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I had to go to the ER today because i passed out in my friends yard. Like full on hit my head on his table. Same thing as last night. I walk a bit. Get dilarious. Start slurring my speech. Then am unaware of my surroundings. Friend drove me and said (i was not with it..) i was not comprehending anything.
Abdominal pain have gotten a lot worse.
They did blood work, ekg, urine and an xray…. All came back normal? My glucose was 103 but my blood pressure was 181/110 when i went in. It lowered to about 128/90 (normal) about an hour later.
They discharged me after giving me IV. They have no idea what was going on. They said it possibly could have been dehydration.. but they arent sure because that wouldnt explain all symptoms even after my IVs. Told me to consult my primary and go to a specialist. Im disappointed because I wanted an answer. I have less answers.
Im at a loss. I dont think its diabetes im not sure what it is. All i know, in the last 24 hours my cramps in my abdomen and sides have gotten worse. I cant even sit. These symptoms have become more prominent to the still existing symptoms like hunger/thirst/bathroom breaks.
Your symptoms are dramatic which gives the impression of pheochromocytoma. Pheochromocytoma should be considered in the differential diagnosis of hypertension, anxiety neurosis, hyper metabolic states, such as thyrotoxicosis or carcinoid syndrome and or insulinoma. That's what one thinks of also at a young age such as yours. Glucose intolerance is very common in pheochromocytoma and sometimes diagnosed after being diagnosed with diabetes. Catecholamines ie adrenalin causes glucose levels to go up and causes the intolerance.
I presume your calcium was normal but if elevated then pheochromocytoma can be a part of MEAII or MEAIII syndromes. So they have to check for other things if it is that.
I am not trying to scare you but there is a possibility that you had pheochromocytoma with hypertensive crisis. It is a hypermetabaolic state that causes people to sweat a lot and they can end up losing weight if they don't compensate by overeating.
There's a reason why all patients newly diagnosed with diabetes or any endocrine disorder for that matter is referred to an endocrinologist. They have to look at all possible connections related to endocrine disorders.
If you ever get into an emergent situation then please mention the pheochromocytoma possibility and I would get an appointment with an endocrinologist ASAP although it takes weeks to see on.
Until then try not to see if this fits and follow recommendation on what not to do or eat.
Your symptoms are dramatic which gives the impression of pheochromocytoma. Pheochromocytoma should be considered in the differential diagnosis of hypertension, anxiety neurosis, hyper metabolic states, such as thyrotoxicosis or carcinoid syndrome and or insulinoma. That's what one thinks of also at a young age such as yours. Glucose intolerance is very common in pheochromocytoma and sometimes diagnosed after being diagnosed with diabetes. Catecholamines ie adrenalin causes glucose levels to go up and causes the intolerance.
I presume your calcium was normal but if elevated then pheochromocytoma can be a part of MEAII or MEAIII syndromes. So they have to check for other things if it is that.
I am not trying to scare you but there is a possibility that you had pheochromocytoma with hypertensive crisis. It is a hypermetabaolic state that causes people to sweat a lot and they can end up losing weight if they don't compensate by overeating.
There's a reason why all patients newly diagnosed with diabetes or any endocrine disorder for that matter is referred to an endocrinologist. They have to look at all possible connections related to endocrine disorders.
If you ever get into an emergent situation then please mention the pheochromocytoma possibility and I would get an appointment with an endocrinologist ASAP although it takes weeks to see on.
Until then try not to see if this fits and follow recommendation on what not to do or eat.
I will bring this up. However, can this appear on a blood test? Urine test? I did both twice and they came back normal
I am like the ER doctors I am guessing. The thing is that you are passing out and that is extremely dangerous and you have doctors kicking the can down the road. It becomes much easier to diagnose something when there are hallmark findings rather than symptoms that don't seem to fit any one picture perfectly.
The diagnosis of pheochromocytoma relies on a careful detailed history. The classic triad is sweating, palpitations and headache. Most of those are due to adrenaline. Adrenaline or the actions of adrenaline don't show up on blood tests specifically. Excess catelcholamines can show up as elevate white counts which you stated you had unless that was a typo.
“Normal for a smoker or one who vapes” on my high hema/wbc etc"
I don't know if you went RBC or not.
Basically on the chemistry panel it might show up as an elevated glucose. It's just not reliable to show up on blood work or routine urinalysis.
Most of the time the diagnosis is missed because nothing shows up and it's mainly a detailed history is needed to be able to suspect the diagnosis and then specialized tests are done.
I remember a class I took on endocrinology given by several endocrinologists since it covered all the areas of endocrinology in his presentation said that he could always detect patient with pheochromocytoma by shaking their hands. They were always sweaty. The ER doctors suggested dehydration and your urine was concentrated. You also stated that you were drinking many glasses of water a day and couldn't keep up that means a lot of sweating is taking place. Dehydration can give orthostatic hypotension and syncope. The problem is it appears you had high blood pressure and not low. Your TSH is normal and so I just remember the endocrinologist what he told the class.
