Re: clinical question: 16 yo WF with high DHEA

[Guest guest]

what's she taking, if anything?

any 'alt/comp' meds, supplements, 'brain-tonics', anything like that?

steve hersch

Helen Yang wrote:

 

Hi,

I have a 16 yo WF patient with severe symptoms of bipolar for years

(seeing psych, but a lot of side effects from meds) Her mom works for

Labcorp so ptcould get "any test done for free". They showed me results

of many tests which showed:

DHEA over 1000 (almost twice as much of upper limit for her age)

plasma Dopamine= 97 (lab range 0-32)

PM cortisol = 4.1, AM cortisol=19

Ferritin increased from 7 to 51

Vit D 25 increased from 21 to 49

CBC, lytes, LFTs, TSH all WNL

Regular menses. Hypothyroidism from prior Lithium tx.

Any help and suggestions woudl be much appreciated.

Thank you very much.

Helen

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[Guest guest]

Helen,From this website, it gives the following differential diagnoses for an elevated DHEA level:http://en.diagnosispro.com/differential_diagnosis-for/dehydroepiandrosterone-dhea-lab-increased/11886-154.htmlNeoplastic DisordersCarcinoma, adrenal cortexCongenital, Developmental DisordersAdrenogenital syndromeVegetative, Autonomic, Endocrine DisordersCushing's disease/SyndromePolycystic ovaries/Stein-LeventhalVirilism syndromeDrugsDehydroepiandrosterone (DHEA) intake SetoSouth Pasadena, CA

Hi,I have a 16 yo WF patient with severe symptoms of bipolar for years (seeing psych, but a lot of side effects from meds) Her mom works for Labcorp so ptcould get "any test done for free". They showed me results of many tests which showed:DHEA over 1000 (almost twice as much of upper limit for her age)plasma Dopamine= 97 (lab range 0-32)PM cortisol = 4.1, AM cortisol=19Ferritin increased from 7 to 51Vit D 25 increased from 21 to 49CBC, lytes, LFTs, TSH all WNLRegular menses. Hypothyroidism from prior Lithium tx.Any help and suggestions woudl be much appreciated.Thank you very much.Helen Hotmail: Trusted email with Microsoft’s powerful SPAM protection. Sign up now.

[Guest guest]

She is on Lamictal and Zyprexa from psych, and Levoxyl for Lithium-induced hypothyroidism. Supplements: fish oil, protein powder, liquid iron, holy basilHTo: From: hersch@...Date: Tue, 30 Mar 2010 19:26:59 -0700Subject: Re: clinical question: 16 yo WF with high DHEA

what's she taking, if anything?

any 'alt/comp' meds, supplements, 'brain-tonics', anything like that?

steve hersch

Helen Yang wrote:

Hi,

I have a 16 yo WF patient with severe symptoms of bipolar for years

(seeing psych, but a lot of side effects from meds) Her mom works for

Labcorp so ptcould get "any test done for free". They showed me results

of many tests which showed:

DHEA over 1000 (almost twice as much of upper limit for her age)

plasma Dopamine= 97 (lab range 0-32)

PM cortisol = 4.1, AM cortisol=19

Ferritin increased from 7 to 51

Vit D 25 increased from 21 to 49

CBC, lytes, LFTs, TSH all WNL

Regular menses. Hypothyroidism from prior Lithium tx.

Any help and suggestions woudl be much appreciated.

Thank you very much.

Helen

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[Guest guest]

Thank you .She has been overweight BMI 27 and with a history of 2 small ovarian cysts. Slightly more hair on the face. We may need adrenal scan and some BW to r/o PCOS.HTo: From: glseto@...Date: Tue, 30 Mar 2010 19:47:32 -0700Subject: Re: clinical question: 16 yo WF with high DHEA

Helen,From this website, it gives the following differential diagnoses for an elevated DHEA level:http://en.diagnosispro.com/differential_diagnosis-for/dehydroepiandrosterone-dhea-lab-increased/11886-154.htmlNeoplastic DisordersCarcinoma, adrenal cortexCongenital, Developmental DisordersAdrenogenital syndromeVegetative, Autonomic, Endocrine DisordersCushing's disease/SyndromePolycystic ovaries/Stein-LeventhalVirilism syndromeDrugsDehydroepiandrosterone (DHEA) intake SetoSouth Pasadena, CA

Hi,I have a 16 yo WF patient with severe symptoms of bipolar for years (seeing psych, but a lot of side effects from meds) Her mom works for Labcorp so ptcould get "any test done for free". They showed me results of many tests which showed:DHEA over 1000 (almost twice as much of upper limit for her age)plasma Dopamine= 97 (lab range 0-32)PM cortisol = 4.1, AM cortisol=19Ferritin increased from 7 to 51Vit D 25 increased from 21 to 49CBC, lytes, LFTs, TSH all WNLRegular menses. Hypothyroidism from prior Lithium tx.Any help and suggestions woudl be much appreciated.Thank you very much.Helen Hotmail: Trusted email with Microsoft’s powerful SPAM protection. Sign up now.

