dima_26
12.12.2008, 05:43
Ув. Специалисты-эндокринологи:
Помогите разобраться со следующими проблемами. Я почти на протяжении 2-х десятилетий (сейчас мне 26), время от времени, был вынужден принимать Преднизолон (Prednisone) в разных дозах (от 5 до 100mg/d) в связи с хр. гломерулонефритом с нефротическим синдромом. Насколько я понимаю, протеинурия перестала беспокоить -- уже примерно 1.5 года в экзогенных глюкокортикоидах нет необходимости, но вот побочные эффекты от них остались. Наск. я понимаю, мои надпочечники никак не придут в норму: "тянет" на соленое, рано утром встать -- проблема, а раньше 2-x ночи на засыпаю, тяжело переносится стресс; остеопороз, т.н. потеря мышечной массы (steroid-induced muscle wasting). По приведенным ниже исследованиям можно сказать в каком состоянии мои надпочечники сейчас, и если нет, что еще нужно сделать, и как восстановить, на сколько это возможно, их нормальную функцию? Заранее спасибо за помощь!
Анализы крови/мочи, 10/22/08:
Test Name In Range Out of Range Reference Range
COMP METAB PANEL W/EGFR
GLUCOSE 84 65-139mg/dL
Note: The glucose reference range is based on a non-fasting state
Sodium 140 135-146 mmol/L
Potassium 4.1 3.5-5.3 mmol/L
Chloride 102 98-110 mmol/L
Carbon Dioxide 25 21-33 mmol/L
Urea Nitrogen 12 7-25 mg/dL
Creatinine 0.85 0.50-1.30 mg/dL
Bun/Creat Ratio NOTE --> Bun/Creat ratio is not reported when the Bun and Creat values are within normal limits.
Calcium 9.8 8.6-10.2 mg/dL
Protein, Total 7.6 6.2-8.3 g/dL
Albumin 4.7 3.6-5.1 g/dL
Globulin, Calc 2.9 2.1-3.7 g/dL
A/G Ratio 1.6 1.0-2.1
Bilirubin, Total 0.9 0.2-1.2 mg/dL
Alk Phosphatase 82 40-115 U/L
AST 32 10-40 U/L
ALT 41 9-60 U/L
EGFR >60 >=60 mL/min/1.73m^2
Microalbumin, Random Urine (w/Creatinine)
Microalbumin 1.1 Not Established mg/dL
Microalbumin, Random Urine
6 <30 mcg/mg Creat
Category: Result (mcg/mg creatinine):
Normal <30
Microalbuminuria 30-299
Clinical albuminuria > or = 300
LDL Cholesterol, Direct 146 High <130 mg/dL
Lipid Panel
Cholesterol, Total 256 High 125-200mg/dL
HDL Cholesterol 85 >=40 mg/dL
Cholesterol/HDL ratio 3.0 < - 5.0
LDL Chol, Calculated 153 High <130 mg/dL
Triglycerides 89 <150 mg/dL
GGT 20 3-70 U/L
LD 128 100-220 U/L
Iron & Iron Binding Cap
Iron, Total 134 45-175 mcg/dL
TIBC 308 250-425 mcg/dL
Transferrin Saturation 44 20-50%
CBC (INCLUDES DIFF/PLT)
WBC 8.9 3.8-10.8
RBC 5.39 4.20-5.80
Hemoglobin 16.0 13.2-17.1 g/dL
Hematocrit 46.8 38.5-50.0 %
MCV 86.8 80-100 fL
MCH 29.7 27-33 pg
MCHC 34.2 32-36 g/dL
RDW 13.9 11-15 %
Platelet Count 308 140-400 Thous
MPV 7.2 Low 7.5-11.5 fL
Total Neutrophils, % 64.8 38-80 %
Total Lymphocytes, % 25.3 15-49 %
Monocystes, % 6.1 0-13 %
Eosinophils, % 3.5 0-8 %
Basophils, % 0.3 0-2 %
Neutrophils, Absolute 5767 1500-7800
Lymphocytes, Absolute 2252 850-3900
Monocytes, Absolute 543 200-950
Eosinophils, Absolute 312 15-550
Basophils, Absolute 27 0-200
Differential An instrument differential was performed.
