Guest guest Posted June 5, 2009 Report Share Posted June 5, 2009 I would refer him to an endocrinologist.Ellen clinical question Hi everyone,I need the benefit of your collective wisdom. 35 year old man with anxiety, insomnia and long standing depression - has been previously diagnosed with ADD, was on Adderall when he first started coming in - someone might have thought he's bipolar because he's on Lamictal. Came in for the above problems in addition to a host of others - sinus problems, low libido, mild asthma, excessive sweating with exertion.Exam is normal.Labs with very high testosterone - total 462 (normal up to 45), free 65.8 (normal up to 5). Fasting glucose is 104, otherwise labs normal (CBC, chem panel, lipids, and on follow up - LH, FSH, PRL all normal as well. HgBAc 6.0). Denies he is taking any exogenous testosterone. Any ideas on this high testosterone? I was thinking that he should have an abd CT to look at his adrenals. Even though he has a normal testicular exam, should I get an ultrasound? I think it is clear that the elevated T is not the reason for all his symptoms, but maybe some. I certainly have to chase it down. I eagerly await advice from you smart people.Lonna Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 5, 2009 Report Share Posted June 5, 2009 Lonna, I am used to much higher normal range of testosterone Eg: Testosterone, Serum 626 ng/dL Range:241-827 What units is your lab using? Right now I can’t find an example of a normal free testosterone. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Lonna Larsh Sent: Friday, June 05, 2009 1:03 PM To: Subject: clinical question Hi everyone, I need the benefit of your collective wisdom. 35 year old man with anxiety, insomnia and long standing depression - has been previously diagnosed with ADD, was on Adderall when he first started coming in - someone might have thought he's bipolar because he's on Lamictal. Came in for the above problems in addition to a host of others - sinus problems, low libido, mild asthma, excessive sweating with exertion. Exam is normal. Labs with very high testosterone - total 462 (normal up to 45), free 65.8 (normal up to 5). Fasting glucose is 104, otherwise labs normal (CBC, chem panel, lipids, and on follow up - LH, FSH, PRL all normal as well. HgBAc 6.0). Denies he is taking any exogenous testosterone. Any ideas on this high testosterone? I was thinking that he should have an abd CT to look at his adrenals. Even though he has a normal testicular exam, should I get an ultrasound? I think it is clear that the elevated T is not the reason for all his symptoms, but maybe some. I certainly have to chase it down. I eagerly await advice from you smart people. Lonna Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 6, 2009 Report Share Posted June 6, 2009 The lab is Labcorp. Total testosterone range is 2-45 ng/dLFree is 0.2-5.0 pg/mLI'll call the lab to double check that they are not giving a range for newborns or something odd like that. LonnaSubject: RE: clinical questionTo: Date: Friday, June 5, 2009, 11:46 AM Lonna, I am used to much higher normal range of testosterone Eg: Testosterone, Serum 626 ng/dL Range:241-827 What units is your lab using? Right now I can’t find an example of a normal free testosterone. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypr actice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: Practiceimprovement 1yahoogroups (DOT) com [mailto:Practiceimp rovement1@ yahoogroups. com] On Behalf Of Lonna Larsh Sent: Friday, June 05, 2009 1:03 PM To: Practiceimprovement 1yahoogroups (DOT) com Subject: [Practiceimprovemen t1] clinical question Hi everyone, I need the benefit of your collective wisdom. 