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[Guest guest]

Mom should be reported. Could it be diet related? Should you repeat a DHEA " S " . Not sure if there is a diet needed prior to dopamine level. You could check you lab resource book. Sometimes too much caffeine stimulates some things but not sure if dopamine is on list. PCOS should not inc DHEAS as that is made in adrenals. Let us know what happens

 

Hi,I have a 16 yo WF patient with severe symptoms of bipolar for years (seeing psych, but a lot of side effects from meds) Her mom works for Labcorp so ptcould get " any test done for free " . They showed me results of many tests which showed:

DHEA over 1000 (almost twice as much of upper limit for her age)plasma Dopamine= 97 (lab range 0-32)PM cortisol = 4.1, AM cortisol=19Ferritin increased from 7 to 51Vit D 25 increased from 21 to 49

CBC, lytes, LFTs, TSH all WNLRegular menses. Hypothyroidism from prior Lithium tx.Any help and suggestions woudl be much appreciated.Thank you very much.Helen

Hotmail: Trusted email with Microsoft’s powerful SPAM protection. Sign up now.

-- M.D.www.elainemd.comOffice:

Go in the directions of your dreams and live the life you've imagined.This email transmission may contain protected and privileged, highly confidential medical, Personal and Health Information (PHI) and/or legal information. The information is intended only for the use of the individual or entity named above.

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[Guest guest]

? Familial Hemachromatosis?

Likely will be a big w/u with ongoing monitoring for a couple years for no dx.

I agree with Elaine. Mom acted as a licensed provider when running the tests.

I would encourage Mom to self-report and tell her that if she did not, I would

be obligated to report. Once she states she reported herself, I would request

to talk to her supervisor to confirm. Perhaps Labcorp can use this event for

training especially when the final healthcare cost is known and no dx is found.

Hopefully, the patient won't be harmed (e.g. radiation exposure, complications

of procedures) during the workup.

You will likely have to get endo involved and if I was the insurance company, I

would not pay for it ... or maybe only 50%.

Craig

>

> >

> >

> > Hi,

> >

> > I have a 16 yo WF patient with severe symptoms of bipolar for years (seeing

> > psych, but a lot of side effects from meds) Her mom works for Labcorp so

> > ptcould get " any test done for free " . They showed me results of many tests

> > which showed:

> >

> > DHEA over 1000 (almost twice as much of upper limit for her age)

> > plasma Dopamine= 97 (lab range 0-32)

> > PM cortisol = 4.1, AM cortisol=19

> > Ferritin increased from 7 to 51

> > Vit D 25 increased from 21 to 49

> >

> > CBC, lytes, LFTs, TSH all WNL

> >

> > Regular menses. Hypothyroidism from prior Lithium tx.

> >

> > Any help and suggestions woudl be much appreciated.

> >

> > Thank you very much.

> >

> > Helen

> >

> > ------------------------------

> > Hotmail: Trusted email with Microsoft's powerful SPAM protection. Sign up

> > now. <http://clk.atdmt.com/GBL/go/210850552/direct/01/>

> >

> >

> >

>

>

>

> --

> M.D.

> www.elainemd.com

> Office:

> Go in the directions of your dreams and live the life you've imagined.

> This email transmission may contain protected and privileged, highly

> confidential medical, Personal and Health Information (PHI) and/or legal

> information. The information is intended only for the use of the individual

> or entity named above.

>

>

>

> If you are not the intended recipient of this material, you may not use,

> publish, discuss, disseminate or otherwise distribute it. If you are not the

> intended recipient, or if you have received this transmission in error,

> please notify the sender immediately and confidentially destroy the

> information that email in error.

>

[Guest guest]

Thank you all for the input.They did have their previous doc order those labs, so likely not needed to be reported.The patient has been seeing psych for years and did not respond well to many of the meds including lactating after taking resperidol. Mom noted that their current psych suspected that this young girl could have a brain tumor that is causing her psych symptoms which did not respond to meds in the usual manner.I wonder to get endocrine or neuro next.HelenTo: From: rossmd@...Date: Wed, 31 Mar 2010 19:15:38 +0000Subject: Re: clinical question: 16 yo WF with high DHEA

? Familial Hemachromatosis?

