DELICATE THUNDER

Since I began this journey I have been tested in nearly every form and fashion imaginable. I have been poked, prodded, injected, irradiated, scanned, biopsied, and operated on. I have had echocardiograms, transesophageal echocardiograms, petscans, catscans, EEG's, EKG's, tilt table tests, stress tests, MUGA scans, and I have had gallons and gallons of my blood drained and thrown away.

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Laboratory blood tests results after diagnosis of polycythemia vera:

• Elevated red blood cell count 6.05 (4.40 to 5.60),

• hemoglobin18.3 (13.7 to 16.7), and

• hematocrit 53.1 (40.0 to 48.0), with

• no normal white blood cell and platelet count.

• Normal electrolytes, glucose, serum urea nitrogen, creatinine, hepatic enzymes, thyrotropin; nonreactive rapid plasma reagin, and negative antinuclear antibodies. 

• Bone marrow is normocellular and without tumor or granuloma, consistent with Polycythemia vera.(8)

• Testosterone level; Testosterone levels tested very low. Total testosterone is 56 ng/dL (reference range; 241ng/dL to 827 ng/dL) and free testosterone is 1.2 ng/dL (reference range; 8.7 ng/dL to 25.1 ng/dL)

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Laboratory blood test results: 13 months after starting Testosterone therapy

• Serum Insulinlike Growth Factor I: level is low 109 ng/mL [reference range: 249 to 290]

• Growth Hormone Stimulation Test (using levodopa, 10mg/kg by mouth) to evaluate for possible adult onset GH deficiency.

• GH measurements are obtained at 0, 30, 60, and 120 minutes with the following levels: 0.2 ng/mL, 0.5 ng/mL, 2.4 ng/mL, 2.2ng/mL, respectively. Normal response is GH greater than 5 micrograms/L, the test indicates GH deficiency Idiopathic hypogonadotropic (hypothalamic-pituitary) failure.

 

Diagnosis: Patient has gonadotropin deficiency resulting from a defect in gonadotropin-releasing hormone (GnRH) secretion. Other potential causes of hypothalamic-pituitary failure include a congenital abnormality, tumor, or prior injury involving the hypothalamic-pituitary axis. (8)

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