35 year old man with anxiety, insomnia and long standing depression - has been previously diagnosed with ADD, was on Adderall when he first started coming in - someone might have thought he's bipolar because he's on Lamictal. Came in for the above problems in addition to a host of others - sinus problems, low libido, mild asthma, excessive sweating with exertion. Exam is normal. Labs with very high testosterone - total 462 (normal up to 45), free 65.8 (normal up to 5). Fasting glucose is 104, otherwise labs normal (CBC, chem panel, lipids, and on follow up - LH, FSH, PRL all normal as well. HgBAc 6.0). Denies he is taking any exogenous testosterone. Any ideas on this high testosterone? I was thinking that he should have an abd CT to look at his adrenals. Even though he has a normal testicular exam, should I get an ultrasound? I think it is clear that the elevated T is not the reason for all his symptoms, but maybe some. I certainly have to chase it down. I eagerly await advice from you smart people. Lonna Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 6, 2009 Report Share Posted June 6, 2009 Sorry, lab was Quest.Subject: RE: clinical questionTo: Date: Friday, June 5, 2009, 11:46 AM Lonna, I am used to much higher normal range of testosterone Eg: Testosterone, Serum 626 ng/dL Range:241-827 What units is your lab using? Right now I can’t find an example of a normal free testosterone. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypr actice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: Practiceimprovement 1yahoogroups (DOT) com [mailto:Practiceimp rovement1@ yahoogroups. com] On Behalf Of Lonna Larsh Sent: Friday, June 05, 2009 1:03 PM To: Practiceimprovement 1yahoogroups (DOT) com Subject: [Practiceimprovemen t1] clinical question Hi everyone, I need the benefit of your collective wisdom. 35 year old man with anxiety, insomnia and long standing depression - has been previously diagnosed with ADD, was on Adderall when he first started coming in - someone might have thought he's bipolar because he's on Lamictal. Came in for the above problems in addition to a host of others - sinus problems, low libido, mild asthma, excessive sweating with exertion. Exam is normal. Labs with very high testosterone - total 462 (normal up to 45), free 65.8 (normal up to 5). Fasting glucose is 104, otherwise labs normal (CBC, chem panel, lipids, and on follow up - LH, FSH, PRL all normal as well. HgBAc 6.0). Denies he is taking any exogenous testosterone. Any ideas on this high testosterone? I was thinking that he should have an abd CT to look at his adrenals. Even though he has a normal testicular exam, should I get an ultrasound? I think it is clear that the elevated T is not the reason for all his symptoms, but maybe some. I certainly have to chase it down. I eagerly await advice from you smart people. Lonna Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 6, 2009 Report Share Posted June 6, 2009 Lonna,According to this document from Quest, it appears that those numbers you quoted are the female norms:http://www.questdiagnostics.com/hcp/intguide/EndoMetab/Gen_Misc/Testosterone/Table%201.pdfNormal range of total testosterone for males ages 18-69 = 250-1100 ng/dL. SetoSouth Pasadena, CA The lab is Labcorp. Total testosterone range is 2-45 ng/dLFree is 0.2-5.0 pg/mLI'll call the lab to double check that they are not giving a range for newborns or something odd like that. LonnaFrom: Kathy Saradarian <qualityfphughes (DOT) net>Subject: RE: clinical questionTo: Date: Friday, June 5, 2009, 11:46 AM Lonna, I am used to much higher normal range of testosterone Eg: Testosterone, Serum 626 ng/dL Range:241-827 What units is your lab using? Right now I can’t find an example of a normal free testosterone. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypr actice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: Practiceimprovement 1yahoogroups (DOT) com [mailto:Practiceimp rovement1@ yahoogroups. com] On Behalf Of Lonna Larsh Sent: Friday, June 05, 2009 1:03 PM To: Practiceimprovement 1yahoogroups (DOT) com Subject: [Practiceimprovemen t1] clinical question Hi everyone, I need the benefit of your collective wisdom. 35 year old man with anxiety, insomnia and long standing depression - has been previously diagnosed with ADD, was on Adderall when he first started coming in - someone might have thought he's bipolar because he's on Lamictal. Came in for the above problems in addition to a host of others - sinus problems, low libido, mild asthma, excessive sweating with exertion. Exam is normal. Labs with very high testosterone - total 462 (normal up to 45), free 65.8 (normal up to 5). Fasting glucose is 104, otherwise labs normal (CBC, chem panel, lipids, and on follow up - LH, FSH, PRL all normal as well. HgBAc 6.0). Denies he is taking any exogenous testosterone. Any ideas on this high testosterone? I was thinking that he should have an abd CT to look at his adrenals. Even though he has a normal testicular exam, should I get an ultrasound? I think it is clear that the elevated T is not the reason for all his symptoms, but maybe some. I certainly have to chase it down. I eagerly await advice from you smart people. Lonna Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 6, 2009 Report Share Posted June 6, 2009 Those look like female norms to me. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Lonna Larsh Sent: Friday, June 05, 2009 6:05 PM To: Subject: RE: clinical question The lab is Labcorp. Total testosterone range is 2-45 ng/dL Free is 0.2-5.0 pg/mL I'll call the lab to double check that they are not giving a range for newborns or something odd like that. Lonna Subject: RE: clinical question To: Date: Friday, June 5, 2009, 11:46 AM Lonna, I am used to much higher normal range of testosterone Eg: Testosterone, Serum 626 ng/dL Range:241-827 What units is your lab using? Right now I can’t find an example of a normal free testosterone. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypr actice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: Practiceimprovement 1yahoogroups (DOT) com [mailto:Practiceimp rovement1@ yahoogroups. com] On Behalf Of Lonna Larsh Sent: Friday, June 05, 2009 1:03 PM To: Practiceimprovement 1yahoogroups (DOT) com Subject: [Practiceimprovemen t1] clinical question Hi everyone, I need the benefit of your collective wisdom. 35 year old man with anxiety, insomnia and long standing depression - has been previously diagnosed with ADD, was on Adderall when he first started coming in - someone might have thought he's bipolar because he's on Lamictal. Came in for the above problems in addition to a host of others - sinus problems, low libido, mild asthma, excessive sweating with exertion. Exam is normal. Labs with very high testosterone - total 462 (normal up to 45), free 65.8 (normal up to 5). Fasting glucose is 104, otherwise labs normal (CBC, chem panel, lipids, and on follow up - LH, FSH, PRL all normal as well. HgBAc 6.0). Denies he is taking any exogenous testosterone. Any ideas on this high testosterone? I was thinking that he should have an abd CT to look at his adrenals. Even though he has a normal testicular exam, should I get an ultrasound? I think it is clear that the elevated T is not the reason for all his symptoms, but maybe some. I certainly have to chase it down. I eagerly await advice from you smart people. Lonna Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 6, 2009 Report Share Posted June 6, 2009 Egad, sorry to waste your time on this. You and are right, they gave me F norms. Thank you for setting me straight.Lonna From: Kathy Saradarian <qualityfphughes (DOT) net> Subject: RE: [Practiceimprovemen t1] clinical question To: Practiceimprovement 1yahoogroups (DOT) com Date: Friday, June 5, 2009, 11:46 AM Lonna, I am used to much higher normal range of testosterone Eg: Testosterone, Serum 626 ng/dL Range:241-827 What units is your lab using? Right now I can’t find an example of a normal free testosterone. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypr actice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: Practiceimprovement 1yahoogroups (DOT) com [mailto:Practiceimp rovement1@ yahoogroups. com] On Behalf Of Lonna Larsh Sent: Friday, June 05, 2009 1:03 PM To: Practiceimprovement 1yahoogroups (DOT) com Subject: [Practiceimprovemen t1] clinical question Hi everyone, I need the benefit of your collective wisdom. 35 year old man with anxiety, insomnia and long standing depression - has been previously diagnosed with ADD, was on Adderall when he first started coming in - someone might have thought he's bipolar because he's on Lamictal. Came in for the above problems in addition to a host of others - sinus problems, low libido, mild asthma, excessive sweating with exertion. Exam is normal. Labs with very high testosterone - total 462 (normal up to 45), free 65.8 (normal up to 5). Fasting glucose is 104, otherwise labs normal (CBC, chem panel, lipids, and on follow up - LH, FSH, PRL all normal as well. HgBAc 6.0). Denies he is taking any exogenous testosterone. Any ideas on this high