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Addison's Disease Message Board

Addison's Disease Board Index

[QUOTE]Have you still had those episodes after you stopped taking the MAOI? Did you have those episodes before taking the MAOI? It sounds very much like pheochromocytoma, an adrenal tumor. BUT MAOI with tyramine can seem very much like that tumor, as your doctor noted. So if you are off the MAOI and still have those symptoms you should be worked up for pheochromocytoma.[/QUOTE]

After I dropped the MAOi to a minimal dose (I am off it entirely now), the blood pressure spikes discontinues, and the orthostatic hypotension events became less frequent and severe. Sorry I did not note this before -- I hope your post was predicated on the other symptoms/data as well, as it sounds like it was. Also, I failed to mention profound cognition issues, including short term memory impairment, and difficulty comprehending spoken and written word.

[QUOTE]Low insulin, elevated glucose, excessive urine volume, elevated creatinine, and especially the elevated norepinephrine all point towards pheochromocytoma. Your doctor must look further into this.
This could also affect your cortisol levels since catecholamines (norepinephrine + epinephrine) are one thing that cause a release of cortisol. If your catecholamines are elevated so will be your cortisol, at some points, and then you might have lowered cortisol at other times.[/QUOTE]

As you can see, my free cortisol levels do not vary much (according to the data) and it apprears that the high is sometime in the late evening/early morning. Even assuming that the high is greater than my midnight level, it still probably would not fall within the range expected at early morning. Thus, it's not merely a circadian rhythm issue -- there's certainly some adrenal impairment. Given the elevated norepinephrine, and the DHEA levels, I am surprised the overal cortisol level is not higher. Perhaps my adrenals have been revved for too long. On the positive side, so I extrapolate from some things that I've read, the moderate DHEA levels, combined with the total free corisol, suggest that my adrenals still have some boogie left in them. I hope that is the case.

[QUOTE]Interesting is also the depressed 17-OH Progesterone which is a precursor of cortisol. This could be due to a defect in the enzymes that convert the different precursors to cortisol. Another thing that could cause your symptoms. The best person to determine if you have an enzyme problem would be an endocrinologist.[/QUOTE]

I am seeing a doctor that specializes in these issues, though he is not board certified as an endo.

[QUOTE]Personally, I don't understand why a doctor would say CFS is not a diagnosis of exclusion for him. If there are things that we understand and can treat, why would he want to diagnose somebody with CFS for which there is really not much we can do. Anything that can be treated really should be ruled out before diagnosing somebody with CFS since once they have that diagnosis, it's way too easy to blame that for anything, leaving the true cause undiscovered.[/QUOTE]

I misspoke. I intended to communicate that he does not diagnose CFS by saying, it's not a, b, or c, so it must be CFS. Rather, he evaluates data from blood, urine, saliva, and stool sample, in concert with symptoms and a physical examination, before ever diagnosing CFS, unlike many doctors. Certainly, he will consider other conditions that bear similar symptoms and data values. I've always been somewhat skeptical about CFS, but the symptoms certainly fit in many respects, and this doctor's methodology has more objective medical backing.

Thanks a lot for taking the time to respond.


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