For many years I’ve seen the same endocrinologist.

He’s a pediatric endocrinologist though, so my mom suggested I might want to consider switching to an adult endocrinologist.

She’s still good friends with my original endocrinologist, and asked him if he would recommend anyone. He said, “yes, see this Dr.”

You could say that “This doctor” is my original endocrinologist’s protege’. They work in the same practice, so if anyone should be qualified, it would be this guy.

Result? He’s awesome.

He’s younger than my current pediatric endocrinologist. Young enough to click with me and gel with my current goals in life; where-as the pediatric Dr. was more fatherly.

When I asked him about the specific endocrinologist goals of a pediatric vs adult doctor, the new doc pointed out that as a pediatric endocrinologist, you tend to have 1 goal

  • Make the kid tall; squeeze every inch you can out of them

Now that I’m an adult though, that goal has come and past. I’m not growing any more. So an adult endocrinologist’s goals are a bit different

  • Maintain appropriate medicine levels to keep you normal
  • Educate you on family planning issues
  • Keep you away from various endocrine problems
    • Conn’s syndrome
    • Diabetes
    • Testicular adrenal rests
    • Heart problems
    • and a myriad of other badness that can occur

Most of the above badness is due, in large part, to you not keeping up with your medication.

I told him how I had specific physical goals in life, and how I wanted him to be the officer in charge of teaching me about my condition and handling the specific medical issues that may arise while trying to achieve said goals.

I know tragically little about my condition, and a lot of what I know is, as he put it when I described what I thought my condition meant, “voodoo” and “plain out wrong”.

I feel bad about that, since my perception of the condition has driven my life for the past 28 years; and my perception was wildly inaccurate.

So he and I had a long talk about a lot of things. He explained, in much more clear terms my deficiency in aldosterone and cortisol. I never knew what my medications replaced. Turns out Fludrocortisone replaces Aldosterone and Dexamethasone replaces Cortisol.

He also explained the tree of metabolic synthesis that happens to get cholesterol to 17-hydroxyprogesterone and that to aldosterone and cortisol. He explained the relationship between the pituitary gland and adrenal glands (finally).

It boils down to a positive feedback loop that occurs between Adrenocorticotropic hormone (ACTH) produced by the pituitary gland and the hormone Cortisol.

If the brain isn’t seeing those produced in significant quantity, it ramps up the ACTH production. Overproduction of ACTH can cause a range of badness to occur, mostly related to effects you see from increased testosterone in a person (not so bad for dudes, but tragic for dude-etts)

It was an enlightening experience. He ordered several tests to baseline my current state, and was thought that (based off my last blood test) that my dosages of fludrocortisone and dexamethasone may both be a little high, and we may be able to knock them back a little. Dexamethasone in particular has some crappy long term effects like osteoporosis.

I left feeling incredibly content, and much less stressed out.

He also suggested that if I remain on my 1.5 pills, that perhaps I should switch up the dose that I take in the morning and night. Right now I take the larger dose in the morning, but he pointed out that the peak of ACTH production occurs early in the morning (2 to 3 am), and that he asks his patients to take the larger dose at night for this reason.

I think he fits the bill. I’m glad to have been referred to him.