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Suggest Treatment For Chronic Extreme Exhaustion
Question: Seeking an endocrinologist
First some context:
I have suffered from periodic episodes of extreme exhaustion for 30 years (my present age is 60) - about times throughout each year. One week, I can run on a treadmill, and suddenly I can barely walk 20 feet. A week or two later, I may be back on the treadmill, but it is almost always like starting over, with slow walks first.
Because it feels like my heart becomes weak, I have entered the hospital a few times fearing heart damage. Subsequent tests show no damage (stress test, echo, and stress echo, ECG). Currently, I am in the middle of such an episode (for about 20 days). A trip to the hospital 7 days ago showed no heart attack or damage, according to troponin, chest xray, ECG, but no echo.
After the beginning of the episode I began to walk on the treadmill again, but that only lasted four days before I “crashed” again. The doctor said I should look into endocrinology. I will see an endocrinologist here, but appointments are over a month away. What concerns me is that my heart capacity seems to diminish. Today it felt like my heart was over-stressed with a half mile, slow, level walk.
My main question is: Can an endocrine problem (guessing thyroid or adrenal) make the heart weak, or make it seem like heart incapacity?
I would love it if you could ask any pertinent questions that might help inform you to inform me.
My previous thyroid tests are normal, but on the low range. My primary doctor says am cortisol is normal. I have often thought this was hormonal, but this time it is taking me a long time to get out of it, and I don’t recall feeling like my heart was struggling quite like this.
If you feel like you have a good handle on this, please indicate that.
First some context:
I have suffered from periodic episodes of extreme exhaustion for 30 years (my present age is 60) - about times throughout each year. One week, I can run on a treadmill, and suddenly I can barely walk 20 feet. A week or two later, I may be back on the treadmill, but it is almost always like starting over, with slow walks first.
Because it feels like my heart becomes weak, I have entered the hospital a few times fearing heart damage. Subsequent tests show no damage (stress test, echo, and stress echo, ECG). Currently, I am in the middle of such an episode (for about 20 days). A trip to the hospital 7 days ago showed no heart attack or damage, according to troponin, chest xray, ECG, but no echo.
After the beginning of the episode I began to walk on the treadmill again, but that only lasted four days before I “crashed” again. The doctor said I should look into endocrinology. I will see an endocrinologist here, but appointments are over a month away. What concerns me is that my heart capacity seems to diminish. Today it felt like my heart was over-stressed with a half mile, slow, level walk.
My main question is: Can an endocrine problem (guessing thyroid or adrenal) make the heart weak, or make it seem like heart incapacity?
I would love it if you could ask any pertinent questions that might help inform you to inform me.
My previous thyroid tests are normal, but on the low range. My primary doctor says am cortisol is normal. I have often thought this was hormonal, but this time it is taking me a long time to get out of it, and I don’t recall feeling like my heart was struggling quite like this.
If you feel like you have a good handle on this, please indicate that.
Brief Answer:
Endocrine
Detailed Answer:
I follow what you are saying.
When I see someone like you in my practice, I order the following tests in addition to a thorough physical examination:
CBC
CMP
TSH
Free T4
25 hydroxy Vitamin D
I have noted that your thyroid labs have been checked and found to be on the low range so it will be important to check them again through a TSH and Free T4.
I also see that your morning cortisol has been deemed normal. If that is the case for sure, then there is no need to repeat the test. It is an important test to make sure you do not have adrenal insufficiency. The test is supposed to be done at 8 am in the morning.
Sometimes vitamin D deficiency can explain some of the symptoms you have. The above mentioned 25 hydroxy vitamin D will hopeful reveal something.
It is quite possible you have already had routine tests like CBC and CMP through your other doctors. If these have been done recently and they were normal then there is no need to repeat them.
They are simple but important tests that can very well cause symptoms of the kind you are experiencing. For example, anemia (low hemoglobin) alone is enough to cause fatigue and exhaustion.
Finally, there is one more potential hormone related cause of your symptoms. Low testosterone. I am generally reluctant to order this test for my patients because there is widespread misunderstanding among patients regarding tis correct interpretation. Unless it is unequivocally low, it is unlikely to be the reason for how you are feeling. And treatment is not justified. Treatment is not without risks either.
Endocrine
Detailed Answer:
I follow what you are saying.
