DHEA supplementation for 12yo DD??? (DD = Dear Daughter)

[Kspedone]

Hi, I'm new to the forum and have enjoyed the insightful knowledge of Dr. Mariano. The physician my family is currently seeing has my DD on Armour 1/2 gr in am and increased to 1/4 gr in pm, HC 5mg BID, and wants to put her on DHEA 5 mg SL Q am due to low levels.

Here are her thyroid results from Labcorp(24 hr after 1/2 gr of Armour):
TSH 5.58 (0.360-5.8)
Free T3 4.1 (11-15 yr 2.6-5.7)
Free T4 1.21 (0.79-1.49)
T3 178 (80-200)

Initial saliva cortisol (1 yr ago):
Morning saliva cortisol 11.7H (3.7-9.5)
Noon coritsol 2.8 (1.2-3.0)
Evening cortisol 0.4L (0.6-1.9)
Night cortisol 0.3L (0.4-1.0)

Initial symptoms were: overweight, generalized puffiness, tired especially in the morning, difficult to wake up, restless sleep, moody, aggressive, more energy in the evening

DHEA-SO4 47.09L (54.4-255)

From 1/28/09:
Ferritin 59.0 (14-150)
25-OH Vit D 55 (20-100)

Is DHEA supplementation wise for a 12 y.o. girl....she has not started menses yet.
Thank you

[DrMariano]

Originally Posted by Kspedone

Hi, I'm new to the forum and have enjoyed the insightful knowledge of Dr. Mariano. The physician my family is currently seeing has my DD on Armour 1/2 gr in am and increased to 1/4 gr in pm, HC 5mg BID, and wants to put her on DHEA 5 mg SL Q am due to low levels.

Here are her thyroid results from Labcorp(24 hr after 1/2 gr of Armour):
TSH 5.58 (0.360-5.8)
Free T3 4.1 (11-15 yr 2.6-5.7)
Free T4 1.21 (0.79-1.49)
T3 178 (80-200)

Initial saliva cortisol (1 yr ago):
Morning saliva cortisol 11.7H (3.7-9.5)
Noon coritsol 2.8 (1.2-3.0)
Evening cortisol 0.4L (0.6-1.9)
Night cortisol 0.3L (0.4-1.0)

Initial symptoms were: overweight, generalized puffiness, tired especially in the morning, difficult to wake up, restless sleep, moody, aggressive, more energy in the evening

DHEA-SO4 47.09L (54.4-255)

From 1/28/09:
Ferritin 59.0 (14-150)
25-OH Vit D 55 (20-100)

Is DHEA supplementation wise for a 12 y.o. girl....she has not started menses yet.
Thank you

DD
What does DD mean? Developmentally Delayed?

THYROID
Thyroid hormone is much higher in children than adults. It is necessary to growth and development - on equal footing with growth hormone. Without thyroid hormone, growth hormone does not work as well.

Total T4 would be useful to know to determine what the thyroid glands are producing and to help determine the degree of suppression of one's thyroid hormone production resulting from the primarily T3 treatment with Armour Thyroid.

TSH > 2.0, from my point of view, is a hypothyroid TSH, and affects behavior significantly. For example, the sympathetic nervous system, often becomes elevated, in compensation, to help generate energy loss from the deficiency of thyroid hormone production (e.g. norepinephrine stimulates production of deiodinase enzymes, increasing T4 to T3 conversion). However, if brain function is compromised, TSH may not be accurately produced. Thus actual thyroid levels and physical signs and symptoms would be a better measure of thyroid function - assuming metabolic-nutritional problems are not occurring (e.g. suboptimal iron, suboptimal vitamin A, etc.), which affect Thyroid function.

HYPOTHALAMIC-PITUITARY-ADRENAL AXIS DYSREGULATION
A classic treatment is adrenal support using hydrocortisone. Hydrocortisone, however, may also suppress adrenal cortex production of the other signals produced in response to stress. This suppression of progesterone, DHEA, pregnenolone, testosterone, estradiol, etc. may have behavioral as well as physical consequences. For example, the deficit in androgen production may lead to impaired bone development, increase insulin resistance, increased fat storage, etc. Thus, when using hydrocortisone, generally it is important to consider adding at least an androgen to make up the deficit in adrenal cortex signaling that results from addition of exogenous hydrocortisone. If adrenal insufficiency is the actual diagnosis, then perhaps all the more important it is to replace a fuller spectrum of hormones from the adrenal cortex. However metabolites of DHEA - e.g. testosterone, estrogens - may need to be monitored to assess for excessive conversion from DHEA.