Likely will be a big w/u with ongoing monitoring for a couple years for no dx.

I agree with Elaine. Mom acted as a licensed provider when running the tests. I would encourage Mom to self-report and tell her that if she did not, I would be obligated to report. Once she states she reported herself, I would request to talk to her supervisor to confirm. Perhaps Labcorp can use this event for training especially when the final healthcare cost is known and no dx is found. Hopefully, the patient won't be harmed (e.g. radiation exposure, complications of procedures) during the workup.

You will likely have to get endo involved and if I was the insurance company, I would not pay for it ... or maybe only 50%.

Craig

>

> >

> >

> > Hi,

> >

> > I have a 16 yo WF patient with severe symptoms of bipolar for years (seeing

> > psych, but a lot of side effects from meds) Her mom works for Labcorp so

> > ptcould get "any test done for free". They showed me results of many tests

> > which showed:

> >

> > DHEA over 1000 (almost twice as much of upper limit for her age)

> > plasma Dopamine= 97 (lab range 0-32)

> > PM cortisol = 4.1, AM cortisol=19

> > Ferritin increased from 7 to 51

> > Vit D 25 increased from 21 to 49

> >

> > CBC, lytes, LFTs, TSH all WNL

> >

> > Regular menses. Hypothyroidism from prior Lithium tx.

> >

> > Any help and suggestions woudl be much appreciated.

> >

> > Thank you very much.

> >

> > Helen

> >

> > ------------------------------

> > Hotmail: Trusted email with Microsoft's powerful SPAM protection. Sign up

> > now. <http://clk.atdmt.com/GBL/go/210850552/direct/01/>

> >

> >

> >

>

>

>

> --

> M.D.

> www.elainemd.com

> Office:

> Go in the directions of your dreams and live the life you've imagined.

> This email transmission may contain protected and privileged, highly

> confidential medical, Personal and Health Information (PHI) and/or legal

> information. The information is intended only for the use of the individual

> or entity named above.

>

>

>

> If you are not the intended recipient of this material, you may not use,

> publish, discuss, disseminate or otherwise distribute it. If you are not the

> intended recipient, or if you have received this transmission in error,

> please notify the sender immediately and confidentially destroy the

> information that email in error.

>

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[Guest guest]

Wonder why Mom picked those tests? What was she

thinking. I have never even seen a “Dopamine level” even from

psychiatrists. Are they even reliable?

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 Helen Yang

Sent: Wednesday, March 31, 2010 3:34 PM

To: practiceimprovement1

Subject: RE: Re: clinical question: 16 yo WF with

high DHEA

Thank you all for the input.

They did have their previous doc order those labs, so likely not needed to be

reported.

The patient has been seeing psych for years and did not respond well to many of

the meds including lactating after taking resperidol. Mom noted that their

current psych suspected that this young girl could have a brain tumor that is

causing her psych symptoms which did not respond to meds in the usual manner.

I wonder to get endocrine or neuro next.

Helen

To:

From: rossmd@...

Date: Wed, 31 Mar 2010 19:15:38 +0000

Subject: Re: clinical question: 16 yo WF with high DHEA

? Familial Hemachromatosis?

Likely will be a big w/u with ongoing monitoring for a couple years for no dx.

I agree with Elaine. Mom acted as a licensed provider when running the tests. I

would encourage Mom to self-report and tell her that if she did not, I would be

obligated to report. Once she states she reported herself, I would request to

talk to her supervisor to confirm. Perhaps Labcorp can use this event for

training especially when the final healthcare cost is known and no dx is found.

Hopefully, the patient won't be harmed (e.g. radiation exposure, complications

of procedures) during the workup.

You will likely have to get endo involved and if I was the insurance company, I

would not pay for it ... or maybe only 50%.

Craig

>

> >

> >

> > Hi,

> >

> > I have a 16 yo WF patient with severe symptoms of bipolar for years

(seeing

> > psych, but a lot of side effects from meds) Her mom works for Labcorp

so

> > ptcould get " any test done for free " . They showed me

results of many tests

> > which showed:

> >

> > DHEA over 1000 (almost twice as much of upper limit for her age)

> > plasma Dopamine= 97 (lab range 0-32)

> > PM cortisol = 4.1, AM cortisol=19

> > Ferritin increased from 7 to 51

> > Vit D 25 increased from 21 to 49

> >

> > CBC, lytes, LFTs, TSH all WNL

> >

> > Regular menses. Hypothyroidism from prior Lithium tx.