When I see someone like you in my practice, I order the following tests in addition to a thorough physical examination:
CBC
CMP
TSH
Free T4
25 hydroxy Vitamin D
I have noted that your thyroid labs have been checked and found to be on the low range so it will be important to check them again through a TSH and Free T4.
I also see that your morning cortisol has been deemed normal. If that is the case for sure, then there is no need to repeat the test. It is an important test to make sure you do not have adrenal insufficiency. The test is supposed to be done at 8 am in the morning.
Sometimes vitamin D deficiency can explain some of the symptoms you have. The above mentioned 25 hydroxy vitamin D will hopeful reveal something.
It is quite possible you have already had routine tests like CBC and CMP through your other doctors. If these have been done recently and they were normal then there is no need to repeat them.
They are simple but important tests that can very well cause symptoms of the kind you are experiencing. For example, anemia (low hemoglobin) alone is enough to cause fatigue and exhaustion.
Finally, there is one more potential hormone related cause of your symptoms. Low testosterone. I am generally reluctant to order this test for my patients because there is widespread misunderstanding among patients regarding tis correct interpretation. Unless it is unequivocally low, it is unlikely to be the reason for how you are feeling. And treatment is not justified. Treatment is not without risks either.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
If I my sum up to be clear for myself: There are some hormonal conditions that could lead me to experience weakness in the heart, such as I described. Correct?
I believe the tests you described were done (except testosterone and am cortisol in the latest round). If those are all normal, are there more refined tests that could indicate something else, or are any such test only done to find detail when the basic tests are out of range?
So, if all of those basic tests you mentioned are normal, then I should look elsewhere, OR should I look deeper into hormonal causes?
I believe the tests you described were done (except testosterone and am cortisol in the latest round). If those are all normal, are there more refined tests that could indicate something else, or are any such test only done to find detail when the basic tests are out of range?
So, if all of those basic tests you mentioned are normal, then I should look elsewhere, OR should I look deeper into hormonal causes?
Brief Answer:
Follow up
Detailed Answer:
1 In your initial question you mention that your primary doctor said your am cortisol was normal. 'Am cortisol' is another way to refer to morning cortisol. It is also known as 8 am cortisol, indicating the conventional time this test is performed at, for those with traditional sleep-wake patters ie those who go to bed at night and wake in the morning.
Sometimes the interpretation of this test can be challenging and is best reserved for an endocrinologist, particularly if it is in the grey zone. It requires a physical examination to place it in the right context.
2 This symptom of 'weakness in the heart' is your way of describing something that can represent a variety of medical conditions with scores of possible causes. SOme of these can be hormone related.
3 If basic tests for screening for hormonal problems are normal then typically there is little reason to proceed to the next level of testing. However, the outcome of an in-perosn physical check-up may reveal things that require further investigation. Because laboratory tests can have limitations.
Follow up
Detailed Answer:
1 In your initial question you mention that your primary doctor said your am cortisol was normal. 'Am cortisol' is another way to refer to morning cortisol. It is also known as 8 am cortisol, indicating the conventional time this test is performed at, for those with traditional sleep-wake patters ie those who go to bed at night and wake in the morning.
Sometimes the interpretation of this test can be challenging and is best reserved for an endocrinologist, particularly if it is in the grey zone. It requires a physical examination to place it in the right context.
2 This symptom of 'weakness in the heart' is your way of describing something that can represent a variety of medical conditions with scores of possible causes. SOme of these can be hormone related.
3 If basic tests for screening for hormonal problems are normal then typically there is little reason to proceed to the next level of testing. However, the outcome of an in-perosn physical check-up may reveal things that require further investigation. Because laboratory tests can have limitations.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
In this current episode, I have been experiencing some perspiration when I eat a meal. Is that any kind of clue about any cause of the overall condition?
Also, can a hormonal problem lead to reduced heart pumping capacity, showing reduced ejection fraction? This might be important to know if that is true, so that if I do an echocardiogram or echo stress test, possibility of a reduced ejection fraction might not be conclusive of heart damage if hormonal imbalances can influence ejection.
If I do pursue further investigation into possible heart problems, I recognize that a nuclear stress test may involve injection of dobutamine, an adrenergic antagonist. Would that be a danger or problem if I happen to already have adrenal insufficiency? (It will take a month or more for me to get in to see an endocrinologist here. If things don’t get better, or get worse, I may need to dig deeper into cardiac investigation before getting to the endocrinologist.)
