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Forum Name: Endocrinology Topics

Question: Addisons, Conns, Cushing and Graves Disease


 Tech Runner - Sat Oct 24, 2009 2:31 am

This is my first post here and to start off I am not trying to self diagnose. I just like to be kept well informed. And well would like to see if maybe these choices are then ones that fit.
To Start I am a 38 yr Diabetic at approx 425lbs, I just recently had a debriment surgery and for an existing leg wound which was found to have a staph infection on top of it. I was given a broad spectrum antibiotic and the Staph infection was cleared. I was then operated on to have the debreminent surgery performed and then a negative pressure wound vac applied. Then graft is in place and we is doing wonderfully. When I was released from the hospital I was given Keflex which I had an allergic reaction to. I went to the ER and was given 50mg of Benadryl and it took care of the reaction. The thing is i then started having anxiety/ panic attacks. I was told that this was due to High BP and was placed on a low dose Benicar ( 20/12 ) this didnot lower enough so it was then increased to 40/12 as well as being given the Xanax to use as need at 1mg. For a while i was doing great, but now I am getting in office BP of 90/80 and at one point 80/60 was told to report to the ER, where they determined that I was 128/86. At the time I was told to wait and I would be the 4th person in. Well low and behold 3 hrs later I was still not looked at again even though I felt like i was going to pass out. I then ripped the bands off and handed them to the guard and left. I contacted my primary in the morning and was given a antibiotic as a caution for being in the ER and an Allergy medicine to clear me out as I had become stuffy headed. I returned to his office once again and when my pressure was taken it was again 90/60. We discussed briefly Addisons and Conns with the impression that it could be Conns. I was give and Gucosteriod to at .1mg to see if that would assist. Turns out that my face and eyes swelled and then meds had to be stopped. I have in process an full blood workup. But I now have insomnia ( i am currently righting this at 03:20am ) and when I do fall asleep I sleep for approx 10hrs. and feel like I have been run over by a convoy of freight trains. Due to my arthritis I cannot get up quickly so i cannot determine if i get dizzy when i stand though i have had bouts of when the room appears to shake back and forth.
I also have been having the need to eat more then I normally would then anxiety attacks are more frequent and i am seeking more salty food then i normally would. ( Due to my wifes diet for end stage renal failure we avoid extra salt ) When I wake I am in pain, sore and fatgiued. I am now up to 3mg of Xanax and also 5 motrin to help combat the pain. Vicodin and Xcontin have never been of any help and i refuse to use them. I guess what I am asking is are we on the right track with Addisons and Conns... I have extremly Low T and fit 90% of the low T diagnostics... or should we be looking elsewhere , once i have a copy of my blood work I have no problem with giving numbers if asked. An yes i am currently looking for someone on my insurance plan to perform a Gastric Band. I have found to many issues for a bypass ....
Thank you to anyone that can provide any usefull information
Thank you
T
 Dr.M.Aroon kamath - Mon Oct 26, 2009 8:55 am

User avatar Hi,
Having gone through your detailed account of your problem, i have the following comments to make...
- your symptoms do not fit well with neither Addison's disease nor conn's syndrome.
- It is quite possible that you may be attributing certain symptoms/events to these disorders.
- You say you are 'seeking' additional salt and attributing this to Addison's.
I am reminded of a saying...."When you hear the hoofs, think 'Horse' and NOT 'Zebra'!. The fact is "Common things Always occur commonly".
The 'common' reason for craving for salt in your case could have been the fact that you had been on a low salt diet for some time on account of your wife's end stage renal failure.Instead you tended to think of Addison's.The low salt diet could have caused the hypotension that you noted.
(kindly note that all these are my first thoughts after reading your account.It is quite possible that i turn out to be entirely wrong and you -entirely right)
Having said that, i feel that you took the right decision by going to the hospital for a check up.
Thank you for this thought provoking post.
 Tech Runner - Mon Oct 26, 2009 9:23 am

Dr.M.Aroon kamath,
Thank you for the reply, It is greatly appreciated. I have been trying to do a lot of my own research as well as looking into other avenues that could be part of the problem. When i wrote up the post I was not including some details that at the time I did not think where relevant. But also more then likely still wont point to Addisons or Conns. The seeking Salt might be due to the fact that of her Renal Diet though I would hope after 20yrs together I would have gotten over the need for it. Though I do not dismiss the idea. Some of the things that I did not mention was for the most part what I thought of as lifestyle and not attributing to my Health. The first being that for the longest time in Grade School ( meaning before Middle / JR High ) I would fluctuate greatly in weight going from "husky" to thin year after year until puberty where I was then stuck in the "Husky" set from then on. During JR and High School the cold did not bother me as much as it does now. I also have seen the same patterns in my brother as we where growing up. I know from last Blood work my Testosterone count was well below the established benchmark and then androgel did not provide any change. The same being with the T3 and T4 Uptake for my Thyroid. To be honest at this point I am waiting for my current blood work and some explanation and or idea to head next. As I have had a severe headache and fatigue for the last 2 weeks or more. As an example I went to bed last night with a blood sugar of 149, and had nothing to eat and went right to sleep awoke ( late ) this morning at 8:30am still feeling fatigued and the headache worse and when I arrived at work this morning my blood sugar was 135. If by chance you have a different Idea as to what may be wrong please let me know my doctor is open to any and all suggestions as he does not like to just "throw" medicine at some one and hope it works....
Thanks again
 Tech Runner - Mon Oct 26, 2009 11:28 am

Just a quick FYI I received the results from my blood work
My Thyroid TSH was 5.3 and my Testosterone was 190

