Q. Why am I having low BP and severe intolerance to stress?
Answered by Dr. Sadaf Mustafa and medically reviewed by iCliniq medical review team.
New
Do you have a question on Adrenal Insufficiency or Addison's Disease? We have medical experts to help you right away. Ask a Doctor Now »
Hi doctor,
I have severe intolerance to stress, low blood pressure, dehydration, hyperpigmentation and a lot of other troublesome symptoms. When I eat my face flushes and my heart rate goes up and my body sweats. I have carbohydrate intolerance as well. My skin is brown in color with a lot of freckles, which is not normal for me. I was recently diagnosed with reactive hypoglycemia and it is getting worse. My diurnal saliva cortisol are as follows. At 8 AM - 1.37, 1 PM - 0.11, 5 PM - 0.33 and at midnight 1.65. I have a high 5-HIAA test too and the value was 7.2. My biggest symptom is the intolerance to stress and low blood pressure with severe weakness.
Related Questions:
• I had an ACTH stimulation test today. Should I get any physical reaction when the ACTH is in?
• Why am I having low BP and severe intolerance to stress?
• Should hypothyroidism medicine be given for TSH level 8.12?
Dr. Sadaf Mustafa
MBBS., RESEARCH FELLOWSHIP., MD (INTERNAL MEDICINE) RESIDENCY COMPLETION., DIPLOMATE IN AMERICAN BOARD OF
General Medicine, Internal Medicine
Hello,
Welcome to icliniq.com.
- Keeping in light all the symptoms you have mentioned, you are most likely suffering from adrenal insufficiency.
- There are two types and the hyperpigmentation usually occurs in primary type also known as Addison's disease. I am taking the AM cortisol as low. I am not sure which unit was the laboratory using. Your symptoms are classical for low cortisol rather than high cortisol.
- You would need investigation for other types of autoimmune disease to make sure it is not part of poly-glandular syndrome and of course treatment for it.
- It appears from your history that you are on thyroid medication which point towards autoimmune adrenalitis (inflammation of adrenals) being a cause for Addison's disease. I would suggest repeating the urinary cortisol again when you are not taking any steroids.
- The elevated 5-HIAA (5-hydroxyindoleacetic acid) represents carcinoid syndrome (group of symptoms is carcinoid tumor, which is a slow-growing neuroendocrine tumor). It happens due to a 5-HIAA secreting mass mostly in bronchus and appendix, but in your case I am wondering if it is in adrenal glands causing adrenal insufficiency.
- In order to generate a better plan of care let me know if you have had ACTH stimulation test. Did you undergo CT or MRI of the abdomen?
- Did you use steroids ever? If yes, how do feel when you use them?
- Do you have diabetes? Can you upload a picture of your most recent blood work which includes CBC (complete blood count), CMP (comprehensive metabolic panel), HbA1c and cholesterol?
Revert back with the answers and reports to an internal medicine physician online -->https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician
Related Questions & Answers
What can be the reason for extreme lethargy in an Addison's disease patient?
Query: Hello doctor, I have Addison's disease and I am taking Hydrocortisone twice daily and Fludrocortisone one daily. I am taking vitamin D supplement. The last endocrinologist appointment showed higher levels of antibodies in the thyroid; however, the thyroid levels remain good and the scan reveals a... Read Full »
Query: Hello doctor, I have Addison's disease and I am taking Hydrocortisone twice daily and Fludrocortisone one daily. I am taking vitamin D supplement. The last endocrinologist appointment showed higher levels of antibodies in the thyroid; however, the thyroid levels remain good and the scan reveals a... Read Full »
Dr. Shaikh Sadaf
Diabetologist, Endocrinologist, Family Physician, General Practitioner
Answer: Hello, Welcome to icliniq.com. I just read your query and from what you have mentioned, it appears that although you have antithyroid antibodies, the thyroid function is normal so there is nothing related to the thyroid that could be responsible for your symptoms. However, it could be attributed to... Read Full »
Diabetologist, Endocrinologist, Family Physician, General Practitioner
Answer: Hello, Welcome to icliniq.com. I just read your query and from what you have mentioned, it appears that although you have antithyroid antibodies, the thyroid function is normal so there is nothing related to the thyroid that could be responsible for your symptoms. However, it could be attributed to... Read Full »
What is an acceptable level of cortisol in someone with PTSD?
Query: Hello doctor, I am a 35 year old male. What is the normal range of cortisol in a 24-hour collected urine probe? Is having too low cortisol levels in 24-hours collected urine probe a clinical matter? In the last six months, I had three urine testings with the account of cortisol between 10-12 &micr... Read Full »
Query: Hello doctor, I am a 35 year old male. What is the normal range of cortisol in a 24-hour collected urine probe? Is having too low cortisol levels in 24-hours collected urine probe a clinical matter? In the last six months, I had three urine testings with the account of cortisol between 10-12 &micr... Read Full »
Dr. Nazma Parveen
General Practitioner
Answer: Hello, Welcome to icliniq.com. You have not mentioned why you got your urine cortisol levels checked. The normal cortisol levels vary between 10 to 100 micrograms and vary from one person to another and is affected by many factors. What are the symptoms you are experiencing? Are you having any sl... Read Full »
General Practitioner
Answer: Hello, Welcome to icliniq.com. You have not mentioned why you got your urine cortisol levels checked. The normal cortisol levels vary between 10 to 100 micrograms and vary from one person to another and is affected by many factors. What are the symptoms you are experiencing? Are you having any sl... Read Full »
In what conditions can a person have cyclical Cushing's syndrome?
Query: Hi doctor, I am 21 years now. I weigh 60 kg and was diagnosed with cyclical Cushing's syndrome at the age of 20. I had an MRI scan for a pituitary tumor in my brain. But, the clinical findings did not match up. I went to a top end endocrinologist who is a professor in endocrinology. I have beard ... Read Full »
Query: Hi doctor, I am 21 years now. I weigh 60 kg and was diagnosed with cyclical Cushing's syndrome at the age of 20. I had an MRI scan for a pituitary tumor in my brain. But, the clinical findings did not match up. I went to a top end endocrinologist who is a professor in endocrinology. I have beard ... Read Full »
Dr. Sumit Srivastava
Internal Medicine Physician
Answer: Hi, Welcome to icliniq.com. No, there is no other pituitary in the brain and sometimes urinary test fails to detect hormones. In cyclical Cushing's, the cortisol levels fluctuate over time, making the diagnosis even more difficult. The source of ectopic hormone production should be searched for, o... Read Full »
Internal Medicine Physician
Answer: Hi, Welcome to icliniq.com. No, there is no other pituitary in the brain and sometimes urinary test fails to detect hormones. In cyclical Cushing's, the cortisol levels fluctuate over time, making the diagnosis even more difficult. The source of ectopic hormone production should be searched for, o... Read Full »
Most Viewed
Why are the veins in the penis swollen?
Hi doctor, I am 29 years old man, currently having issues with my penis. So it has been exactly one week where I was do ...Read more »
Is my behavior indicative of bipolar disorder?
Hello doctor, I am 18 years old and I do not know what is wrong with me. I think I have severe depression and anxiety, ...Read more »
What Are the Advancements in Cancer Treatment?
With advances in science, cancer treatment is not just the domain of surgery, but radiation therapy and chemotherapy equ ...Read more »