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Suggest Treatment For Lower Abdominal Bloating, Night Sweats And Ovarian Cyst

Posted on Mon, 21 Sep 2015

Question: 14 yr old daughter, depression, anger, sadness, hyperactivity, suicidal thoughts, joint pain, hair loss, night sweats, hot flashes, one painful ovarian cyst rupture, constant lower abdominal bloating. Short stature (4'10.5"), periods started age 12, breast development started age 10. Suffered 2 concussions and 3 whiplash injuries in past 2 years, chronic neck pain not alleviated by physical therapy, radio frequency ablation, chiropractic. Trying to determine depression is caused by dealing with chronic pain or by hormonal imbalance. Therapist says severe depression, needs to see a psychiatrist for medication. Will follow up but feel I'm missing something with the other hormonal type symptoms. My gut tells me there is a relation between possible adrenal stress and mood/depression. Endoscope will be performed for bloating to rule out Celiac or ulcer. Any possible correlation between any of these? Should testing be done for adrenal fatigue/cortisol or serotonin levels/thyroid/hormones? She also has a fleshy cyst on her right collarbone at the end near her neck. Going for ultrasound next month. Could be nothing but doc says it's close to lymph nodes, wants to check if it's dermological or something else. She's been through so much, I don't want to overlook anything. Should we see a pediatric endocrinologist? We've tried so many doctors, some have just blown her off, but her pain is real, as are the other symptoms.

Answered by Dr. Pradeep Kumar Jain (1 hour later)

Brief Answer:
Hormonal evaluation should be done

Detailed Answer:
Hello

I understand your concern.I have gone through the detail history and I agree with you.You are right there is clear connection between adrenal stress/other hormonal imbalance and mood disorder/short stature.
The symptoms you have mentioned can be due to hormonal disturbances like excess androgen(PCOD),hypothyroidism,Cushing syndrome(excess of adrenal hormone cortisol) and few others.
If she is lagging midparental height and the history is not suggestive of constitutional delay hormonal assessment is needed even for the workup of short stature.
Chronic pain can be there even when all the reports like Xray and MRI are normal.Hormonal imbalance itself can cause chronic nonspecific annoying pain.
Ovarian cyst also gives a strong suspicion for hormonal cause.Regarding the swelling I agree with your doctor as painless XXXXXXX lesion that is not attached to skin or underlying structures in collar bone area is most commonly due to some lymph node swelling.
So I would suggest that you must get an appointment from pediatric endocrinologist and discuss for the need of investigations like thyroid function test,free androgen excess,cortisol level,prolactin level and may be 17 hydroxyprogesterone and insulin like growth factors.

I hope this helps.Please let me know if you have any more doubts.
Wishing for your child's speedy recovery.
Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Pradeep Kumar Jain (32 hours later)

Thank you for confirming my suspicions. A psychiatrist also recommending seeing a neurologist to rule out postconcussive syndrome. Her pediatrician agrees that we seek an appointment with an endocrinologist.

The only other question I have is in regards to the lump on her collarbone. I wanted to clarify that it is located at the end closest to her throat and that it is painful. I'm not sure if that makes any difference, but please let me know if that changes your thoughts.

She had the endoscope yesterday and no evidence of inflammation, Celiac, or ulcers were found, but biopsies were taken. The doctor did notice that she still had food in her stomach and since she did not eat for 6 hours that should not be there. In our initial appointment she did mention a slow emptying of the stomach could also be a cause for the constant bloating, and now it seems that may be the reason. We will do the gastric emptying test after we receive the biopsy reports. She did say that anxiety and stress could cause this to happen, and since it started to get really bad after her last concussion and whiplash injury this past XXXXXXX it seems to tie together with her other symptoms.

Thank you again for your input. I appreciate it greatly.

Answered by Dr. Pradeep Kumar Jain (4 hours later)

Brief Answer:
Get an ultrasound done

Detailed Answer:
Thanks for follow up

There can be so many causes of swelling in the mentioned area.The most likely cause of swelling is bony or lymph node.
In most of the cases clinical examination is sufficient to say whether it is bony or lymph node swelling.
In case it is lymph node again it can be due to infection/inflammation,benign lymph node swelling or rarely some malignancy.
I would suggest you to get an ultrasound done and if it is a lymph node USG guided biopsy should also be done to find out the cause of swelling.

Till then analgesic and antibiotic should be given.The swelling will decrease if it is due to infection.

Regards

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar