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

 

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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.

 

 

Answered



Hello,

Welcome to dr.sitehome.info.

  • 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?

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