Urinalysis, Complete
Color Yellow Yellow
Appearance Clear Clear
Glucose, QL Negative Negative
Bilirubin, Urine Negative Negative
Ketones Negative Negative
Specific Gravity 1.021 1.001-1.035
Blood Negative Negative
PH 7.0 5.0-8.0
Protein, Total, QL Negative Negative
Nitrite Negative Negative
Leukocyte Esterase Negative Negative
Squamos Epithelial Cells None Seen <or=5 cells
WBC None Seen <or=5 cells
Bacteria None Seen None Seen
RBC None Seen <or=3 cells
Hyaline Casts None Seen None Seen
Vitamin D,1,25-Dihydroxy 67 19-67 pg/mL
Hepatitis C Ab
HCV Ratio 0.03 <1.0 Ratio
Hepatitis C Ab Non Reactive Non Reactive
Vitamin D,25-OH, LC/MS/MS 51 20-100 ng/mL
Cystatin C 0.8 0.5-1.0 mg/L
Creatinine, Random Urine 192 20-370 mg/dL
Folate Serum 15.9 >5.4 ng/mL
PSA, Total 0.82 0.0-4.0 ng/mL
Hemoglobin A1C 5.0 <6.0%
TSH, 3rd Generation 1.26 0.40-4.50 mIU/L
Ferritin 168 20-345 ng/mL
T4, Free 1.6 0.8-1.8 ng/dL
Vitamin B12, Serum 780 200-1100 pg/mL
DHEA SULFATE 368 110-510 mcg/dL
Также копия DEXA исследования от 6/20/08:
Dear Dr:
The following report summarizes important densitometry results on your patient using the Hologic QDR4500A energy densitometer and performed on 6/20/08 for osteoporosis.
T-Score= Standard deviation from peak bone mass
Z-Score= Standard deviation from age-matched reference values
Site Studied____________BMD g/cm2 _____T-Score______Z-Score
Lumbar Spine (L1-L4)_____0.704_______-2.8__________-2.8
Total Hip (Right) __________ 0.795_______-1.6__________ -1.6
Femoral Neck (Right)_____ 0.662_______-2.0__________ -2.0
Distal Radius (Left) 0.608_______-3.1__________ -3.1
This is a baseline study and, therefore, there are no interval changes.
Interpretation: The World Health Organization defines osteoporosis as a bone mineral density 2.5 standard deviations below a young normal, sex-matched group (T score less than –2.5). Osteopenia (low bone mass) is defined as a bone mineral density that is 1 to 2.5 standard deviations below young, normal, sex-matched population (T score between –1 and –2.5).Using these criteria, on the basis of bone density at the lumbar spine your patient has osteoporosis.
Помогите разобраться со следующими проблемами. Я почти на протяжении 2-х десятилетий (сейчас мне 26), время от времени, был вынужден принимать Преднизолон (Prednisone) в разных дозах (от 5 до 100mg/d) в связи с хр. гломерулонефритом с нефротическим синдромом. Насколько я понимаю, протеинурия перестала беспокоить -- уже примерно 1.5 года в экзогенных глюкокортикоидах нет необходимости, но вот побочные эффекты от них остались. Наск. я понимаю, мои надпочечники никак не придут в норму: "тянет" на соленое, рано утром встать -- проблема, а раньше 2-x ночи на засыпаю, тяжело переносится стресс; остеопороз, т.н. потеря мышечной массы (steroid-induced muscle wasting). По приведенным ниже исследованиям можно сказать в каком состоянии мои надпочечники сейчас, и если нет, что еще нужно сделать, и как восстановить, на сколько это возможно, их нормальную функцию? Заранее спасибо за помощь!
Анализы крови/мочи, 10/22/08:
Test Name In Range Out of Range Reference Range
COMP METAB PANEL W/EGFR
GLUCOSE 84 65-139mg/dL
Note: The glucose reference range is based on a non-fasting state
Sodium 140 135-146 mmol/L
Potassium 4.1 3.5-5.3 mmol/L
Chloride 102 98-110 mmol/L
Carbon Dioxide 25 21-33 mmol/L
Urea Nitrogen 12 7-25 mg/dL
Creatinine 0.85 0.50-1.30 mg/dL
Bun/Creat Ratio NOTE --> Bun/Creat ratio is not reported when the Bun and Creat values are within normal limits.