> >

> > Any help and suggestions woudl be much appreciated.

> >

> > Thank you very much.

> >

> > Helen

> >

> > ------------------------------

> > Hotmail: Trusted email with Microsoft's powerful SPAM protection.

Sign up

> > now. <http://clk.atdmt.com/GBL/go/210850552/direct/01/>

> >

> >

> >

>

>

>

> --

> M.D.

> www.elainemd.com

> Office:

> Go in the directions of your dreams and live the life you've imagined.

> This email transmission may contain protected and privileged, highly

> confidential medical, Personal and Health Information (PHI) and/or legal

> information. The information is intended only for the use of the

individual

> or entity named above.

>

>

>

> If you are not the intended recipient of this material, you may not use,

> publish, discuss, disseminate or otherwise distribute it. If you are not

the

> intended recipient, or if you have received this transmission in error,

> please notify the sender immediately and confidentially destroy the

> information that email in error.

>

Hotmail has tools for the New Busy. Search, chat and e-mail

from your inbox. Learn More.

[Guest guest]

Has anyone looked at her adrenal glands? I would look there or at her current meds. I assume her thyroid is now normal off the lithium

From: [ ] On Behalf Of Kathy Saradarian [qualityfp@...]

Sent: Wednesday, March 31, 2010 2:47 PM

To:

Subject: RE: Re: clinical question: 16 yo WF with high DHEA

Wonder why Mom picked those tests? What was she thinking. I have never even seen a “Dopamine level” even from psychiatrists. Are they even reliable?

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 Helen Yang

Sent: Wednesday, March 31, 2010 3:34 PM

To: practiceimprovement1

Subject: RE: Re: clinical question: 16 yo WF with high DHEA

Thank you all for the input.

They did have their previous doc order those labs, so likely not needed to be reported.

The patient has been seeing psych for years and did not respond well to many of the meds including lactating after taking resperidol. Mom noted that their current psych suspected that this young girl could have a brain tumor that is causing her psych symptoms

which did not respond to meds in the usual manner.

I wonder to get endocrine or neuro next.

Helen

To:

From: rossmd

Date: Wed, 31 Mar 2010 19:15:38 +0000

Subject: Re: clinical question: 16 yo WF with high DHEA

? Familial Hemachromatosis?

Likely will be a big w/u with ongoing monitoring for a couple years for no dx.

I agree with Elaine. Mom acted as a licensed provider when running the tests. I would encourage Mom to self-report and tell her that if she did not, I would be obligated to report. Once she states she reported herself, I would request to talk to her supervisor

to confirm. Perhaps Labcorp can use this event for training especially when the final healthcare cost is known and no dx is found. Hopefully, the patient won't be harmed (e.g. radiation exposure, complications of procedures) during the workup.

You will likely have to get endo involved and if I was the insurance company, I would not pay for it ... or maybe only 50%.

Craig

>

> >

> >

> > Hi,

> >

> > I have a 16 yo WF patient with severe symptoms of bipolar for years (seeing

> > psych, but a lot of side effects from meds) Her mom works for Labcorp so

> > ptcould get " any test done for free " . They showed me results of many tests

> > which showed:

> >

> > DHEA over 1000 (almost twice as much of upper limit for her age)

> > plasma Dopamine= 97 (lab range 0-32)

> > PM cortisol = 4.1, AM cortisol=19

> > Ferritin increased from 7 to 51

> > Vit D 25 increased from 21 to 49

> >

> > CBC, lytes, LFTs, TSH all WNL

> >

> > Regular menses. Hypothyroidism from prior Lithium tx.

> >

> > Any help and suggestions woudl be much appreciated.

> >

> > Thank you very much.

> >

> > Helen

> >

> > ------------------------------

> > Hotmail: Trusted email with Microsoft's powerful SPAM protection. Sign up

> > now. <http://clk.atdmt.com/GBL/go/210850552/direct/01/>

> >

> >

> >

>

>

>

> --

> M.D.

> www.elainemd.com

> Office:

> Go in the directions of your dreams and live the life you've imagined.

> This email transmission may contain protected and privileged, highly

> confidential medical, Personal and Health Information (PHI) and/or legal

> information. The information is intended only for the use of the individual

> or entity named above.

>

>

>

> If you are not the intended recipient of this material, you may not use,

> publish, discuss, disseminate or otherwise distribute it. If you are not the

> intended recipient, or if you have received this transmission in error,

> please notify the sender immediately and confidentially destroy the

> information that email in error.

>

Hotmail has tools for the New Busy. Search, chat and e-mail from your inbox.

