Adrenal Hyperplasia, The Dukan Diet & Strength Training

[ryanwrthls]

hey no prob dawg I do this stuff for a living, lol.

Ryan

[ic66]

Hi nora,
I am a 63 year old female. I have been diagnosed with adrenal hyperplasia by a cat scan. I will have my first appointment with an endocrynologist next week. I do not want to take any steroids (prednisone). i am 5ft. 3 inches. Ten weeks ago I weighed 175 pounds. Since then I have drastically reduced carbs, have been walking on treadmill 3 to 6 miles a day, and have lost 18 pounds. So, I now weigh 157 pounds I need to loose another 20 pounds at least. I was wondering if you had a lab test for DHEA-S? Before I lost the 18 pounds my lab work indicated DHEA-S was 1.5 UG/M or 150 micrograms per deciliter.
Other labs done when I weighed 175 indicated
CHOL 164
HDLC 72
LDLC 87
TRIG 29
NHDL 92
TESTOSTERONE 84 NG/DL
DHEA-S was 1.5 UG/M or 150 micrograms per deciliter
Fasting glucose is 87
HEMOGLOBIN A1C 5.6
EST AVG GLUCOSE - EAG 114 . - MG/DL
CORTISOL 12.5 . - UG/DL
FSH 84.2 . - MIU/ML
LUTEINIZING HORMONE 34.5 . - MIU/ML
SEX HORMNE BIND GLOB 50 NMOL/L
PROLACTIN 7 NG/ML
ALT (SGPT) 39 IU/L


I am desperately hoping I can get my adrenal hyperplasia under control by further weight loss and exercise, instead of having to take steroids (Prednisone).
What are the consequences of refusing to take steroids when you have been diagnosed with adrenal hyperplasia?

[ryanwrthls]

Hey there --

Nora has a congenital form of adrenal hyperplasia which results in a buildup of adrenal androgens. These issues typically arise earlier in life, depending on the severity of the enzyme deficiency and, therefore, symptoms (more severe deficiency means symptoms appear earlier in life). In most cases of very mild CAH, symptoms appear at some point before age 25 or 30.

Your age would indicate a secondary adrenal hyperplasia (not an enzyme deficiency), which would more likely indicated a cortisol excess as opposed to a deficiency (i.e. you won't be treated with steroids). It's hard to postulate what the cause may be, since we don't know the reason why the doctor ordered DHEAS in the first place (DHEA-S is a marker for adrenal androgen overproduction).

In the case of secondary adrenal hyperplasia, it's not only the DHEA-S that is overproduced, but every other hormone produced by the adrenal gland (cortisol, aldosterone, estrione in post-menopausal women and testosterone). DHEA-S is a precursor for testosterone.

It's hard to know what the cause of the hyperplasia is without knowing any of the circumstances. Although it appears that your DHEA-S level isn't high enough to be a red flag for an adrenal adenoma (benign tumor). These levels are usually above 7mcg/mL.

Some of the differentials might include polycystic ovarian syndrome (this causes adrenal hyperplasia later in life), benign pituitary adenomas producing ACTH (a hormone that stimulates the adrenal glands), some types of medications, etc etc etc.

It's my guess that your doctor will ask for a 24 hour urine collection for cortisol. If the result is abnormal, the next thing to do is to localize the source with a low dose overnight dexamethasone suppression test (you get 1mg dexamethasone and they check your cortisol levels in the morning). If this is abnormal, then they do a high dose overnight dexamethasone suppression test to further narrow the diagnosis.

This is my guess. I highly doubt you will be given cortisol. Congenital adrenal hyperplasia is a condition resulting in a cortisol deficiency, whereas secondary adrenal hyperplasia results in a cortisol excess from another cause.

Ryan

[ic66]

Ryan,
Thanks so much for your response. I originally went to my internist 10 weeks ago because I noticed brown spots in the armpit area. The internist said it might be Acanthosis Nigricans. She ordered various labs and an abdominal cat scan beccause the DHEA-S was elevated.

"CT ABDOMEN WITH AND WITHOUT CONTRAST (CTA3)
GDT FOCUSED CT OF THE ADRENAL GLANDS.

HISTORY: THIS 62 YEAR OLD WOMAN HAS ELEVATED DHEAS AND TESTOSTERONE.

COMPARISON: NONE

FINDINGS:

THERE IS MINIMAL SYMMETRIC BILATERAL ADRENAL THICKENING. THERE ARE
NO ADRENAL NODULES.

WHAT IS MOST LIKELY A SMALL LEFT RENAL CYST IS NOT COMPLETELY
INCLUDED ON IMAGES WITH IV CONTRAST.

THERE IS FATTY INFILTRATION OF THE LIVER."

After the CT Scan my internist emailed me this message:
"The ct scan shows no nodules on the adrenal glands. The adrenal glands are prominent, called hyperplasia and may be the cause of these mild elevation of the dheas. I would like For you to see an endocrinologist to evaluate this and the lab tests further and how best we should treat this"

I am thinking the Acanthosis Nigricans may be due to insulin resistance, although my fasting blood sugar was 87 (tested 10 weeks ago when I weighed 175 pounds and before I started low carb eating and exercise) and at the same time my HEMOGLOBIN A1C was :
HEMOGLOBIN A1C 5.6
EST AVG GLUCOSE - EAG 114 . - MG/DL

I am thinking if the fasting glucose and A1c were done today they would be even lower due to 18 pound weight loss and exercise done in past 10 weeks. So I hope I am not diabetic.

