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Forum Name: Endocrinology Topics

Question: pheochromocytoma? Cushings?


 squooge - Tue Jul 24, 2007 12:44 pm

I am 40 yo female who's only past health concerns is hypertension that started in my first pregnacy, returned to normal, elevated during my second pregnancy and has stayed high. I take Altace for about 3 years and have had good control. I also have a MVP that requires no treatment other that antibiotics during dental work. About a year ago I started to have muscle weakness and fatigue that eventually kept me from exercising. I also gained about 30 pounds in a year, some probably due to my inability to work out. My hands and feet are swollen. My hair started thinning and I have left flank/rib pain that is sore on palpation. I have had 3 episodes of tachycardia/flushing. One happened in the doc's office and my resting pulse was 140. He ran a bunch of test. All were normal but the following:

plasma creatinine .78 (range .9-1.3)
plasma calcium8.65 (range 8.8-10.2)
normetanehprine, 24 hr ur 389 (range 52-320)
cortisol, 24 hr ur 61 (range 4-50)

He says that none of the tests explain my symptoms and there is no further investigation warranted. He then mentioned a stress test and cardiac ultrasound. Would you agree?
 Dr. Chan Lowe - Tue Jul 31, 2007 3:38 pm

User avatar Hi Squooge,

Your symptoms make me suspicious of hypothyroidism. This commonly will present as fatigue and weight gain. It also can cause thinning hair.

Pheochromocytomas are quite rare. I would have expected your urine levels of normetanephrine to be higher with a pheo. Your plasma creatinine should really be considered normal even though technically outside the normal range. The calcium level is only slightly low. I suspect if you were to check an ionized calcium level (the bioactive form) it would be normal.

Cortisol fluctuates significantly during the day. It is best to have it tested early in the morning when more standard normals have been determined. Even with this, your level is not particularly high.

Follow up with your doctor is important. If there is concern about your heart a stress test and ultrasound are appropriate.

Best wishes.

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