Help with symptoms/labs? Feeling a bit hopeless again.
Please let me know if you think this could be pituitary related - or not-, and what tests you might recommend that I forcefully request. I am hopeless at this point.
I am 42 y.o. female, feeling gradually more and more tired for a few years with the past year being by far the worst.
Fatigue, constantly cold no matter the layers, can't tolerate cold or hot temperatures, orthostatic low blood pressure, no libido, gained about 25-30 lbs in a year between the belly button and mid thigh only (15 lbs since June), feel queasy or not hungry most of the time, but eating for energy and (to be honest!) some comfort dark chocolate, always tired, can only think well for a few hours after waking up in am or after nap, hands feel weak. lots more little nagging things.
Have seen 3 pcps -
1st did blood workup & sleep apnea test. Said all was normal. Wanted to put me on daily stimulant.
2nd did a few more tests, said my symptoms could be tied to heart function, echo cardiograph showed everything was great. Said if I was too tired to work part time and have family life that I should quit.
3rd tested for auto immune diseases, chronic viral infections, thinks I am sub clinical hypo thyroid and my adrenal glands aren't working well. Also said to look into chronic fatigue and fibromyalgia. Also said if I didn't want to go to an endocrinologist that I should try nutritional iv therapy.
Had to stop working and my one last hobby 10/12 due to the fatigue.
Endo checked thyroid and did acth stim test. Put me on 25 mcg levothyroxine.
TSH 3.13 (.465-4.68) 2.12 in 11/11, raising steadily since then
T3 free 3.36 (2.77-5.27) was 3.48 in 11/11
Free T4 .84 (.59-2.19) was 1.3 in 2005, .95 11/11
cortisol 7.6 (4.5-22.7) was 10 in 03/12, in 7s every other check since then
ACTH 14 (10-60) only test
stim test cortisol levels 30 min 23.6, 60 min 28.7
thyroid antibodies both negative when taken in 11/11.
No other testing that falls into the endocrinology area.
8 weeks later did recheck and found that TSH had come down to 1.38, but no improvement in how I felt. Switched to smallest Armour dose and said I could use levothyroxine, armour or nothing, see you in 6 months.
Finally got into the university hospital endo yesterday. She saw the note from the 3rd pcp and zeroed in on chronic fatigue w/o even considering anything else. Seriously - she looked up the symptoms for cfs and never looked into anything else or asked any other questions. I asked about the low cortisol and low acth - possible secondary adrenal issues.
She said that I would have more tests off and different symptoms if I was having pituitary problems. But I have no other blood tests on pituitary hormones, and she didn't ask any symptoms?
She also said that my adrenals would not have responded to the stim test due to atrophy if it was secondary ai.
She went out and spoke with the head of her department - said that he said they treat subclinical hypothyroid, why not subclinical secondary AI. She chose to refer me to a chronic fatigue specialist. This makes me really angry because 1) she didn't know what the symptoms for cfs are 2) the only symptoms of cfs I have are fatigue and orthostatic low blood pressure 3)I told her that the pcp and I had looked into it and decided I don't have the main symptoms or enough of the symptoms.
Please - any advice you can give me would be so very appreciated. I have no idea what to do.
Re: Help with symptoms/labs? Feeling a bit hopeless again.
Suzanne, in my opinion you may well have Addison's disease. You have many symptoms, and the ACTH stim test, your cortisol level should double or more from 30 minutes to 60 minutes, which it did not. There are a few things additional that could be done, but I think you are very symptomatic for adrenal insufficiency and should be treated. Two additional tests to support that diagnosis nwould be anti-adrenal antibodies, as Addison's is an autoimmune disease, and a serum aldosterone level to check the mineralcorticoid part of adrenal insufficiency that causes orthostatic hypotension. Be sure to follow the positional directions prior to that blood draw. Other clues- look on your test results for lower range sodium (Na+) and higher range potassium (K+). They may be in normal range but borderline. Since you've been seen at the University endo clinic, I would return and ask to see the head of department armed with info, and ask for treatment based on not doubling your cortisol levels after ACTH. They can also do a pituitary panel if you are concerned about pituitary insufficiency. That includes all the anterior pituitary hormones. Good luck! Your PCP could order the adrenal antibodies and aldosterone for you. Also, see if you have any dark pigment deposits in the creases where your joints flex, inside your mouth, around the aereolas or overall darkening of skin color, like a tan, and point that out to Drs if you do.
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