testosterone? I was thinking that he should have an abd CT to look at his adrenals. Even though he has a normal testicular exam, should I get an ultrasound? I think it is clear that the elevated T is not the reason for all his symptoms, but maybe some. I certainly have to chase it down. I eagerly await advice from you smart people. Lonna Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 8, 2009 Report Share Posted June 8, 2009 If they look buff, I tell them they're lying about the steroids. But yes, doing the endo workup is important. I scare these steroid guys with impending liver failure, huge cysts eating into their chest wall (saw that happen once,down to the sternum). Anemia, baldness, impotence...they have all stopped using steroids.I can always tell the steroid look...they are always disproportionayely built up. To: Sent: Friday, June 5, 2009 1:03:25 PMSubject: clinical question Hi everyone,I need the benefit of your collective wisdom. 35 year old man with anxiety, insomnia and long standing depression - has been previously diagnosed with ADD, was on Adderall when he first started coming in - someone might have thought he's bipolar because he's on Lamictal. Came in for the above problems in addition to a host of others - sinus problems, low libido, mild asthma, excessive sweating with exertion.Exam is normal.Labs with very high testosterone - total 462 (normal up to 45), free 65.8 (normal up to 5). Fasting glucose is 104, otherwise labs normal (CBC, chem panel, lipids, and on follow up - LH, FSH, PRL all normal as well. HgBAc 6.0). Denies he is taking any exogenous testosterone. Any ideas on this high testosterone? I was thinking that he should have an abd CT to look at his adrenals. Even though he has a normal testicular exam, should I get an ultrasound? I think it is clear that the elevated T is not the reason for all his symptoms, but maybe some. I certainly have to chase it down. I eagerly await advice from you smart people.Lonna Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 8, 2009 Report Share Posted June 8, 2009 Lonna has a point. CareCore refused an pituitary MRI on a patient of mine because the prolactin was inh the normal range. For a woman. Which he is not.nancy To: Sent: Friday, June 5, 2009 6:15:00 PMSubject: RE: clinical question Sorry, lab was Quest. From: Kathy Saradarian <qualityfphughes (DOT) net>Subject: RE: [Practiceimprovemen t1] clinical questionTo: Practiceimprovement 1yahoogroups (DOT) comDate: Friday, June 5, 2009, 11:46 AM Lonna, I am used to much higher normal range of testosterone Eg: Testosterone, Serum 626 ng/dL Range:241-827 What units is your lab using? Right now I can’t find an example of a normal free testosterone. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypr actice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: Practiceimprovement 1yahoogroups (DOT) com [mailto:Practiceimp rovement1@ yahoogroups. com] On Behalf Of Lonna LarshSent: Friday, June 05, 2009 1:03 PMTo: Practiceimprovement 1yahoogroups (DOT) comSubject: [Practiceimprovemen t1] clinical question Hi everyone,I need the benefit of your collective wisdom. 35 year old man with anxiety, insomnia and long standing depression - has been previously diagnosed with ADD, was on Adderall when he first started coming in - someone might have thought he's bipolar because he's on Lamictal. Came in for the above problems in addition to a host of others - sinus problems, low libido, mild asthma, excessive sweating with exertion.Exam is normal.Labs with very high testosterone - total 462 (normal up to 45), free 65.8 (normal up to 5). Fasting glucose is 104, otherwise labs normal (CBC, chem panel, lipids, and on follow up - LH, FSH, PRL all normal as well. HgBAc 6.0). Denies he is taking any exogenous testosterone. Any ideas on this high testosterone? I was thinking that he should have an abd CT to look at his adrenals. Even though he has a normal testicular exam, should I get an ultrasound? I think it is clear that the elevated T is not the reason for all his symptoms, but maybe some. I certainly have to chase it down. I eagerly await advice from you smart people.Lonna Quote Link to comment Share on other sites More sharing options...
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