Calcium 9.8 8.6-10.2 mg/dL
Protein, Total 7.6 6.2-8.3 g/dL
Albumin 4.7 3.6-5.1 g/dL
Globulin, Calc 2.9 2.1-3.7 g/dL
A/G Ratio 1.6 1.0-2.1
Bilirubin, Total 0.9 0.2-1.2 mg/dL
Alk Phosphatase 82 40-115 U/L
AST 32 10-40 U/L
ALT 41 9-60 U/L
EGFR >60 >=60 mL/min/1.73m^2
Microalbumin, Random Urine (w/Creatinine)
Microalbumin 1.1 Not Established mg/dL
Microalbumin, Random Urine
6 <30 mcg/mg Creat
Category: Result (mcg/mg creatinine):
Normal <30
Microalbuminuria 30-299
Clinical albuminuria > or = 300
LDL Cholesterol, Direct 146 High <130 mg/dL
Lipid Panel
Cholesterol, Total 256 High 125-200mg/dL
HDL Cholesterol 85 >=40 mg/dL
Cholesterol/HDL ratio 3.0 < - 5.0
LDL Chol, Calculated 153 High <130 mg/dL
Triglycerides 89 <150 mg/dL
GGT 20 3-70 U/L
LD 128 100-220 U/L
Iron & Iron Binding Cap
Iron, Total 134 45-175 mcg/dL
TIBC 308 250-425 mcg/dL
Transferrin Saturation 44 20-50%
CBC (INCLUDES DIFF/PLT)
WBC 8.9 3.8-10.8
RBC 5.39 4.20-5.80
Hemoglobin 16.0 13.2-17.1 g/dL
Hematocrit 46.8 38.5-50.0 %
MCV 86.8 80-100 fL
MCH 29.7 27-33 pg
MCHC 34.2 32-36 g/dL
RDW 13.9 11-15 %
Platelet Count 308 140-400 Thous
MPV 7.2 Low 7.5-11.5 fL
Total Neutrophils, % 64.8 38-80 %
Total Lymphocytes, % 25.3 15-49 %
Monocystes, % 6.1 0-13 %
Eosinophils, % 3.5 0-8 %
Basophils, % 0.3 0-2 %
Neutrophils, Absolute 5767 1500-7800
Lymphocytes, Absolute 2252 850-3900
Monocytes, Absolute 543 200-950
Eosinophils, Absolute 312 15-550
Basophils, Absolute 27 0-200
Differential An instrument differential was performed.
Urinalysis, Complete
Color Yellow Yellow
Appearance Clear Clear
Glucose, QL Negative Negative
Bilirubin, Urine Negative Negative
Ketones Negative Negative
Specific Gravity 1.021 1.001-1.035
Blood Negative Negative
PH 7.0 5.0-8.0
Protein, Total, QL Negative Negative
Nitrite Negative Negative
Leukocyte Esterase Negative Negative
Squamos Epithelial Cells None Seen <or=5 cells
WBC None Seen <or=5 cells
Bacteria None Seen None Seen
RBC None Seen <or=3 cells
Hyaline Casts None Seen None Seen
Vitamin D,1,25-Dihydroxy 67 19-67 pg/mL
Hepatitis C Ab
HCV Ratio 0.03 <1.0 Ratio
Hepatitis C Ab Non Reactive Non Reactive
Vitamin D,25-OH, LC/MS/MS 51 20-100 ng/mL
Cystatin C 0.8 0.5-1.0 mg/L
Creatinine, Random Urine 192 20-370 mg/dL
Folate Serum 15.9 >5.4 ng/mL
PSA, Total 0.82 0.0-4.0 ng/mL
Hemoglobin A1C 5.0 <6.0%
TSH, 3rd Generation 1.26 0.40-4.50 mIU/L
Ferritin 168 20-345 ng/mL
T4, Free 1.6 0.8-1.8 ng/dL
Vitamin B12, Serum 780 200-1100 pg/mL
DHEA SULFATE 368 110-510 mcg/dL
Также копия DEXA исследования от 6/20/08:
Dear Dr:
The following report summarizes important densitometry results on your patient using the Hologic QDR4500A energy densitometer and performed on 6/20/08 for osteoporosis.
T-Score= Standard deviation from peak bone mass
Z-Score= Standard deviation from age-matched reference values
Site Studied____________BMD g/cm2 _____T-Score______Z-Score
Lumbar Spine (L1-L4)_____0.704_______-2.8__________-2.8
Total Hip (Right) __________ 0.795_______-1.6__________ -1.6
Femoral Neck (Right)_____ 0.662_______-2.0__________ -2.0
Distal Radius (Left) 0.608_______-3.1__________ -3.1
This is a baseline study and, therefore, there are no interval changes.
Interpretation: The World Health Organization defines osteoporosis as a bone mineral density 2.5 standard deviations below a young normal, sex-matched group (T score less than –2.5). Osteopenia (low bone mass) is defined as a bone mineral density that is 1 to 2.5 standard deviations below young, normal, sex-matched population (T score between –1 and –2.5).Using these criteria, on the basis of bone density at the lumbar spine your patient has osteoporosis.