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What causes elevated free metanephrines levels, fatigue, blurred vision and memory issues?

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Posted on Mon, 9 May 2016
Question: Hello- About 6 months ago I was diagnosed with Autoimmune encephalitis and started on IVIG. I am somewhat better, but they are still trying to find the main source of my new health issues. I just saw an Endocrine for the first time and was changed from Levothyroxine 50 mcg daily to Synthroid 175 mcg. Prior to this, my BP and pulse have been consistently elevated. I have blurred vision, confusion, memory issues, fatigue and nightsweats in addition to multiple other vague symptoms.
I have elevated serum plasma free normetanephrines and a new MRI result that shows "the pituitary gland is mildly enlarged, measuring 9 mm in midline height. The gland may be slightly larger when compared to the prior study".

My big question for you is this. These results were sent to a non-surgical Endocrine doctor 2 hours away in XXXXXXX Ohio and a Head and Neck Oncologist where i live in XXXXXXX Ohio. Both of which coincedentally, gave me "work-in" appointments on the same day! Can you help me decide (before tomorrow) which doctor I should see for my circumstances. I can provide you much more information if you need it?
Thank you- XXXXXXX
doctor
Answered by Dr. Binu Parameswaran Pillai (4 hours later)
Brief Answer:
Endocrinologist

Detailed Answer:
Good day,
Noted your concern. With the elvated free plsma metanephrines, has a pheochromocytoma /paraganglionoma been ruled out?
Another possibiity of elevated free metanephries is due to stress.
I noted that your dose of thyroid medication has been increased substantially from 50 mcg to 175 mcg a day. This mean that your TSH would have been very high. Hypothyroidism ( inadequately treated) cause TSH to go up due to excess production of TSH by pituitary gland in response to low serum Free T4 and Free T3 levels. Pitutary gland tend to increase in size to produce excess TSH. This could be a reason why your pituitary gland size has increased. Encephalitis itself can cause pituitary gland to enlarge ( hypophysitis).
In my opiion the best person to consult would be your endocrinologist. He will guide you to the best person. A head and neck oncologist may not be able to help you significantly. Could you attach the pituitary MRI images?

Regards
Binu

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Binu Parameswaran Pillai (22 minutes later)
Hello and thank you.
I am attaching my TSH values so you can see the significant trend while on treatment.
Everything you explained makes sense and puts me at a little more ease, but something is still underlying all of this.
I will look for the MRI and try to send very soon.
I am planning to keep the head and neck oncology appointment due to my history of abnormal ganglion growth and abnormal fixed mass in my neck. He specializes in pheo/paraganglionomas. you and i think alike. i ordered my own lab test of metanephrines and contacted him due to my symptoms and my history/new onset of HTN and tachycardia (on holter as well). So, yes and no to your question of the work-up. I have been my best advocate fortunately.
i am concerned about my blurred vision and eyelid droop as well. it's noticeable to my friends and family and gets worse with increased stress. I probably forgot to mention that my magnesium has been significantly low even with IM supplementation. Vita D very low, potassium low and I think calcium low as well.
There are too many physical changes and findings and subtle abnormalities in labs and imaging, that intuitively I know something is not ok. I just don't know what.
again, thank you for your time. i appreciate that you are willing to look at MRI imaging. i will upload documents.

doctor
Answered by Dr. Binu Parameswaran Pillai (13 hours later)
Brief Answer:
MRI images not received

Detailed Answer:
Noted the results.
TSH is high at 6 and need to be corrected.However, i wonder if such a jump in dose from 50 mcg to 175 mcg was necessary or not!!! I would say not. Or was your dose 150 mcg and now changed to 175 mcg ??

Eye droop and blurring of vision need to be seperately evaluated , preferab;y by a neurologist.

The low Magnesium need evaluation. We need to do 24 hour urine magnesium tests. Are you on long term diuretics or acidity pills like Omeprazole?

I havenot received MRI images
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Binu Parameswaran Pillai

Endocrinologist

Practicing since :2003

Answered : 1435 Questions

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What causes elevated free metanephrines levels, fatigue, blurred vision and memory issues?

Brief Answer: Endocrinologist Detailed Answer: Good day, Noted your concern. With the elvated free plsma metanephrines, has a pheochromocytoma /paraganglionoma been ruled out? Another possibiity of elevated free metanephries is due to stress. I noted that your dose of thyroid medication has been increased substantially from 50 mcg to 175 mcg a day. This mean that your TSH would have been very high. Hypothyroidism ( inadequately treated) cause TSH to go up due to excess production of TSH by pituitary gland in response to low serum Free T4 and Free T3 levels. Pitutary gland tend to increase in size to produce excess TSH. This could be a reason why your pituitary gland size has increased. Encephalitis itself can cause pituitary gland to enlarge ( hypophysitis). In my opiion the best person to consult would be your endocrinologist. He will guide you to the best person. A head and neck oncologist may not be able to help you significantly. Could you attach the pituitary MRI images? Regards Binu