Not perfect fit but you have to start somewhere.
You are going to have to run it through your doctor again and if he can't suggest a more thorough investigation then get a specialist in endocrinology. They deal with water metabolism since most of it is hormonal and then entire endocrine system. Your PCP can order screening test for pheochromocytoma unless he has a better idea.
It's basically catecholamine levels in blood and or urine. Did they ever do imaging of the abdomen and looked at the adrenal gland?
The body converts carbs to sugar. Urination is one way the body gets rid of excess sugar.
That's true however there are many contradictory findings that make it difficult from an outside perspective to figure out what is happening. There are too many loose ends that don't match.
That's just one example that you mention. It is true that when one has high blood glucose it does spill over into the urine because the body can only absorb so much glucose the rest is released into the urine. When that happens, it attracts the water based on osmosis, creating more urine volume. The more volume of urine the more times one goes to the bathroom to pee. Those are not routine events and it is considered pathological when it does happen. A normal person will not get high enough blood sugar levels to make it spill over into the urine. This level varies but it is in the 180 mg/dl range. It is not normal to have glucose in the urine.
Their A1C and blood sugar levels have not been documented to reach such high blood sugar levels nor have there been any positive urine glucose levels in their urine. That means that is just not happening in this case.
There is no polyuria confirmed in this case either. One way to determine that is to monitor the urine volume over a 24-hour period and measure the volume. It's an often misunderstood phrase when one says they went to the bathroom often. One needs to separate going to the bathroom because their bladder is full versus going to the bathroom because they have an urge to urinate. Those are two distinct differences. We try to use objective criteria to evaluate subjective findings. In this case, we use urine-specific gravity to determine if the body is conserving water or getting rid of water. When the body is considering water then it concentrates the urine by producing less urine. A person that is dehydrated produces less urine and would not go to the bathroom often because of a full bladder. The OP had a high specific gravity meaning they were conserving water consistent with dehydration. They should not be going to the bathroom a lot to urinate. The only thing that that would suggest is an urgency to urinate rather than increased volumes. People who drink a lot of water will pee a lot of water but their urine specific gravity will be low indicating that the excess water is being eliminated from the body. The urgency issue is a loose end. The history of polyuria (increased volume) has not been confirmed with objective testing (high volume low specific gravity).
Huge Update because a lot of people are invested, and to be frank, so am I. Im aware and have come to terms that there will be something wrong with me.
I went back to see my PCP. Supposedly the hospitals did the wrong tests if I had Slurred Speech, Cramps/Muscle Pains, no bladder control and thirst.
She immediately did a quick neuro exam. Very basic. I failed 4/5 tests. My smile was crooked. My eyebrows being raised were unequal and i didnt follow the finger.
Referring me to a neurologist. With the cramps, slurred speech, my food getting stuck in my throat involuntary, bladder issues, thirst issues, and BP all over the place… and more… she warned me, it could be MS. The symptoms are so broad and alot of people have mistakenly thought they had diabetes.
Thanks for the update. Neurology is not my forte mainly because it isn't clinical laboratory intensive like other areas of medicine.
I was suspecting a transient ischemic attack when you went into the ER with those symptoms which were resolved and they came up empty for all tests. They saw you in person and they are ER doctors who would be expected to do a neurological exam with those symptoms.
It would have been advantageous to go to a stroke center when and if anybody has stroke symptoms. When one calls 911 the paramedics make that evaluation and they will send patients with certain symptoms to specific locations that are better able to meet their needs. Slurred speech and weakness are obvious signs of a possible stroke.
It really reaffirms the fact that doctors who actually saw you have very diverging actions and explanations. The same doctor you first saw did nothing but review again over all of the clinical details and tests and came up with a different possible diagnosis. The ER doctors came up with different actions although they said they didn't have answers. It's nearly impossible for anybody here to come up with an accurate diagnosis. When the first doctor did nothing but give you a clean bill of health and you continued to passing out then action needed to be taken. There was no assurances that your PCP would do anything or figure it out. Glad to see that changed.
So the neurologist will be doing imaging studies, nerve conduction studies along with a spinal tap and blood draw. The spinal fluid has changes normally associated with MS although not 100% specific, suggestive of. Elevations of certain proteins (myelin basic protein) and some antibodies in there yielding oligoclonal bands.
Recent news implicated EBV virus as a potential cause of MS. EBV normally does not leave the body once one is infected. It is a herpes family virus and so it remains inside cells and can become reactivated later down the road. One can have reactivations that would exasserbate MS symptoms. The theory is there an overlapping antigen between the EBV and myelin sheath Schwann cells that line the nerves. They wrap around the nerves and insulate the nerves for better conduction of impulses.
I hope you don't have MS and it's something better. In any event they will start working on some way to treat active infections with EBV. Some The current herpes medications are not effective clinically.
it can be very upsetting and we all understand how it can emotionally impact a person. I just want to let you know that we are here to help you so don't feel alone. I am sure family will help and don't underestimate total strangers who might want to help as well.
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