And now, I may have another clue. I have been gaining strength in the past couple of days, and just began walking on the treadmill. I am slow now. I walk about one mile in 30 minutes, and this time I got a bit dizzy and fuzzy headed (but no pains or breathing difficulty). So, now I want to know if hormones can cause that dizziness or fuzzy head.
I may have more than one thing going on, but one thing really suggests a hormonal problem, to me. I have a very odd sex problem. If I engage in sexual activity of any kind, it becomes a problem. If I continue onto an orgasm, then I fall slowly fall into a period of exhaustion, usually profound by the next day. If instead, I interrupt and cease before orgasm, then my blood pressure rises, lasting sometimes for days. The constant heavy heart beat finally exhausts, me and then I crash anyway. My best course of action is to avoid sex. I have no erection problem. In fact, I must ignore spontaneous erections that occur in the middle of the night. As you might imagine, this is difficult to tolerate, particularly over long term.
These are many questions, but this may be my last shot at it for this inquiry. Please tell me what you can.
Also, can a hormonal problem lead to reduced heart pumping capacity, showing reduced ejection fraction? This might be important to know if that is true, so that if I do an echocardiogram or echo stress test, possibility of a reduced ejection fraction might not be conclusive of heart damage if hormonal imbalances can influence ejection.
If I do pursue further investigation into possible heart problems, I recognize that a nuclear stress test may involve injection of dobutamine, an adrenergic antagonist. Would that be a danger or problem if I happen to already have adrenal insufficiency? (It will take a month or more for me to get in to see an endocrinologist here. If things don’t get better, or get worse, I may need to dig deeper into cardiac investigation before getting to the endocrinologist.)
And now, I may have another clue. I have been gaining strength in the past couple of days, and just began walking on the treadmill. I am slow now. I walk about one mile in 30 minutes, and this time I got a bit dizzy and fuzzy headed (but no pains or breathing difficulty). So, now I want to know if hormones can cause that dizziness or fuzzy head.
I may have more than one thing going on, but one thing really suggests a hormonal problem, to me. I have a very odd sex problem. If I engage in sexual activity of any kind, it becomes a problem. If I continue onto an orgasm, then I fall slowly fall into a period of exhaustion, usually profound by the next day. If instead, I interrupt and cease before orgasm, then my blood pressure rises, lasting sometimes for days. The constant heavy heart beat finally exhausts, me and then I crash anyway. My best course of action is to avoid sex. I have no erection problem. In fact, I must ignore spontaneous erections that occur in the middle of the night. As you might imagine, this is difficult to tolerate, particularly over long term.
These are many questions, but this may be my last shot at it for this inquiry. Please tell me what you can.
Brief Answer:
Second follow up
Detailed Answer:
I suggest you request your doctor to consider ordering a blood test for 'Plasma Free Metanephrines'.
It is a screening test for a condition called 'Pheochromocytoma'. It is a rare condition that causes symptoms similar to the ones you are experiencing.
There is no need to fast for this blood tests and it can be done at anytime.
Second follow up
Detailed Answer:
I suggest you request your doctor to consider ordering a blood test for 'Plasma Free Metanephrines'.
It is a screening test for a condition called 'Pheochromocytoma'. It is a rare condition that causes symptoms similar to the ones you are experiencing.
There is no need to fast for this blood tests and it can be done at anytime.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Okay. I had too many questions. I will pursue that blood test, but could you answer at least the question about whether or not an endocrine problem could throw off an echocardiogram or echo stress test. (That is, can the heart capacity be reduced hormonally, and yield a limited ejection fraction, even if the heart structure is healthy?) And if I can get another question, would dobutamine be of any concern if there is adrenal insufficiency?
Brief Answer:
Third follow up
Detailed Answer:
1 Endocrine problems can cause abnormalities on heart related tests. For example, there is an effect of 'Pheochromocytoma' on the structure of the heart in some cases.
The test called 'Plasma Free Metanephrines' aims to screen for this condition
2 If you truly have significant untreated adrenal insufficiency, it would not be a good idea to undergo a dobutamine stress test
Third follow up
Detailed Answer:
1 Endocrine problems can cause abnormalities on heart related tests. For example, there is an effect of 'Pheochromocytoma' on the structure of the heart in some cases.
The test called 'Plasma Free Metanephrines' aims to screen for this condition
2 If you truly have significant untreated adrenal insufficiency, it would not be a good idea to undergo a dobutamine stress test
Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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