Learn More.

[Guest guest]

Yeah Kathleen! I'm with you. Have seen this several times in my practice. Elevated DHEA won't necessarily make her 'look like a man' but may disinhibit her a little and make her a 'titch' more aggressive. Both of these, on top of ADD/ bipolar stuff could be enough to explain problems. Again, I have a gal in my practice, age 30, who had similar symptoms for over a decade before we dx'd. Partial 21 hydroxylase deficiency!

Lynette I Iles MD 301 South Iowa Ste 2Washington IA 52353 Flexible Family Care'Modern medicine the old-fashioned way' This e-mail and attachments may contain information which is confidential and is only for the named addressee.  If you have received this email in error, please notify the sender immediately and delete it from your computer.

[Guest guest]

Thanks from your imp psychiatrist kathleen aka Beans Sent from my Verizon Wireless BlackBerryDate: Fri, 2 Apr 2010 13:08:07 -0500To: < >Subject: Re: clinical question: 16 yo WF with high DHEA Yeah Kathleen! I'm with you. Have seen this several times in my practice. Elevated DHEA won't necessarily make her 'look like a man' but may disinhibit her a little and make her a 'titch' more aggressive. Both of these, on top of ADD/ bipolar stuff could be enough to explain problems. Again, I have a gal in my practice, age 30, who had similar symptoms for over a decade before we dx'd. Partial 21 hydroxylase deficiency!Lynette I Iles MD 301 South Iowa Ste 2Washington IA 52353 Flexible Family Care'Modern medicine the old-fashioned way' This e-mail and attachments may contain information which is confidential and is only for the named addressee.  If you have received this email in error, please notify the sender immediately and delete it from your computer.

[Guest guest]

Hey guys,

Now this is from a non-licensed non clinical person so take it for what it is... And I'm wondering if this was even brought up previously in this thread, But don't good old fish oil gel caps have a good amount of DHEA in them??? There are presently studies underway supporting fish oil suppliments in helping with the symptoms of depression and especially BiPolar I believe. I believe there has already been some actually properly controlled studies on the effectiveness that have reached significant levels of findings. I know that there are more Psych's advicing suppliments of fish oil and previously threaded Vit "D" too. So what might this mean for this patient with the elevated levels verses these studies??? Have you inquired about fish, tuna or suppliment consumption? I gather you did already, but I just thought I'd throw this out there as food for thought....

To: Sent: Fri, April 2, 2010 2:31:49 PMSubject: Re: clinical question: 16 yo WF with high DHEA

Thanks from your imp psychiatrist kathleen aka Beans Sent from my Verizon Wireless BlackBerry

From: Lynette Iles <liles64gmail (DOT) com>

Date: Fri, 2 Apr 2010 13:08:07 -0500

To: <Practiceimprovement 1yahoogroups (DOT) com>

Subject: Re: [Practiceimprovemen t1] clinical question: 16 yo WF with high DHEA

Yeah Kathleen! I'm with you. Have seen this several times in my practice. Elevated DHEA won't necessarily make her 'look like a man' but may disinhibit her a little and make her a 'titch' more aggressive. Both of these, on top of ADD/ bipolar stuff could be enough to explain problems. Again, I have a gal in my practice, age 30, who had similar symptoms for over a decade before we dx'd. Partial 21 hydroxylase deficiency!

Lynette I Iles MD 301 South Iowa Ste 2Washington IA 52353 Flexible Family Care'Modern medicine the old-fashioned way' This e-mail and attachments may contain information which is confidential and is only for the named addressee. If you have received this email in error, please notify the sender immediately and delete it from your computer.

[Guest guest]

Yes omega 3 fish oils can be beneficial for depression and bipolar disorder, However, the fish oils contain DHA not DHEA. Not the same thing. DHA is Docosahexaenoic acid an essential fatty acid. DHEA is a hormone produced in the adrenals. Speaking of supplements, did you ask if she is

taking DHEA as some people use this for mood.Kathleen aka beansSubject: Re: clinical question: 16 yo WF with high DHEATo: Date: Friday, April 2, 2010, 2:52 PM

Hey guys,

Now this is from a non-licensed non clinical person so take it for what it is... And I'm wondering if this was even brought up previously in this thread, But don't good old fish oil gel caps have a good amount of DHEA in them??? There are presently studies underway supporting fish oil suppliments in helping with the symptoms of depression and especially BiPolar I believe. I believe there has already been some actually properly controlled studies on the effectiveness that have reached significant levels of findings. I know that there are more Psych's advicing suppliments of fish oil and previously threaded Vit "D" too. So what might this mean for this patient with the elevated levels verses these studies??? Have you inquired about fish, tuna or suppliment consumption? I gather you did already, but I just thought I'd throw this out there as food for thought....

