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HomeAnswersInternal Medicineadrenal insufficiencyWhat causes low BP and severe stress intolerance?

Why am I having low BP and severe intolerance to stress?

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

iCliniq medical review team

Published At May 20, 2016
Reviewed AtJune 29, 2023

Patient's Query

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 mcg/dL, 1 PM - 0.11 mcg/dL, 5 PM - 0.33 mcg/dL and at midnight 1.65 mcg/dL. I have a high 5-HIAA test too and the value was 7.2 mg/24 h. My biggest symptom is the intolerance to stress and low blood pressure with severe weakness.

Answered by Dr. Sadaf Mustafa


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?

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Sadaf Mustafa
Dr. Sadaf Mustafa

Internal Medicine

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