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ChaoticNeutral · 03-30-2011, 07:16 AM

Hello, everyone!

I come with yet another request for help analyzing my symptoms and test results. I'm seeing a great doctor who so far seems to be very dedicated, who I'll be seeing again on April 8th, after the last two test results (ADH serum levels and adrenocorticotrophic) arrive.

My doctor's hypothesis is adrenal insufficiency, but the latest test results seem to disagree with that, so I'd like to hear some opinions. I'm aware this is a pacient-to-pacient forum, but any help will be welcome. I'm tired of feeling so bad so frequently, missing class, watching my life pass by while I'm bedridden with overwhelming fatigue.

The symptoms started around September/2010. I haven't been sleeping well since then - on the average, I wake up every 2:30hrs to urinate. It doesn't matter how much I drink or don't. The fatigue got worse this year. Sometimes, out of nowhere it's like my "power cable" is unplugged. I feel completely exhausted, drained, even my speech becomes slurred. My heart rate dropped from around 75-80bpm to 59-60bpm. I get dizzy when I stand up - sometimes only a few times per day, sometimes every single time I sit and then stand. I've been having bloating, flatulence and lose stool constantly. My hair started to fall, nothing excessive but SO much more than it did before.

Lately I've been having salt cravings (and less frequently sugar cravings), and have no appetite even when completely hungry - the thought of food disgusts me.

The stream of lab tests started after in February I got a sudden, piercing pain at my stomach. It was so terrible I couldn't walk. It was like I was being stabbed, right under the lower left side of where the stomach is (I think). I went to the ER and came back home with no answers. There was much noise going on in my bowels, and a sonography just showed there was some fluid accumulated between my intestines. The pain started to get better after three or four days.

When the sudden, extreme fatigue starts, I get very emotional. It could be just me being scared, of course. I've been on treatment for depression before, but stopped the meds (gradually) after two years since other coping mechanisms (better life, physical activity, etcetera) showed to be far more efficient (the meds made no difference, only gave me side effects). Recently I've been very moody, though. Going from crying nonstop (even though I don't really feel THAT sad) to being terribly aggressive.

My most recent lab tests are as follows. Bear in mind I take contraceptive pills, so that's probably why some are a little bit messed up. Also, forgive any spelling problem, English isn't my first language.

TSH: 2.4 uUI/mç (range: 0.4 - 4)
FT4: 0.90 ng/dl (0.89 - 1.73)
Cortisol: 34.5 ug/dl (5 - 25)
Prolactin: 18.3 ng/ml (1.9 - 25)
LH: 0.1 mUI/ml (??)
FSH: 0.10 mUI/ml (??)
Serum sodium: 142.0 mmol/l (136 - 145)
Serum potassium: 4.4 mEq/l (3.5 - 5.2)
Serum osmolarity: 294.27 mOsm/K (note it's osmolaRity) (285 - 310)

These were made a few days before:

Direct coombs: negative
Platelets: 226 000 /uL (150 000 - 400 000)
Reticulocytes: corrected: 1.1%, not corrected: 0.9%
VCM: 107.2 fl (my doctor gave me B12 shots since macrocytosis was going on for months even though the B12 levels were around 350, as seen in other tests. I won't be writing the rest of the hemogram results here, as I think it's not relevant. Let me know if it is though!)
Urine pH: 8.0
Urine density: 1 010
Negative for protein, glycose, hemoglobin on urine.
Serum albumin: 3.6 g/dL (3.5 - 5)
Serum bilirubin: direct 0.4 mg/dL, total 0.6 and indirect 0.2
Serum calcium: 9.3 mg/dL (8.4 - 10.2)

24hrs urine chlorides: 284 mEq/24hrs
24hrs urine volume: 4500 mL (and I drank much less than I usually do)
Urine creatinine: 851 mg/24hrs (800 - 2800)
Serum glycose: 77mg/dL (74 - 106)
Serum potassium: 4.4 mEq/L (3.5 - 5.1)
LDH: 444 U/L (313 - 618)
Serum magnesium: 2.2 mg/dL (1.6 - 2.3)
Serum sodium: 142 mEq/L (137 - 145)
Urine sodium: 306 mEq/24hrs (40 - 220)
Serum osmolarity: 287 mOsm/L (275 - 305)
Urine osmolarity: 587 mOsm/L (???)
Urine protein: 405 mg/24hrs (42 - 225)
AST: 18 U/L (14 - 36)
ALT: 62 U/L (9 - 52)

Stool sample showed nothing wrong (no fat, blood, parasites).

Thank you so much for taking your time to read so much whinning and please please please, if you have anything to share, any hypothesis or results interpretation, please do!

ChaoticNeutral · 04-05-2011, 03:22 PM

Edited to add reference values. Anyone has anything to say? :/

KCA82 · 04-05-2011, 04:29 PM

ALT enzymes considerably elevated. Dont think the issue is a Liver problem. Its something causing the higher level ALT. Where were your stomach pains located exactly? Could be a glandular disorder causing the extreme mood swings. Glandular because they regulate hormone production and secretion. The salt cravings could indicate Hypothyroid or doubtedly, but possibly diabetes.