More important than adrenal support is to consider causes of HPA Axis dysregulation. This would include excessive sympathetic nervous system activity, increased immune system activity (proinflammatory cytokines of the immune system can reduce adrenal cortex hormone production), etc. Excessive sympathetic nervous system activity has numerous causes. For example, it may be in compensation for energy production impairment at several levels, it may be genetically determined as part of nervous system function. Here, nervous system treatment (e.g. with psychiatric medications) may be very useful.

NUTRITION
Optimizing nutrition all the more is important in a developing child. High density nutrition - as discussed in the book, Nourishing Traditions, by Sally Fallon - is highly important to optimize brain development. Saturated fats and fat-soluble vitamins are particularly important in brain development. Iron deficiency is a common cause of attentional problems and dysruptive behaviors. Considering optimizing iodine is useful in conjunction with thyroid hormone treatment. Etc.

[Kspedone]

Dr. Mariano,

Thank you for your reply. Sorry about the abbreviation...DD means "dear daughter" used on other boards.
I feel our current doctor is treating the labs and looking a symptoms, but is not getting to the underlying cause...especially since you are talking about the nervous system. But, I am appreciative that he is at least trying to help her...other doctors have said she is just fine. My daughter has always been intolerant to heat since a baby. After just several minutes out in the heat her face is beet red and it has always been that way. At her last well-check, she is now 50% for height and 95% for weight. As a younger child, she was always 95% for height and weight. I don't want to mess her up more by giving her medications she doesn't truly need, or not finding the true cause for all of her issues. This is very stressful for me as a mother! I want to do what is best for her.

[DrMariano]

Originally Posted by Kspedone

Dr. Mariano,

Thank you for your reply. Sorry about the abbreviation...DD means "dear daughter" used on other boards.
I feel our current doctor is treating the labs and looking a symptoms, but is not getting to the underlying cause...especially since you are talking about the nervous system. But, I am appreciative that he is at least trying to help her...other doctors have said she is just fine. My daughter has always been intolerant to heat since a baby. After just several minutes out in the heat her face is beet red and it has always been that way. At her last well-check, she is now 50% for height and 95% for weight. As a younger child, she was always 95% for height and weight. I don't want to mess her up more by giving her medications she doesn't truly need, or not finding the true cause for all of her issues. This is very stressful for me as a mother! I want to do what is best for her.

A serious deterioration in growth rate (such as a 95th percentile height child going down to a 50-percentile in height) requires further evaluation as to the causes. Hypothyroidism and growth hormone deficiency (implying causes of hypopituitarism), in addition to lack of nutrition (e.g. stimulant treatment, iodine deficiency, iron deficiency, etc.), would be considerations that come to mind.

In a female, there is a shorter time to catch up since the growth plates start closing as soon as menses start.

[Kspedone]

Thank you for your insight! My husband is active duty Air Force, and he would like to take her to Wilford Hall Medical Center in San Antonio to a Pedi Endo. I'm very hesitant to do this because as a nurse I know how they will most likely think...as most mainstream docs do, but I guess it's a start. I just feel like I'm wasting time.

[Kspedone]

Dr. Mariano,
Would giving my daughter HC cause her IGF-1 to decrease? For testing, would you recommend weaning off the HC prior to seeing the Pedi Endo? I know the docs at Wilford Hall will go nuts if they find out she's on HC and Armour!

[DrMariano]

Originally Posted by Kspedone

Dr. Mariano,
Would giving my daughter HC cause her IGF-1 to decrease? For testing, would you recommend weaning off the HC prior to seeing the Pedi Endo? I know the docs at Wilford Hall will go nuts if they find out she's on HC and Armour!

The use of Cortisol in the treatment of behavioral problems and non-adrenal insufficiency is not a recognized treatment by endocrinologists.

Thus, presenting already with hydrocortisone as a treatment may throw off their thinking process, and potentially prejudice their assessment.

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Note also that frequently, if a physician ends up thinking a person has a mental illness, their thinking becomes highly prejudiced or clouded by this. This causes some physicians to completely miss the presence of a physical illness in their assessment.

For example, when patients present with panic attacks and chest pain as a symptom syndrome to the emergency room, a significant number (e.g. up to 25%) are actually having a heart attack. Yet, if the physician prematurely attributes the chest pain to the panic attack and forgets to thus do an cardiac evaluation (e.g. EKG, blood tests), the heart attack can be missed. The physician may think chest pain is "all in your head."

Unfortunately, this is common human response given the stigma of mental illness.

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Hydrocortisone's effect on IGF-1 may vary depending on multiple factors. If the suppression of testosterone and DHEA signaling from the adrenal cortex is significant then IGF-1 may decrease. If the use of Hydrocortisone improves thyroid signaling, then IGF-1 may increase. The sum of these and other signal interactions may either increase, decrease, or have no change at all in IGF-1. The potential loss of IGF-1 is one reason balancing hydrocortisone treatment with an androgen is an important consideration.