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DrRussMD, Board Certified MD
Category: Endocrinology
Satisfied Customers: 65671
Experience:  Board certified Internal medicine and Integrative medicine. Many years of experience all areas.
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My son is aged 14 and has developed very high blood pressure

Customer Question

My son is aged 14 and has developed very high blood pressure (180 and over) - along with all the classic symptoms of Cushings Syndrome - rapid weight gain, expanded midriff & trunk, 'buffalo hump', striated marks on the skin (abdomen & shoulders), purpura on the ankles, etc. His blood pressure is being treated and has come under control with a combination of Amlodipine and Prazosin, but we are concerned about how to diagnose and deal with the underlying causes, which are still unclear.

Kidney function is normal. Two separate kidney and brain scans have revealed no obvious signs of a tumor on either the adrenal or pituitary glands and two sets of blood tests have both shown normal cortizol levels. We are waiting for the results of a 24-hour urine test but have been told it's unlikely we will get a high cortizol answer. My questions are:

- Is this possibly a case of 'Pseudo-Cushings' - ie is it possible that my son has abnormal
enzyme action and cannot deal with 'normal'cortizol output in his body?
- Are there other possible Endocrine explanations for his intense symptoms?
- What do we need to do to get some definite answers and a course of action?
- What can we safely do in the meantime to try to get things more under control?
(NB - my son's weight has increased from 105 to 111 kg in just 4 weeks and his waistline from 40" to 42" - he is 'ballooning' in front of our eyes, and we know he isn't over-eating because he is with us all the time now.)

Final question - we live in the UK and would like to know how to find a specialist (private if necessary) with the right experience to help us with diagnosis and treatment.

Thank you!

J Keen
Submitted: 4 years ago.
Category: Endocrinology
Expert:  DrRussMD replied 4 years ago.
Hello from JA

I am Dr. Thomas, board certified in internal medicine and I can help you with this and any follow up questions. I cover a lot of ground and might give you an answer or ask for information, but use reply to communicate with me for questions or added details.

No I do not think this is pseudo Cushings.
The 24 hour urine for free cortisol should be definitive.

Pseudo Cushings will still have abnormal cortisol

You have not mentioned thyroid studies and specifically TSH.

There are new normals on this parameter that most docs have not caught up with. TSH must be between .3 and 3.

I would also look at diet of course.

I would look at inflammatory markers in relation to diet.

And a sex hormone panel.

Heart problems, particularly with echocardiogram, should be ruled out.

Kidney problems need to be ruled out.

The doctor to see is an endocrinologist or at least an internal medicine specialist.

There are adolescent medicine specialists within the field of internal medicine.

OK. If you have further questions or details, use reply to expert.
Otherwise please choose a positive rating . But, still come back if you need to…think of something later, etc. Bonuses are appreciated.