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What causes chronic nausea and loss of appetite with hot flashes?

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Posted on Sat, 19 Mar 2016
Question: 18 year old female who is not overweight, who has chronic nausea, very little appetite, 3-4 seizures in last 3 years while conscious with involuntary movements, extremely moody, intolerance to hot and cold- feels like temperature regulator is off, hot flashes start at base of spine and travel upward, ends up feeling jumpy in her stomach, and then her teeth chatter. Has had many blackouts in one or both eyes that do not last long, also has had what she describes as heat waves in her vision. She has a small pineal cyst. Sounds impossible with all of these weird symptoms, but this is what we are dealing with. Some hot flashes end with clammy forehead that's sweaty. mpv of 6.9fl, plt 331.0, rdw 13.6%, mcv 94.4 fl, MCH 32.37 pg, mchc 34.29,rdw 13.6%, cch 32.37 pg, chloride 107 m/M, estimated avg glucose 108 mg/dL, hgb 14.5 g/dL, rbc 4.48, hct 42.3%. Any thoughts are greatly appreciated! :)
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Answered by Dr. Sassen S Kwasa (35 minutes later)
Brief Answer:
Check a TSH/Free T4! Please note ? hypo/hyperthyroidism

Detailed Answer:
Welcome to HCM: Good day, please note that this patient cold have hypothyroid and hyperthyroidism, both will present in this manner, other things could be adrenal disease specifically Pheochromocytoma, especially the fact that you mention eye involvement, her pituitary could be a cause for alarm, in essence spelling what is termed MEN or Multiple Endocrine Neoplasia. Please zero in on endocrinologic testing starting with TSH/Free T4, Metanephrines and Cortisol. Thanks and I hope this helps.
Above answer was peer-reviewed by : Dr. Raju A.T
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Follow up: Dr. Sassen S Kwasa (3 days later)
Thank you very much for your reply! I wanted to get back to you earlier, but my computer was having a problem. I recently found out she has high Vitamin B12 in her blood, low Vit D, and higher glucose levels. I will attache the labs. I previously forgot to mention that she had a blocked maxillary sinus they found doing an MRI for the seizures...had it operated on successfully just in case it was helpful, but it didn't change her situation. It was silent sinus syndrome, where bones were collapsing around sinus due to blockage. She had congenital vesicouretral reflux, and it was successfully operated on when she was 5 years old. She had an abdominal ultrasound that revealed some fluid in the Morrison's pouch. We still don't know why that's there, some doctors do not know what the M-pouch is- me either- had to look it up. She has had no trauma to her abdomen- ever. She does get abdominal pain often, and feels like she cannot breathe deeply enough at times. Thank you!
doctor
Answered by Dr. Sassen S Kwasa (19 hours later)
Brief Answer:
No problem, I think endocrinology will have some answers moving forward.

Detailed Answer:
The documents you sent are password protected, the only report I could see was thew MRI.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Sassen S Kwasa (2 hours later)
Hi Dr. Kwasa,

Sorry for the mixup on the password required files. I just uploaded one (all combined) with no password needed. Our insurance was cancelled, and so I am trying to get as much info as possible before heading to the endocrinologist. She has been taking her blood sugar at home for the last couple of days, and has had 120, and 126 for fasting glucose, and similar values for 2 hours after eating. Thank you.
doctor
Answered by Dr. Sassen S Kwasa (21 hours later)
Brief Answer:
She is NOT diabetic, her HbA1C is normal, that is a more reliable test

Detailed Answer:
Welcome back to HCM

Please note that she also will need a PTH to be done, this is because her Vit-D is low, she might have malabsorption of Vitamins D,A,K,E pointing to a pancreatic issue.

But again this would be Endocrinologist who can comment on this, interesting all other labs are normal so far.

Let me know if there's any more queries

Kind Regards
Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Answered by
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Dr. Sassen S Kwasa

Internal Medicine Specialist

Practicing since :2012

Answered : 502 Questions

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What causes chronic nausea and loss of appetite with hot flashes?

Brief Answer: Check a TSH/Free T4! Please note ? hypo/hyperthyroidism Detailed Answer: Welcome to HCM: Good day, please note that this patient cold have hypothyroid and hyperthyroidism, both will present in this manner, other things could be adrenal disease specifically Pheochromocytoma, especially the fact that you mention eye involvement, her pituitary could be a cause for alarm, in essence spelling what is termed MEN or Multiple Endocrine Neoplasia. Please zero in on endocrinologic testing starting with TSH/Free T4, Metanephrines and Cortisol. Thanks and I hope this helps.