Dr. Thiyagarajan. T
Diabetology
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Patient's Query
Hello doctor,
I am 52 years old. I have facial flushing, perimenopause, carcinoid tumor and medical anxiety. My symptoms of facial flushing started eight months back, when my face turned bright red and there was no sweating. This happened twice every month and lasted for around ten minutes. I got my colonoscpy two years back, and it was normal. Also, my doctor has suggested chromogranin A blood test and 5-HIAA test and both were normal. . My estradiol levels were 24 pg/mL and FSH was 77 mIU/mL. My doctor suggested the symptoms could be due to perimenopause. I feel that the symptoms are due to carcinoid tumor. I have also mentioned to my doctor that I am on tablets Prozac and Tradazone, and the symptoms could be due to serotonin syndrome. However, they suggested that I have been using them for several years and in much higher doses. What could be the reason for my symptoms?
Kindly advise.
Hello,
Welcome to icliniq.com.
I understand your concern.
The symptoms can be due to perimenopausal vasomotor condition or serotonin syndrome. However, the chances of having such symptoms due to a carcinoid tumor are less, as your chromogranin A and 5-HIAA test results are normal. Menopause can also be the reason. Is there a family history of stroke, blood clots, heart attack, or breast or uterine cancers? I suggest you consult a psychiatrist and a gynecologist for further guidance. After considering the risks and benefits, they can suggest whether menopausal hormone therapy is better for you. Regarding splotches in the elbow and knuckles, I suggest you consult a dermatologist.
I hope this helps.
Thank you.
Patient's Query
Hello doctor,
Thank you for the response.
I got cardiac ablation done for atrial fibrillation. Also, I had my uterus biopsied before IUD, which was normal. There is also no history of blood clots or heart attacks. Also, my hematocrit, CBC, 24-hour urine tests, and metabolic tests were normal. My autoimmune tests were also normal except for slightly raised ANA. My question is, I was on tablet Prozac 40 mg and tablet Trazadone 300 mg a few years ago. Now, I am on 10 mg of tablet Prozac and 50 mg of Trazadone. Can I develop serotonin syndrome suddenly after being on these drugs for several years?
Kindly advise.
Hello,
Welcome back to icliniq.com.
Serotonin syndrome occurs when a new medicine is added or the dosage is escalated. Also, having only hot flashes for serotonin syndrome is less likely. As you are taking lower doses than before, it cannot be serotonin syndrome. I hope this helps.
Thank you.
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Diabetology
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