
> Ahmed Waise
> Laboratory Medicine
> York Hospital
>
>
>
> -----Original Message-----
> From: Clinical biochemistry discussion list
> [mailto:[log in to unmask]] On Behalf Of Fiona Davidson
> Sent: 29 November 2012 12:22
> To: [log in to unmask]
> Subject: ? Cushings
>
> Dear all,
>
> We currently have a patient very similar to the one posted here by Avril
> Wayte in August.
>
> The patient is a 62 year old gentleman with an incidentally found adrenal
> mass, negative screen for phaeo and aldosteronism. Two 24 hour UFC have
> been well within the normal range at 38nmol and 44nmol but he has failed to
> suppress his cortisol post dexamethasone on several occassions (post dex
> cortisol 135-176nmol/L). He is asymptomatic, not obese and not depressed.
>
>
> Unlike Avril's patient this gentleman is only on Thyroxine and Aspirin so
> drug interfernce seems unlikely?
>
> Any suggestions would be very welcome!
>
> Fiona Davidson
> Pre-Reg Clinical Biochemist
> Kingston Hospital NHS Trust
>
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