Thanks again ....
 Dr.M.Aroon kamath - Mon Oct 26, 2009 7:15 pm

User avatar Hi,
Your testosterone is low.I see that your TSH is on the higher side of the lab reference range.It would have been more generous of you to let us know the T3 & T4 values as well, as all these add up in arriving at a reasonably sensible opinion.Thank you for the update.
 Tech Runner - Wed Oct 28, 2009 11:17 am

When I had called in to get the results they gave me the basics. I have the full blood work results coming in later today so i can give you the T3 and T4 results as well.
They ruled out Addisons and CHF which I was relieved at as CHF runs in the family heavily on my mothers side.
Thanks again
 Dr.M.Aroon kamath - Fri Oct 30, 2009 10:24 am

User avatar Hi,
If you got better, i will be the first to be satisfied.Get well soon.Cheers!
 Tech Runner - Thu Nov 12, 2009 1:21 pm

Dr.M.Aroon kamath and anyone else wishing to give me some ideas....
I have 2 sets of blood work test results now.
I will post the first set, then the 2nd set since i don't know what is relevant so I will post everything i can. I will not post the normal range listings as I a sure more of you don't need that ...

First Set of Blood Work:
T4 ( Thyroxine ) 6.9
T3 Uptake 30
Free Thyroxine Index 2.1
Cortisol 7.3
Progesterone <0.2 ( Low)
CBC with Diff/Platetelet
WBC 6.7
RBC 4.36
Hemoglobin 13.8
Hematocrit 38.7
MCV 88
MCH 31.5
MCHC 35.7
RDW 13.2
Platelets 147
Neutrphils 74
Lymphs 17
Monocytes 6
Eos 3
Neutrophils ( absolute ) 5.0
Lymphs ( Absolute ) 1.1
Eos ( Absolute ) 0.2
Baso ( Absolute ) 0.0

Comp metabolic Panel (14)
Glucose , Serum 171 High
BUN 0
Creatinine, Serum 0.93
eGFR > 59
Bun / Creatine Ratio 10
Sodium, Serum 140
Potassium, Serum 3.7
Chloride, Serum 106
Carbon Dioxide Total 22
Calcium, Serum 8.8
Albumin, Serum 4.0
Protein Total, Serum 6.4
Globulin Total 2.1
A/G Ratio 1.7
Bilirubin 0.4
Alkaline Phosphatase, s 62
AST (SGOT) 28
ALT (SGPT) 35

Lipid Panel
Cholesterol Total 166
Triglycerides 152 High
HDL Cholesterol 38 Low
VLDL Cholesterol Cal 30
LDL Cholesterol Calc 98

TSH 5.330 High

Testosterone Serum 194 Low

Hemoglobin A1C 5.9

Angiotensin-Converting Enzyme
ACE 69 High

Prostrate Specific AG Serum 0.3

That is the end of the first blood work

The next current blood work is a little longer , but listed the same way. But in a different order as it was a different lab.

Testosterone % Free 0.13 (L)

TSH ( Ultra Sensitive ) 5.02 ( H )
Free T4 ( Free Thyroxine ) 1.08

Estradiol 68 (H)

Testosterone, Free and Total
Testosterone Total 797
Testosterone Free 1.05

LH 5.1

CBC W/Diff
White Blood Count 8.7
Red Blood Count 4.93
Hemoglobin 15.0
Hematrocrit 44
MCV 89
MCH 30.4
MCHC 34.3
RDW 13.2
Platelet Count 162
MPV 9.8
Neutrophils (Absolute) 5.60
Lymphocytes (Absolute) 2.20
Monocytes (Absolute) 0.60
EOSINOPHILS (Absolute) 0.30
BASOPHILS (Absolute) 0.00
Neutrohils % 64.6
Lymphomcytes % 25.6
Monocytes % 6.6
EOSINPHILS % 2.9
Basophils % 0.3

Prolactin 15.7

Blood work is approx 6 weeks apart and after having a Shot of Testosterone in the upper left arm. The Shot was given 1 week after the first blood work was done.
Let me know your thoughts and ideas. The first few days after the shot I felt pretty good, but now I feel the same as I did before. Run down, exhausted and fatigued.
My sugar tests have been running in the 220's in the morning after breakfast, after that they are normally around 120 to 160 for the rest of the day. I take 45 of lantus in the morning and 30 at night and on a sliding scale of 4 units for every 50 points above 150. Also I have noticed that I am getting the shakes if i go below 120. I was at 112 the other day and was shaking like crazy. Also I have been having bouts of sleeplessness and bouts of falling asleep at anytime... This has not become a real endangerment to my career as it is happening at work as well. I do have sleep apnea and currently use my BiPap every time I sleep and its current setting is 14

Thanks again, I know this is not easy but I need some king of answer other then my being overweight. I have been overweight since i was a child and never had the issues I am having now.

Thanks again
 Dr.M.Aroon kamath - Sat Nov 28, 2009 4:39 am

User avatar Hello,
Thanks for your follow- up post.
You have said..."I will not post the normal range listings as I a sure more of you don't need that ...".
The reference ranges are the most important in interpreting any laboratory values.Without this information, it would not be right to venture any opinion.

Thanks all the same!
 Tech Runner - Sat Nov 28, 2009 5:27 pm

Dr.Aroon Hamath,

I did not realize that the standard range levels will be needed. I will post those as soon as I can. And I understand where you are coming from.

Thanks again.

T
 Dr.M.Aroon kamath - Tue Dec 08, 2009 11:39 am

User avatar Hi,
Thank you for the update. Thank you for your deep understanding and warmth. Good luck!

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