Anne-MarieIn a word, "Yes" it is possible to have CAH and have elevated anabolics and what "appear" to be normal cortisol levels. Since the normal cortisol reference ranges are very wide, and no two people are alike, many LOCAH adults can go undiagnosed merely because their cortisol levels fall within the normal ranges. In reality, they are often at the lower to middle end of the normal ranges and not quite making enough cortisol. So although the levels appear to be within normal limits, they are never quite making enough for their own physiological needs. This means, any amount of cholesterol not able to be converted to cortisol, can be shunted down the metabolic pathways to be converted to excess anabolics and 17 OHP which is the pre cursor hormone for anabolic hormones made by the adrenal glands. In other words, your adrenal glands are making more of those hormones than they should for a female, which unfortunately may mean loss of weight or body fat stores, increased muscular appearance, hirsutism or extra hair growing on the face or darkening of the body hair.
Loss of hair or thinning of hair on the head can also occur, which occurs due to a rise in a hormone known as DHT (dehydrotestosterone) which is predominantly a male type hormone and the reason why many men lose their hair. You can take drugs or herbs to block the production of DHT, but it does not address the adrenal glands never quite making enough cortisol. So as a consequence I think it can affect thydroid problems also. Need to study that more. The above are just some of the physical symptoms that can occur and be noted in the early stages. Other’s may be your menstrual cycle not being regular and infertility due to PCOS and other hormonal factors. If cortisol levels are not elevated enough to deal with some bad periods of stress, you may also note that you cannot cope with it and have symptoms of depression or of being quite nervous and anxious etc.
They need to be checking and paying attention mainly to the 17 OHP and also other anabolics such as androstenedione or testosterone to diagnose this condition rather than paying any attention to the cortisol levels as like I say, the cortisol levels can "appear" to be within the normal limits, but some degree lower than "your normal."