Brief Answer:
I would suggest some key points as follows :

Detailed Answer:
Hello!

Thank you for asking on HCM!

Regarding your concern, I would like to suggest some key points as follows :

(1) Facing your high BP values, it is necessary to close the monitor. Your BP (several times daily) for a couple of days, to determine whether you have persistent hypertension, requiring medical treatment.

(2) Your extreme fatigue, even after sleeping, and your sleepiness during working hours need special attention. First of all we need to perform comprehensive differential diagnosis between a sleep apnea syndrome, adrenal glands insufficiency or any infectious diseases. A sleep apnea syndrome should be sought out by performing a polysomnography test, arterial blood gas analysis. If suspicion arise after these tests yiu should consult a specialist on the field (neurologist, etc...).
Adrenal insufficiency shouod be excluded by performing cortisol dosing and its derivatives. Aldosterone should be tested too to exclude another cause of hypertension. Available imagine tests (like echo, CT or MRI) may be helpful if suspicions are raised. Regarding a possible infection a discussion with an internist or infectious disease specialist should be done to review your whole previous medical history, and a careful physical examination should be done. Careful physical exakinations should be performed.
A further investigation regarding your monocytosis and elevated ESR is necessary.

(3) Regarding your elevated bilirubin levels and abdominal pain a careful physical examination by an internist and an abdominal ultrasound are necessary too.

Hope to have been helpful!

Feel free to ask me whenever you need! Greetings! Dr. Iliri

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Brief Answer:
I would suggest some key points as follows:

Detailed Answer:

Hello again, dear XXXXX!

I am sorry about those typing errors; this is because of my unexpected commitments (professional) even during the weekends.

I tried to correct my first response, and to incorporate further explanations for you.

If you need more clarifications, do not hesitate to ask me!

I reviewed carefully all your medical tests.

There result some few changes:

I) a slightly increased FT4 hormone, but it doesn’t confirm clearly hyperthyroidism (as TSH is normal). Thyroid echo and thyroid scintigraphy, coupled with a visit to your endocrinologist, will definitely clarify this issue. Hypothyroidism (is not an explanation of your clinical scenario) is excluded by thyroid hormone levels dosing and associated tests.

II) a slightly increased LDL-cholesterol, but you can manage it with diet modulation to a healthy one (I strongly recommend Mediterranean diet).

III) a slightly increase in bilirubin and ALT; an abdominal ultrasound should be performed to investigate the gallbladder, and also rule out hepatic steatosis.

IV) a slightly increase in Lymphocytes and ESR; a possible inflammation or infection. The recommendation below.

Regarding your concern, I would like to suggest some key points as follows:

(1) Facing your high BP values, it is necessary to closely monitor your BP (several times daily) for a couple of days, to determine whether you have persistent hypertension, requiring medical treatment.

(2) Your extreme fatigue, even after sleeping, and your sleepiness during working hours need special attention.

First of all we need to perform a comprehensive differential diagnosis between a sleep apnea syndrome, adrenal glands insufficiency, or any infectious diseases.

a) A sleep apnea syndrome should be sought out by performing a polysomnography test and arterial blood gas analysis. If suspicions are raised after these tests, you should consult a specialist on the field (neurologist, etc).

b) Adrenal insufficiency should be excluded by performing cortisol dosing and its derivatives.

Aldosterone should be tested also, to exclude a possible cause of hypertension.

Available imagine tests (like abdominal echo, CT or MRI) may be helpful if suspicions are raised.

c) Regarding a possible infection, a discussion with an internist or infectious disease specialist should be done to review your whole previous medical history.

A careful physical examination should be performed.

A further investigation regarding your abnormally increased lymphocytes and elevated ESR is necessary.

(3) Regarding your elevated bilirubin levels and abdominal pain a careful physical examination by an internist and an abdominal ultrasound are necessary too.

Hope to have been helpful!

Feel free to ask me whenever you need! Greetings! Dr. Iliri

So, at the end, to cut it clear and short for you, I would summarize as follows:

Recommended tests:
1)     Investigation of possible sleep apnea syndrome:
a)     Polysomnography study
b)     Arterial blood gas analysis
c)     Specialist consultation (neurologist, pulmonologist, etc), if a) and b) are abnormal.

2)     Investigation of possible adrenal insufficiency:
a)     Cortisol curve dosing
b)     Aldosterone curve dosing to exclude possible hyperaldosteronism (an etiological adrenal cause of hypertension in young adults).
c)     Endocrinologist (or internist) consultation, if a) and b) are abnormal.

Eventual additional imagine tests will be necessary (abdominal ultrasound, abdominal CT or MRI), if suspicions are raised for an adrenal glands disorder (as guided by your physician).

3)     Investigation of thyroid glands:
a)     Thyroid echo
b)     Thyroid scintigraphy (if after consulting endocrinologist, suspicions about thyroid dysfunction are raised)

4)     Investigation of possible infections:
a)     Consult with your internist or infectious disease specialist about your previous medical history, actual complains; undergo a careful physical exam and show the performed tests (complete blood count, ESR,etc)
b)     Several additional tests as you doctor advises (there are many of them, and they are guided by clinical suspicions).

Seems that all the above is a bit confounding, but if followed step by step, it may lead to a final response to your answer.

Best regards,
Dr. Iliri

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