From: "beans1933yahoo (DOT) com" <beans1933yahoo (DOT) com>To: Practiceimprovement 1yahoogroups (DOT) comSent: Fri, April 2, 2010 2:31:49 PMSubject: Re: [Practiceimprovemen t1] clinical question: 16 yo WF with high DHEA

Thanks from your imp psychiatrist kathleen aka Beans Sent from my Verizon Wireless BlackBerry

From: Lynette Iles <liles64gmail (DOT) com>

Date: Fri, 2 Apr 2010 13:08:07 -0500

To: <Practiceimprovement 1yahoogroups (DOT) com>

Subject: Re: [Practiceimprovemen t1] clinical question: 16 yo WF with high DHEA

Yeah Kathleen! I'm with you. Have seen this several times in my practice. Elevated DHEA won't necessarily make her 'look like a man' but may disinhibit her a little and make her a 'titch' more aggressive. Both of these, on top of ADD/ bipolar stuff could be enough to explain problems. Again, I have a gal in my practice, age 30, who had similar symptoms for over a decade before we dx'd. Partial 21 hydroxylase deficiency!

Lynette I Iles MD 301 South Iowa Ste 2Washington IA 52353 Flexible Family Care'Modern medicine the old-fashioned way' This e-mail and attachments may contain information which is confidential and is only for the named addressee. If you have received this email in error, please notify the sender immediately and delete it from your computer.

[Guest guest]

As I said, I'm not the clinical one here at our office, and worse yet, I'm dyslexic and a terrible speller too..... Oh well. Thanks for the correction there..... And that is why I sit where I do and she does the doctoring around here. As it should be.

To: Sent: Fri, April 2, 2010 4:03:03 PMSubject: Re: clinical question: 16 yo WF with high DHEA

Yes omega 3 fish oils can be beneficial for depression and bipolar disorder, However, the fish oils contain DHA not DHEA. Not the same thing. DHA is Docosahexaenoic acid an essential fatty acid. DHEA is a hormone produced in the adrenals. Speaking of supplements, did you ask if she is taking DHEA as some people use this for mood.

Kathleen aka beans

From: Bleiweiss <hockeyref1yahoo (DOT) com>Subject: Re: [Practiceimprovemen t1] clinical question: 16 yo WF with high DHEATo: Practiceimprovement 1yahoogroups (DOT) comDate: Friday, April 2, 2010, 2:52 PM

Hey guys,

Now this is from a non-licensed non clinical person so take it for what it is... And I'm wondering if this was even brought up previously in this thread, But don't good old fish oil gel caps have a good amount of DHEA in them??? There are presently studies underway supporting fish oil suppliments in helping with the symptoms of depression and especially BiPolar I believe. I believe there has already been some actually properly controlled studies on the effectiveness that have reached significant levels of findings. I know that there are more Psych's advicing suppliments of fish oil and previously threaded Vit "D" too. So what might this mean for this patient with the elevated levels verses these studies??? Have you inquired about fish, tuna or suppliment consumption? I gather you did already, but I just thought I'd throw this out there as food for thought....

From: "beans1933yahoo (DOT) com" <beans1933yahoo (DOT) com>To: Practiceimprovement 1yahoogroups (DOT) comSent: Fri, April 2, 2010 2:31:49 PMSubject: Re: [Practiceimprovemen t1] clinical question: 16 yo WF with high DHEA

Thanks from your imp psychiatrist kathleen aka Beans

Sent from my Verizon Wireless BlackBerry

From: Lynette Iles <liles64gmail (DOT) com>

Date: Fri, 2 Apr 2010 13:08:07 -0500

To: <Practiceimprovement 1yahoogroups (DOT) com>

Subject: Re: [Practiceimprovemen t1] clinical question: 16 yo WF with high DHEA

Yeah Kathleen! I'm with you. Have seen this several times in my practice. Elevated DHEA won't necessarily make her 'look like a man' but may disinhibit her a little and make her a 'titch' more aggressive. Both of these, on top of ADD/ bipolar stuff could be enough to explain problems. Again, I have a gal in my practice, age 30, who had similar symptoms for over a decade before we dx'd. Partial 21 hydroxylase deficiency!

Lynette I Iles MD 301 South Iowa Ste 2Washington IA 52353 Flexible Family Care'Modern medicine the old-fashioned way' This e-mail and attachments may contain information which is confidential and is only for the named addressee. If you have received this email in error, please notify the sender immediately and delete it from your computer.