ChaoticNeutral · 04-05-2011, 05:07 PM

Thank you for your answer, KCA82. I'm not finding much on the internet about something that could cause an elevated ALT level, other than liver issues. One site does say, and I quote: "other common health conditions, such as diabetes, heart disease, and thyroid disease, can cause or augment liver transaminase elevations." Do you have any hypothesis? I've been wondering if my thyroid isn't a little bit crazy, and in fact I just posted on the thyroid issues forum here. About the diabetes, I don't know. My blood glucose levels have been consistently low since around September/2010 (always under 80, the range being 70-100). Could someone have diabetes even with a low glucose?

The pain was right under the stomach. You know where the sternum ends? In that space, a little bit to the left. The pain has gone, but I'd really like to know what started it in the first place, if it's related to the other physical issues I've been having or if it was some isolated thing. I'm not one to get sick frequently, let alone have to go to the ER. And the pain continued for a week before slowly disappearing.

I'll be talking to my doctor again next Friday, and I hope to have more answers, or at least another doctor, this time an Endocrinologist, to talk to.

ChaoticNeutral · 04-06-2011, 08:57 AM

The remaining results just arrived. It seems that indeed I have no adrenal problem. That's a huge relief!

Now, I just hope to find something that explains those symptoms and get it solved as soon as possible. It's always wonderful to know you *don't* have some illness, but on the other hand it's very distressing to feel so bad and have no diagnosis and, as a consequence, no treatment.

Here are the results:

ACTH: 10.1 pg/ml (7.2 - 63.3)
ADH (vasopressin): <1.4 pg/ml (<24)
Serum osmolarity: 294.25 mOsm/Kg (280 - 310)

ChaoticNeutral · 04-07-2011, 02:52 PM

I'll be staying in a hospital next Monday and Tuesday for more tests, including a water deprivation test (to investigate the possibility of diabetes insipidus) and a tomography of the pituitary, as my symptoms remain unexplained, specially the polyuria that is keeping me from sleeping for nearly eight months now.

As for the depression, I'm still feeling awful. Honestly, it's hard to even come here to post. I just feel like disappearing from the universe altogether.

Tennis8240 · 05-05-2011, 04:44 PM

Hi. I'm no expert in this at all, but I've been reading a lot on these boards, and have hypothyroidism and adrenal insufficiency along with some other things. To me it seems you are hypothyroid. Your Free T4 is too low. Also, having a cortisol level that high seems like it might be Cushings, which is basically the opposite of Addison's. I'm not sure where the ACTH levels sit as related to Cushings though. I have adrenal insufficiency and my cortisol was 3.5. They either never did an ACTH level or never told me what it was. Cushings just might be something for you to look into, and I would definitely see someone about your Free T4

Good luck, and hope you feel better

eka4987 · 05-18-2011, 12:08 AM

Cortisol: 34.5 ug/dl (5 - 25)???
Wouldn't that be high?
I find it odd you have an ACTH of 10 but a high cortisol. My ACTH is 10 and Cortisol 7.2. To think my doctor doesn't think there is a problem. I would really do research on Cushing's Syndrome and do some more testing. ACTH is what tells your body to make cortisol and yours isn't saying to make a lot of cortisol although it is. Are you on steroids because that could affect your Cortisol. If not that would raise concern for me.

confused34 · 06-08-2011, 04:09 PM

Quote:

Originally Posted by eka4987

Cortisol: 34.5 ug/dl (5 - 25)???
Wouldn't that be high?
I find it odd you have an ACTH of 10 but a high cortisol. My ACTH is 10 and Cortisol 7.2. To think my doctor doesn't think there is a problem. I would really do research on Cushing's Syndrome and do some more testing. ACTH is what tells your body to make cortisol and yours isn't saying to make a lot of cortisol although it is. Are you on steroids because that could affect your Cortisol. If not that would raise concern for me.

I agree, cortisol shouldnt be that high with a ACTH value of 10. Cushings is a possiblity. A late night cortisol test might be inorder to rule out cushings. The odd thing here is the low Blood sugar as I would expect a higher than normal BS level with that high of a cortisol level. The Dr should have looked at the relationship of the ACTH to the cortisoll and thought to himself,. umm the ACTH is inappropriately low for a high cortisol. http://jcem.endojournals.org/content/83/2/348.abstract
sorry for the Ramble.

Jennifer S · 07-10-2011, 06:26 PM

I know this may sound small, considering your symptoms. I know the extent of your circumstances. but I do have adrenal failure. On a hunch I had my doctor check my vitamin D level. It was virtually gone! She put me on 50,000 IU a week, and although I still battle extreme fatugue most of the time, it has helped tremendously. I had no idea that even with the extent of my disease that one vitamin could make such a difference, my hair stopped falling out, my joints and bones feel a little better. I know that addisons disease can be hard to diagnose, and that it has to be an 8 A.M test. Good luck!! and God Bless!!! I stayed in prayer, and faithful that God would lead them to the problem, I almost had to die, and came out of a septic shock coma, and told them to check my adrenal glands, which I had no idea what they were at the time, but God saved me, by speaking through me, so if that can happen, I have faith for you!

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