How to treat acne, dizziness, and weight gain?

Hello,

Welcome to icliniq.com.

I understand your concern.

There may be three possibilities. Either your polycystic ovarian syndrome and hypothyroidism are two separate disorders, or it may be a pituitary or autoimmune disease that affects many organs.

When did you last check your thyroid levels? If it is too low, then you will have disturbed periods. The pituitary is the master endocrine gland that controls all other glands. Please do tests for TRH (thyrotropin-releasing hormone), GnRH (gonadotropin-releasing hormone), and repeat ACTH (adrenocorticotropic hormone), which will show whether there is any problem with the pituitary.

If there is any problem in these tests, then the pituitary gland is affected and can be treated. Also get c-ANCA (cytoplasmic anti-neutrophil cytoplasmic antibody), p-ANCA (perinuclear anti-neutrophil cytoplasmic antibody), and ANA (anti-nuclear antibody) tests to rule out autoimmune disease.

If any abnormalities are seen in these tests, then you may have an autoimmune disease, which can also be controlled by drugs.

I hope this helps.

Thank you.

Hello,

Welcome back to icliniq.com.

I can understand your concern.

Even if the MRI (magnetic resonance imaging) of the brain and pituitary is normal, we cannot rule out pituitary disease. Minor pituitary abnormalities are not detected by MRI.

My advice is to do the above tests to rule out pituitary disease, which can cause variation in prolactin levels. Since your reports for autoimmune disorders are negative, we can relax in that area. Since you have been using birth control pills for a long time, they can also cause severe weight gain and Cushing's syndrome-like symptoms.

Please do the above tests and also consult your gynecologist regarding the side effects of oral birth control pills.

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.

Hello,

Welcome back to icliniq.com.

I can understand your concern.

I went through the reports (attachment removed to protect the patient’s identity) posted by you. Your reports are fine, and you definitely do not have Cushing's. Moreover, your BMI (body mass Index) is 25, which is quite normal (high normal). So, I do not think you have any disease that is causing you unusual weight gain.

Hypothyroidism can cause weight gain, but in your case, your free T4 (thyroxine) is slightly on the higher side. It would have been more informative if you had uploaded the TSH (thyroid-stimulating hormone) report.

The other possibility is that the birth control pills that you take, even Yasmin, can cause weight gain. From your side, what you need to do is keep your thyroid levels under control.

Kindly upload your recent TSH so that I can adjust your medication dose. Ask your gynecologist for an alternative medication for your period problem.

Continue exercising and make slight increments in the time or intensity of exercise. Otherwise, you do not have any endocrinological problems. One more piece of advice is to get tested for diabetes.

I hope this information will help you.

Thank you.

Hello,

Welcome back to icliniq.com.

I can understand your concerns.

Your TSH is in the normal range. So, the decision to reduce your thyroid medication dose is right. Coming to your cortisol levels, normal morning levels of cortisol are 7 to 28 μg/dL. In your case, it is 34 μg/dL, which is a mild elevation. This mild elevation can be explained by your consumption of Yasmin tablets.

My recommendation is to stop taking Yasmin for two months and monitor your weight. Also, repeat serum cortisol after two months. I strongly feel that after stopping Yasmin with continued exercise and diet, you will start losing weight.

I hope this helps.

Thank you.

Hello,

Welcome back to icliniq.com.

I can understand your concern.

There are two issues here. Weight gain and high cortisol. High cortisol and weight gain could be due to Yasmin intake. As you are saying that weight gain is happening even after stopping Yasmin for six months, we need to consider other causes of weight gain.

What I need to know is whether your cortisol was tested while you were on Yasmin or not. If it was done while you were on Yasmin, then I recommend you repeat the cortisol levels after two months of stopping Yasmin. Or get a test called free cortisol, which is not affected by Yasmin intake.

If the cortisol test was already done while not on Yasmin, then I recommend further testing. Since your ACTH (adrenocorticotropic hormone) is normal, we need to evaluate the adrenal cause of elevated cortisol. In that regard, I recommend a CT (computed tomography) scan of the adrenal gland and review the report.

Do not be in a rush to get started on medication to bring down cortisol. We should first know what the cause of elevated cortisol is, as certain tumors can also cause elevated cortisol.

I hope this helps.

Thank you.

Hello,

Welcome back to icliniq.com.

I can understand your concern.

The normal range for urinary free cortisol is 3.5 - 45 µg/dL/24 hours, while you have 60 µg/dL. This could be taken as suggestive of Cushing's, but a normal Dexamethasone suppression test goes against Cushing's.

So, there is a dilemma here. That too is a normal MRI (magnetic resonance imaging) brain, pituitary, and adrenal scans support the diagnosis as not Cushing's. There are two options for you.

One waits for six to eight weeks and repeats the test, that is urinary free cortisol and Dexamethasone suppression test, or gets started on treatment with Ketoconazole or Metyrapone.

One thing you need to understand is that starting treatment with Ketoconazole or Metyrapone may cause reduced efficacy of Yasmin. Among the two options, I recommend the first one.

I hope this helps.

Thank you.

Hello,

Welcome back to icliniq.com.

I can understand your concern.

Not all tumors will be seen in MRI (magnetic resonance imaging). But next time, when you go for a scan, ask for a pituitary scan and not just an MRI of the brain. Also, get it in an MRI of 3 Tesla strength.

After the start of medication, your weight gain will slow down. But I do not think you will lose weight. For weight loss, you need to continue a diet and exercise. Your headache, anxiety, and feeling of tiredness will reduce. You may have irregular periods due to the reduced effectiveness of Yasmin.

I hope this helps.

Thank you.

Hello,

Welcome back to icliniq.com.

I can understand your concern.

Yes, you will lose weight. Please follow my advice for a better outcome. You should avoid non-vegetarian food, including chicken. Eat more fruits and vegetables. Whatever exercise you do, make sure that you increase the intensity or duration or both every two weeks.

You can try herbal supplements like Garcinia, which improves metabolism and helps in weight loss. Ask an alternative for Yasmin with your gynecologist.

I hope this helps.

Thank you.

Hello,

Welcome back to icliniq.com.

I can understand your concern.

Mifepristone is not approved for long-term treatment. I recommend you go ahead with Metyrapone only. Regarding an alternative for Yasmin, you need to discuss it with your gynecologist and ask for a non-steroidal medicine.

Seasonale also will not help. Yes, I do suggest you avoid meat and fish. Egg white is fine, but chicken and mutton have to be stopped.

I hope this helps.

Thank you.

Hello,

Welcome back to icliniq.com.

I can understand your concern.

The dexamethasone suppression test is done to differentiate between Cushing's syndrome and Cushing's disease. Suppression is seen either in normal individuals or in Cushing's disease. So, this indicates that you have Cushing's disease.

The basic requirement for this test is that women who are taking oral contraceptive pills (Yasmin in your case) should discontinue the drug for at least six weeks before the test. If you have done the test while on Yasmin, then this test does not hold any significance.

I hope this helps.

Thank you.