[Guest guest]

Thank you all for the input. No, she had not been taking any DHEA.What is the best way to check 21 hydroxylase level?Thank you.HelenTo: From: beans1933@...Date: Fri, 2 Apr 2010 13:03:03 -0700Subject: Re: clinical question: 16 yo WF with high DHEA

Yes omega 3 fish oils can be beneficial for depression and bipolar disorder, However, the fish oils contain DHA not DHEA. Not the same thing. DHA is Docosahexaenoic acid an essential fatty acid. DHEA is a hormone produced in the adrenals. Speaking of supplements, did you ask if she is

taking DHEA as some people use this for mood.Kathleen aka beansFrom: Bleiweiss <hockeyref1>Subject: Re: clinical question: 16 yo WF with high DHEATo: Date: Friday, April 2, 2010, 2:52 PM

Hey guys,

Now this is from a non-licensed non clinical person so take it for what it is... And I'm wondering if this was even brought up previously in this thread, But don't good old fish oil gel caps have a good amount of DHEA in them??? There are presently studies underway supporting fish oil suppliments in helping with the symptoms of depression and especially BiPolar I believe. I believe there has already been some actually properly controlled studies on the effectiveness that have reached significant levels of findings. I know that there are more Psych's advicing suppliments of fish oil and previously threaded Vit "D" too. So what might this mean for this patient with the elevated levels verses these studies??? Have you inquired about fish, tuna or suppliment consumption? I gather you did already, but I just thought I'd throw this out there as food for thought....

From: "beans1933yahoo (DOT) com" <beans1933yahoo (DOT) com>To: Practiceimprovement 1yahoogroups (DOT) comSent: Fri, April 2, 2010 2:31:49 PMSubject: Re: [Practiceimprovemen t1] clinical question: 16 yo WF with high DHEA

Thanks from your imp psychiatrist kathleen aka Beans Sent from my Verizon Wireless BlackBerry

From: Lynette Iles <liles64gmail (DOT) com>

Date: Fri, 2 Apr 2010 13:08:07 -0500

To: <Practiceimprovement 1yahoogroups (DOT) com>

Subject: Re: [Practiceimprovemen t1] clinical question: 16 yo WF with high DHEA

Yeah Kathleen! I'm with you. Have seen this several times in my practice. Elevated DHEA won't necessarily make her 'look like a man' but may disinhibit her a little and make her a 'titch' more aggressive. Both of these, on top of ADD/ bipolar stuff could be enough to explain problems. Again, I have a gal in my practice, age 30, who had similar symptoms for over a decade before we dx'd. Partial 21 hydroxylase deficiency!

Lynette I Iles MD 301 South Iowa Ste 2Washington IA 52353 Flexible Family Care'Modern medicine the old-fashioned way' This e-mail and attachments may contain information which is confidential and is only for the named addressee. If you have received this email in error, please notify the sender immediately and delete it from your computer.

The New Busy is not the too busy. Combine all your e-mail accounts with Hotmail. Get busy.

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Dear Helen,I am not sure the best way to go about making the diagnosis-if she has 21 hydroxylase deficiency it is most likely a partial not total deficiency. I'm not sure about measuring the enzyme -I think you mostly measure androgen and cortisol metabolites. I would suggest letting an endocrinologist help with making the diagnosis.I hope this is of some helpKathleen aka beansFrom: Bleiweiss <hockeyref1yahoo (DOT) com>Subject: Re: [Practiceimprovemen t1] clinical question: 16 yo WF with high DHEATo: Practiceimprovement 1yahoogroups (DOT) comDate: Friday, April 2, 2010, 2:52 PM

Hey guys,

Now this is from a non-licensed non clinical person so take it for what it is... And I'm wondering if this was even brought up previously in this thread, But don't good old fish oil gel caps have a good amount of DHEA in them??? There are presently studies underway supporting fish oil suppliments in helping with the symptoms of depression and especially BiPolar I believe. I believe there has already been some actually properly controlled studies on the effectiveness that have reached significant levels of findings. I know that there are more Psych's advicing suppliments of fish oil and previously threaded Vit "D" too. So what might this mean for this patient with the elevated levels verses these studies??? Have you inquired about fish, tuna or suppliment consumption? I gather you did already, but I just thought I'd throw this out there as food for thought....

