Q. Of late, I have a lot of health issues including weight gain, hair loss, and easy bruising. Why?

Answered by
Dr. Uphar Gupta
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jun 28, 2017

Hello doctor,

I am a 43 year old female. My height is 5 feet 6 inches, and I weigh 185 lbs. I feel awful. Please tell me what you think may be wrong. Most of my adult life weight was 150 to 155 lbs. A sudden weight gain started five years ago. My weight is now always in the 175 to 185 range. I eat an extremely healthy diet. I do not eat any processed meat, almost no processed food, wheat, sugar or dairy. I eat only whole foods. I cannot control my weight unless I starve. The majority of the weight is concentrated only in the abdomen, breast, neck, and face. I have isolated fat pockets shaped like eggs above the collar bones, and my face is round and red. My upper back has an odd fat hump. My legs and arms are thin, calves too thin, butt too small, and, I look nine months pregnant.

I was bulimic from the age of 23 up to 40. I still struggle with eating disorders, but I am not purging as much as I used to. Osteopenia was detected last year. I have lowered energy, generalized fatigue, and muscle weakness from the past two years. My sleep issues have gotten much worse in the past four or five years. I have trouble falling asleep, and sometimes I am awake throughout the night. I have depression, anxiety and get extremely emotional of late. I suffered a nervous breakdown, extreme sensitivity, paranoia, high anxiety, and worry. I rarely, if ever, leave the house. So, I have no friends. Sometimes, I will not even go outside for two or three weeks at a time. My cognitive difficulties have become very noticeable in the past three years or so. I often cannot find words, have trouble with spatial intelligence, have no short term memory, have difficulty with long-term memory as well. I feel lost like I am floating.

I have had a high blood pressure for at least five years now, but it was never officially diagnosed. My BP still fluctuates and is not controlled with the daily 20 mg Lisinopril. My legs and feet have been swollen for the past three or four years. My hands and neck too sometimes look swollen and puffy. My feet feel hot and sweaty often. I have high cholesterol levels from five years, but it is currently untreated. My legs, arms, and hands bruise extremely easily. It takes a very long time to heal. The skin on my hands and arms are thin and shiny, The skin of my upper arms, hands, and face, have lots of broken capillaries. My hair once almost fell out completely, about 60 percent of it, all at once. Now my hair is odd, thin and dry. I also notice some increased facial hair in the past year. I have toenail fungus from the previous five years or so. I had three rounds of anti-fungal treatment, but it would not go away. 

I have acid reflux from the past three or four years. I always have constipation, which has gotten worse over the past five or six years. I have extreme bloating from the past five or six years. It happens anytime I eat, irrespective of what type of food it is. I first encountered kidney stones five years ago and had to undergo surgery the same year and, one again in the subsequent year. I was informed by my urologist that I have many stones. I have passed one since, but do not know how much more I have. About seven years ago, I had some inflammatory eye problem, which I was told was chalazia. I still have trouble with both the eyes. Sometimes, they are painful, and I spend the morning with a blurred watery vision. I was diagnosed with scoliosis as a teenager, for which I underwent a spine reconstruction surgery last year.  I am recovering well, but do not know yet if the bone graft was a complete success. I still experience some pain. I had a rectocele repair surgery twenty years ago. I still have some issues, but I think it is due to chronic constipation. Also, I have recurring hemorrhoid which I also believe is due to chronic constipation. I have been on some form of opioid for the past two years. And, the six months following my surgery, I was on extremely strong medicines. I took Dilaudid for about three months.

I had lab tests done ten days prior, and I am concerned about few values. Cortisol - 19.5, ACTH-Mayo - 63 pg/mL , FSH - 6.4 mlU/mL, LH - 2.1 mlU/mL, Progesterone - 0.21 ng/mL, and Estradiol - 21. I have stopped all of my supplements for about two months except collagen and biotin. I did not think it would affect any of my results. Then, I read that biotin can cause false high positives. I do not think this would have impacted my results, as they are all relatively low. Also, as I noted, the cortisol and ACTH is supposed to be tested around 8 AM, but I was not tested until noon.

#

Hello,

Welcome to icliniq.com.

I have gone through your history, and commend you for the detailed presentation.

You appear to be suffering from Cushing's syndrome. You have probably consumed steroids as a supplement or for pain relief.

You have achieved menopause at an early age, but still, we do not characterize this as abnormal. So, do not worry.

I suggest the following:

  1. Continue your anti-hypertensive medications.
  2. Get a TSH level done.
  3. Plan to get an MRI of the pituitary gland later.
  4. Start Atorvastatin for cholesterol, 20 mg at 10 PM.

As I attribute all your issues to hypothyroidism, everything is manageable.

For more information consult an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician

Thank you doctor,

I did have TSH levels tested. It was in the normal range. I also had a 24UFC that was normal. I do feel like I match so many of the Cushing's symptoms. I am quite positive that I have never taken a steroid as a pain relief or as a supplement. If the TSH is normal, and ACTH is high, serum cortisol slightly elevated, but 24UFC normal could that still be Cushing's? And, if you are attributing all the symptoms to hypothyroidism, is Cushing's also a type of hypothyroidism? If not, what is leading me to it? Why are my FH and LSH so low? That does not seem to fit any of the parameters. If it is Cushing's, what do I do about it? If you could please look again, answer my questions and send any further suggestions as to my next steps, I would be so grateful. I am so tired, I can barely move and I feel like I have lost my life.

#

Hello,

Welcome back to icliniq.com.

  • Low levels of FSH and LH are hinting towards an etiology in the pituitary, that is, hypopituitarism.
  • Tumors in the pituitary are benign and easily managed by either a minimally invasive surgery or medications such as Ketoconazole.
  • The most common symptoms of Cushing’s disease are unexplained weight gain, particularly around the neck and midsection, thinning of the arms and legs, muscle weakness, diabetes, high blood pressure, easy bruising, depression, insomnia, poor concentration, irregular or absence of menstrual periods in women, and weakening of the bones and fractures. So, in my opinion, you do fit in this spectra.

Get an MRI of the brain with a pituitary fossa evaluation to confirm the diagnosis. Review with reports.

Revert with more information to an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician

Hello doctor,

Thank you for all your explanations. I have one last question. Does my normal result for the 24UFC, rule out Cushing's? Should I have that test repeated? 

#

Hello,

Welcome back to icliniq.com.

  • Except for the 24-hour urine free cortisol levels, everything is pointing towards Cushing's.

I suggest you do the following:

  1. Low-dose dexamethasone suppression test: It is a confirmatory test. That is, 24-hour urine free cortisol is a standard test, but we can confirm only after this test. If the values are normal, we can say for sure it is Cushing's.
  2. MRI of the pituitary gland to rule out a prolactinoma.

For further queries consult an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician


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