Does any of this additional information I have provided give you any new insights? After what you wrote above, I am hopeful the endocrinologist will not say I need to take prednisone. So, my plan is to keep losing weight, and exercising to avoid diabetes down the road. I will see the endo doctor for the first time next week. If she wants me to take prednisone for adrenal hyperplasia, I will refuse. I've had my wake up call and I am determined to improve my condition without steroids.
Again, thank you very much for yourprevious response.

[noramorta]

Hi Pat,

Thank you for posting & sharing! Ryan couldn't have explained it better - he's a real expert! Indeed I have late onset congenital adrenal hyperplasia, something I have to live with now & control & my issues are obviously different especially that I'm learning this at 28! I been struggling with weight & high cholesterol & testosterone levels for about 5 years now with issues that resulted in irritiating hirsutism (which I treated with mild laser sessions) & stubborn fat loss leaving me at a very high weight of 82kg for about a year, in spite of leading a somewhat active lifestyle. Yet I decided enough was enough, I was unhappy with my heaviness & decided to venture into a new diet, by limiting or nearly cutting out carbs, subsequently I was able to lose about 7kgs (aprox 15lbs) in under two months to date. My periods returned to regular, albeit it low & short, my mood swings got reduced as well as my cholesterol & testosterone levels. I'm more energized & am generally more focused & alert in most elements of my life. I figured since my testosterone levels are naturally high then I'd take advantage of it & get leaner! So far it seems to be working, but there's still so much one learns about their body - so I'm hoping for no after effects!! Certainly exercising & following a clean diet, and in my case, a clean low carb with little saturated fats diet is working well with my body needs.

If you'd like an idea of the diet I'm following, visit http://www.thedukandiet.co.uk. I purchased the book & the recipe book & have been an avid followed of it, with some of my twists

I hope my input was useful, I'd be happy to share anything else.

Cheers,
Nora

[ic66]

Hi Nora,
Thanks for your response. Perhaps I'll post again after my endo appt. next week. I'm determined to get fit!

[ryanwrthls]

Although acanthosis nigricans is associated with high levels of insulin (insulin resistance), it can also occur with high levels of other growth hormones such as DHEAS, growth hormone, IGF-1 and testosterone. It typically occurs at areas of skin flexure (like the arm pits or under the breast). I'm pretty sure it's reversible once you get the hormones under control. Basically what happens is that these growth hormones cause proliferation of skin cells and melanocytes (the ones that create pigment). Thus, thick, brown skin. I'm not sure why it happens only in areas of flexure.

A diagnosis of diabetes in the clinic can be made if you have a single HbA1C >6.5 or a fasting glucose of >126 on two separate occasions. You don't have either of these, so I doubt your are diabetic. It takes about 3 months for HbA1C to accurately reflect the average glucose level over that period of time.

To me, it appears your adrenal hyperplasia may be out of your immediate control. In other words, losing weight or following a specific diet may not be the answer. The only way to know for sure is to run the 24hr urinary cortisol and the dexamethasone suppression test to localize the source of excessive ACTH or angiotensin (hormones that stimulates the adrenal gland to produce more hormones and, when there's too much ACTH, to increase in size.

Without a whole lot of info, it's hard to give a definitive answer without lab tests / endocrinology consult. I highly doubt you will need any sort of steroid since you don't have any enzyme deficiencies (these types of problems develop much earlier in life, sometimes even noticeable on ultrasound before the baby is born). It's more likely that all of the hormonal levels are high (including cortisol)

The weight loss will definitely help with the fatty liver though! I'd say just keep doing what your doing, as being healthy is deterrent for any disease process!! Just be careful with salt in the diet, as adrenal hyperplasia means high levels of aldosterone and cortisol which both lead to hypertension.

Ryan

[ic66]

Ryan, Thanks for your additional information. I will just have to be patient and wait and see what the endo doctor says next week.

[noramorta]

Hi Ryan & all,

Hope everyone's staying healthy & doing well.

A little update. I finally got my results on 17-hydroxy-progesterone & that has decreased from >20ng/ml to a 12ng/ml! Still high for female with female normal range stating max to be 1.82.

I'd attach my lab results but can't figure out how.

So net:

- Within 52 days I lost 9 kilos from 82kgs (my recorded highest) to now a stable 74-73kgs.
- Still on The Dukan Diet: high protein, low-carb, low-fat & low-sugar mostly
- Accordingly, my total cholesterol & triglycerides went down significantly. Also testosterone levels, yet still high for female, & 17-hydroxy-progesterone went down significantly.
- Menstruation cycle not affected
- Weight loss slow but evident

Due to political unrest in Egypt, I haven't been working out regularly for the past 14days & only lost 1 or 2 kilos at the most with my weight being quite stable. Did do some 20 to 30mins mild walking about 8days out of the 14 & one aerobics session over all a couple of days ago now that situation settled down. This has, however, led me to feel weaker & I recently I seem to struggle in the mornings with a slight bought of fatigue or what would feel like low-blood pressure, not sure. It's that feeling when you're eye-lids get heavy & feel a bit woozy & like I want to go immediately to sleep. For some reason, I get better in the second part of the day & more energized. Not working out regularly within 2 weeks certainly took it's toll on me.

Your comments, if any, would be highly appreciated