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Adrenal fatigue. Adrenaline rush, fast pulse after meal, poor appetite. EKG, Holter monitor done. Reason?

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Practicing since : 2002
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Have you ever treated anyone for adrenal fatigue? I am female, and when I was 18, one day after I had breakfast, eggs, toast, jelly, and full glass of orange juice. About 30 minutes or so after I ate, I was having symptoms of adrenaline rush, fast pulse felt like I couldn't breath. The symptoms ran many hours after I ate. I finally went to see a doctor about it when I was like 20 years old. Doctor said I probably was eating too much sugar. I had an EKG done at that time and a holter monitor for 24 hours. I declined to do the glucose tolerance test. When I fasted, I did not have the symptoms. I started eating smaller and smaller meals. I went from 107lbs to 95lbs over a few years time. I always weighed like 92lbs for the last few years. It seemed like I became sensitive to all kinds of foods. I am now 30 years old, weigh 87lbs, 5'4". I have hemoglobin of 9.8. My pulse is like 98-100 most of the day. I am have a poor appetite. I eat like 1200 calories a day.
Posted Wed, 11 Jul 2012 in Thyroid Problem and Hormonal Problems
Answered by Dr. Anantharaman 5 hours later

Thanks for the query.

I am an endocrinologist and have worked closely with endocrinology patients.

After going through the details provided, there seems to be two different issues:
1) A history of post meal hyperglycaemia related symptoms ten years ago
2) At present you have weight loss anemia and fatigue along with poor appetite

Your problem which happened ten years ago is probably a post meal hyperglycemia. It can sometimes happen if you take a large carbohydrate meal like the one you had. The problem happens due to an imbalance between amount of insulin produced and the absorbed glucose - likely to happen if you have insulin resistance. Insulin resistance is associated with body weight. Being overweight with more body fat can increase your chances of insulin resistance.

Since you've had this problem only once and has not recurred, it’s probably not worth worrying about it now. It needs to be addressed only if it happens repeatedly. Your doctor was correct in asking you to limit the carbohydrate and attempt a modest weight loss.

Regarding the issue you are having now - we cannot assume anything about it. It requires a detailed evaluation with a complete hemogram, liver and kidney function test. You also must be tested for diabetes with fasting and if required glucose tolerance test (GTT). In addition you also will need a thyroid function test in view of your high heart rate.

I suggest you consult an XXXXXXX medicine specialist or your General physician and get a complete evaluation done so that we can find out what is the problem.

I also would like to know about what's happening to your menstrual cycles - are they regular and whether or not there is excessive bleeding?

Hope this suffices. Do get back if you have any clarifications.

Dr. Anantharaman
Above answer was peer-reviewed by
Follow-up: Adrenal fatigue. Adrenaline rush, fast pulse after meal, poor appetite. EKG, Holter monitor done. Reason? 9 hours later
Thank you Dr. Anantharaman. I have a menstrual cycle every month. It last about 3 days. The pad I use seems to fill up during the course of one day. I have had my thyroid levels checked. My doctor states that they are normal.
If that was post meal hyperglycemia? would I need to take metformin? or diaxzide?
Answered by Dr. Anantharaman 3 hours later
Sorry about the typo in my earlier response- its post meal hypoglycaemia and not hyperglycaemia.
What really happens is this
In a normal person, insulin is produced following a meal in two phases the first phase happens within a few minutes the second phase happens 30 to 60 min later.
If you are overweight and have insulin resistance, this may lead to an abnormal pattern of second phase insulin release which either could be excessive or both excessive and delayed, at this point in time about 1-2 hrs after a meal all the glucose that you have absorbed has gone into the muscles and if there is excess insulin it can push the glucose down further- this is something that we see fairly commonly . It usually improves with exercise and weight loss. Like it did in your case.
However if you continue to have these symptoms that is tremor, sweating, hunger nervousness along with a low glucose in the post meal period you might need to go in for a prolonged fast like what you underwent earlier but it should start with the usual meal that you have which precipitates such symptoms. But from what you are saying if your symptoms have not recurred in the last ten years. It's not worth your while thinking about it.
Diazoxide or metformin may not be appropriate treatments for you at this time- as we may be dealing with some other issue rather than post prandial hypoglycaemia. The one thing that tells me that you do not have this disorder is your weight loss that almost never happens with post prandial hypoglycaemia you invariably tend to gain weight if it is persisting
You don't seem to have excess bleeding but women commonly have iron deficient anemia so you need a basic evaluation looking at the cause for you anemia - low hemoglobin- the normal level is 13 yours is 9.8 . This will usually involve
1) Hb,total count,differential count,platelet count,peripheral smear exam,reticulocyte count. These are usually done as a part of the complete blood count.
2) You should in addition get- ferritin,Serum B12, RBC folate levels
3) A liver and kidney function test are required along with fasting and post meal glucose
As I had said earlier please XXXXXXX an XXXXXXX medicine specialist
Regarding your symptoms. it's unlikely that these are due to an endocrine problem
If you are worried about your adrenal function you can get the following done
1) an a.m cortisol - should be given before 9 am
2) a serum sodium and potassium
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