Sorry for the book ahead of time, but my case is complicated.
So, I thought I finally had my answer and the doc taking care of me in the hospital was 70% sure this was it: adrenal insufficiency. I was very happy to finally have a diagnosis that would explain my symptoms and lead to actual treatment so that I could have my life back, but it turns out a may not have the diagnosis after all.
My morning cortisol level was the following while I was hospitalized:
Cortisol at 6am-2.1 mcg/dL
We all know that level is not normal. However, since then, my morning cortisol levels have been normal at 15 and 18, both taken at 9 am on two separate days. My aldosterone level was pretty much nonexistent (only 1) at 9 am though , and I am having a repeat cortisol and aldosterone test Monday morning because of my abnormal aldosterone and prior abnormal cortisol in the hospital.
However, I was told by my physician that my ACTH stim test was not only normal, but robust. I do not have the actual numbers yet.
Why I was admitted to the hospital:
Diffuse abdominal pain. Severe vomiting. Diarrhea. This turned into a BP going into the 70s/50s once I got onto the floor. After many fluid boluses, my BP stayed in the 80s/50s for a day and a half long after the vomiting had ceased. My HR fell to 50 and did not compensate my low BP. All I did was mainly sleep during my hospital stay. My BP and HR returned back to baseline and I was discharged without medication because the endocrinologist wanted to do more testing. The only thing out of whack was my WBC (docs think it was a stress response, not an infection, as it goes up with every one of these episodes), and my transferrin and iron binding capacity, of which I received a bag of iron. And, of course, the cortisol level.
I had to be watched in the hospital one other time previously overnight because of these symptoms and have had multiple ED visits. My BP has since been 90 systolic since my last hospital stay. It has been normal other times. It seems I’m truly having intermittent hypotension.
Since the last hospitalization, I have been back to the ED once. I had a near passing out episode where my vision went completely black, but I could still hear. Thankfully, I was laying down when it happened. I promptly vomited after I nearly passed out, so off to the ED I went…again. They gave me 2 liters of fluid in the ED and sent me home.
My salt has always been 134-135, but has gone up to 140 because I make a point to eat a ton of salt. I have never had high potassium levels.
Symptoms I’ve had:
Wt loss (decrease by 16 lbs.; have been able to gain 5 back with careful dieting), nausea every day, intermittent vomiting periods, constipation, dizziness, intermittent headaches, and brain fog, abdominal pain and swelling, debilitating fatigue and weakness (been getting worse since January; had to go out of work on Feb 20), and joint pain without outward signs of inflammation. Some days I’ve felt like I was going to collapse and die. Others, like today, I feel less crappy, but still not normal.
I have seen a rheumatologist and GI doc. I’ve had a colonoscopy, endoscopy, CT colonography, MRCP, ultrasounds, CT scans, stool testing, Lyme disease testing, TSH, celiac disease, all kinds of rheumatology tests etc. I am having sx for an ovarian cyst removal on May 23. It is 3 cm. CT colonography only showed gaseous distention of the small bowel. Everything else has been completely normal.
I was a functioning, working adult prior to this. I would like to return to “my old normal” if possible and am just looking for clues. Any help or information would be much appreciated. I just don’t understand why my AM cortisol was that low in the hospital when I was that sick. I also don’t understand why my HR didn’t kick up with that low pressure.
Has anyone experienced or heard of anything like this? Is it still possible that this is true adrenal insufficiency and my adrenals are in a stage where they’re only working somewhat when they feel like it? Have my labs not completely "caught up" all the way? Has anyone ever gone on a therapeutic trial of hydrocortisone just to see if their symptoms improved? Should I even ask? I’m concerned about my upcoming surgery if this could possibly be adrenal insufficiency.
My father also has adrenal insufficiency.
Thanks in advance.