From: "beans1933yahoo (DOT) com" <beans1933yahoo (DOT) com>To: Practiceimprovement 1yahoogroups (DOT) comSent: Fri, April 2, 2010 2:31:49 PMSubject: Re: [Practiceimprovemen t1] clinical question: 16 yo WF with high DHEA

Thanks from your imp psychiatrist kathleen aka Beans Sent from my Verizon Wireless BlackBerry

From: Lynette Iles <liles64gmail (DOT) com>

Date: Fri, 2 Apr 2010 13:08:07 -0500

To: <Practiceimprovement 1yahoogroups (DOT) com>

Subject: Re: [Practiceimprovemen t1] clinical question: 16 yo WF with high DHEA

Yeah Kathleen! I'm with you. Have seen this several times in my practice. Elevated DHEA won't necessarily make her 'look like a man' but may disinhibit her a little and make her a 'titch' more aggressive. Both of these, on top of ADD/ bipolar stuff could be enough to explain problems. Again, I have a gal in my practice, age 30, who had similar symptoms for over a decade before we dx'd. Partial 21 hydroxylase deficiency!

Lynette I Iles MD 301 South Iowa Ste 2Washington IA 52353 Flexible Family Care'Modern medicine the old-fashioned way' This e-mail and attachments may contain information which is confidential and is only for the named addressee. If you have received this email in error, please notify the sender immediately and delete it from your computer.

The New Busy is not the too busy. Combine all your e-mail accounts with Hotmail. Get busy.

[Guest guest]

My last patient, after having several abnormal testosterone levels (ie DHEA) we checked a 17 alphahydroxyprogesterone level, which was elevated. The endocrinologists around here would have never ordered one.

 

Dear Helen, I am not sure the best way to go about making the diagnosis-if she has 21 hydroxylase deficiency it is most likely a partial not total deficiency. I'm not sure about measuring the enzyme -I think you mostly measure androgen and cortisol metabolites. I would suggest letting an endocrinologist help with making the diagnosis.

I hope this is of some help

Kathleen aka beans

From: Bleiweiss <hockeyref1yahoo (DOT) com>

Subject: Re: [Practiceimprovemen t1] clinical question: 16 yo WF with high DHEA

To: Practiceimprovement 1yahoogroups (DOT) comDate: Friday, April 2, 2010, 2:52 PM

 

Hey guys,

    Now this is from a non-licensed non clinical person so take it for what it is... And I'm wondering if this was even brought up previously in this thread, But don't good old fish oil gel caps have a good amount of DHEA in them??? There are presently studies underway supporting fish oil suppliments in helping with the symptoms of depression and especially BiPolar I believe. I believe there has already been some actually properly controlled studies on the effectiveness that have reached significant levels of findings. I know that there are more Psych's advicing suppliments of fish oil and previously threaded Vit " D " too. So what might this mean for this patient with the elevated levels verses these studies??? Have you inquired about fish, tuna or suppliment consumption? I gather you did already, but I just thought I'd throw this out there as food for thought....

 

From: " beans1933yahoo (DOT) com " <beans1933yahoo (DOT) com>To: Practiceimprovement 1yahoogroups (DOT) comSent: Fri, April 2, 2010 2:31:49 PM

Subject: Re: [Practiceimprovemen t1] clinical question: 16 yo WF with high DHEA  Thanks from your imp psychiatrist kathleen aka Beans Sent from my Verizon Wireless BlackBerry

From: Lynette Iles <liles64gmail (DOT) com>

Date: Fri, 2 Apr 2010 13:08:07 -0500

To: <Practiceimprovement 1yahoogroups (DOT) com>

Subject: Re: [Practiceimprovemen t1] clinical question: 16 yo WF with high DHEA

 

Yeah Kathleen! I'm with you. Have seen this several times in my practice. Elevated DHEA won't necessarily make her 'look like a man' but may disinhibit her a little and make her a 'titch' more aggressive. Both of these, on top of ADD/ bipolar stuff could be enough to explain problems. Again, I have a gal in my practice, age 30, who had similar symptoms for over a decade before we dx'd. Partial 21 hydroxylase deficiency!

Lynette I Iles MD 301 South Iowa Ste 2Washington IA 52353 Flexible Family Care'Modern medicine the old-fashioned way' This e-mail and attachments may contain information which is confidential and is only for the named addressee.  If you have received this email in error, please notify the sender immediately and delete it from your computer.

The New Busy is not the too busy. Combine all your e-mail accounts with Hotmail. Get busy.

-- Lynette I Iles MD 301 South Iowa Ste 2Washington IA 52353 Flexible Family Care'Modern medicine the old-fashioned way'

This e-mail and attachments may contain information which is confidential and is only for the named addressee.  If you have received this email in error, please notify the sender immediately and delete it from your computer.