Endo is being dismissive.
My 13 year old daughter has multiple symptoms of Cushing's - moon face, irregular periods, hirsutism, significant weight gain at odds with her diet, facial plethora, mild insulin resistance, striae on her sides, breasts, upper arms and upper thighs.
Looking at trends, when she'd had her period for about a year, she was getting it monthly, ranging from 21-29 days apart. In the past 6 months, she's had 4 periods, ranging from 36-51 days apart.
She did a 1mg dexamethasone suppression test and she did not suppress - she had results of 2.7 ug/dL for cortisol and <1.5 pg/mL for ACTH.
She has had two sets of late night salivary cortisol testing. Both times she returned one night in range and one night out of range. The upper limit of the lab range was 0.09 ug/dL. The first set she had a night at 0.121 ug/dL and a night at 0.043 ug/dL. The second set she had a night at 0.05 ug/dL and a night at 0.21 ug/dL. I ordered the second set out of pocket on my own since the endo was dismissive after the first set.
All other extensive bloodwork she's had done has returned as normal.
Endo says that salivary needs to be greater than 0.27. From what I can find, this seems to be based on a study from 2000. I sent her a study from 2021 on the lnsc in children, which concluded that anything over 0.09 was abnormal in kids.
She seems to chalk everything up to my daughter being overweight - and wants to put her on meds for the insulin resistance and hirsutism.
It's incredibly difficult to find a pediatric endo accepting new patients and I've been unsuccessful in getting my kid in anywhere else.
It seems, at the least, that additional testing should be called for. I'm not sure what I should be asking for, we have a return visit early next month.