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Had fatigue and gastric bypass. Having leg cramps, foot pain, muscular fatigue. Blood test showed Hyponatremia. Suggest?

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I have had long term fatigue. I am 55 years old and 10 years post gastric bypass. I can relate the fatigue back into my 30's. Recently starting having leg cramps, foot pain, muscular fatigue. Had blood work for the millionth time last week and it showed hyponatremia )129 and a blood sugar of 61 (asymptomatic). Have had hypoglycemic symptoms for many years with it worsing after the bypass. Have to be careful to always eat protein if I have any refined carbs. Also have salt cravings. Doctor wants to just repeat the labs because she thinks it might be an error. I being a nurse, look these things up and came up with Addison's disease. This would explain many of my symptoms. She said she will do a fasting cortisol level. I don't think this test will show anything as I've read that an ACTH stimulation test is what will really show if I have Addison's disease. What are your thoughts?
Posted Fri, 7 Jun 2013 in Medicines and Side Effects
Answered by Dr. Nirmala P 6 hours later
Thanks for asking in Healthcare Magic.

The intensity of symptoms of Addison's disease varies depending upon the duration and the degree of severity. The usual symptoms are fatigue, weakness, nausea, vomiting, anorexia, mucosal and cutaneous pigmentation, hypotension and occasionally hypoglycemia. Enhanced sensory modalities for taste (salt craving), smell and hearing may occur.

Yes, you are right. The ACTH stimulation test helps in the diagnosis of primary adrenal insufficiency (Addison's disease). Here the cortisol response after 60 minutes of 250 micro gms of Cosyntropin is measured. This along with the aldosterone level gives an indication whether the adrenal insufficiency is primary or secondary.

In the early stages of Addison's disease, there may not be much change in the level of parameters like plasma ACTH to clinch the diagnosis. On the contrary, there may be normal plasma ACTH. This can mislead the diagnosis. But the stress induced increase of ACTH may not be there. ACTH stimulation test will help at this level itself.

As the changes in electrolyte level (high potassium, low sodium and low bicarbonate) due to aldosterone deficiency also occurs at a later stage, these may not be helpful in guiding the diagnosis in the earlier stage. Hence a provocation test like ACTH test is more helpful in finding out if the deficiency is due to primary or secondary deficiency.

Since it is a provocation test you should also be careful if it will suit you and you should discuss this with your treating Dr.

I hope this helps. Please address to me if you have any further concerns.

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