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What Causes Joint And Muscle Pain With Fatigue, Nausea And Excessive Sweating?

Posted on Sat, 3 Oct 2015

Question: I have had all over joint, muscle pain, extreme fatigue, nausea, extreme sweating, weakness, headache, for the past two months. Now, I feel unusually thirsty and feel the need to urinate more than usual. CBC has been normal, Rheumatoid factor neg. CT of chest and abdomen ok. Lab abnormalities include inflammation factor at 50 and ALP is 287. I'm being referred to an oncologist for further evaluation. In the meantime, my PCP and I have been grasping at straws. Any ideas? Also, I have a family history on both sides of leukemia and both non-Hodgkins and Hodgkins Lymphoma. Also, my mother had a pituitary tumor. Should these be of a concern to me with the symptomology?

Answered by Dr. Mohammed Taher Ali (5 hours later)

Brief Answer:
Suspicious of Hyperparathyroidism

Detailed Answer:
Dear Ma'am, Hi
Good morning.

I have gone through your query and I am of the opinion that the features described are suggestive of a hormonal disorder referred to as Hyperparathyroidism. This is due to increased production of parathyroid hormone.
I would advise you to kindly consult an endocrinologist for further evaluation like
1. Serum calcium & phosphorous levels,
2. Bone mineral density test (bone densitometry),
3. 24-hour collection of urine for calcium
4. Abdominal ultrasound, etc.

Hope the suggestion given above could be useful in ascertaining the diagnosis.

Wishing you best of your health.

Above answer was peer-reviewed by : Dr. Neel Kudchadkar

Follow up: Dr. Mohammed Taher Ali (19 hours later)

I looked at my labs and my total calcium level was normal. I think ALT and AST is thyroid, correct? If so, that was both normal. Did not see phosphorous, but saw Alkaline Phosphatase, normal. Have not had an abdominal u/s done, but had abdominal CT done, normal. Have not had a bone density done. But know I am osteogenic. Does this r/o Hyperparathyroidism or more testing as you suggested? I do want to add that I am on a blood thinner for Factor 5, and since all of the symptoms have started, I have had trouble keeping my INR level in check. It keeps wanting to go higher. They have decreased my dose of Coumadin, but my level keeps going higher anyway. Don't know where this factors in, but to me it is a concern. Last week my number was 4.6. Target for me is between 2 and 3.

Answered by Dr. Mohammed Taher Ali (3 hours later)

Brief Answer:
The alkalaline phosphatase (ALP) level is increased

Detailed Answer:

Dear Ma'am, Hi
Good morning.
Thanks for your kind reply.

Regarding ALT & AST enzymes; they are usually raised in patients with liver or gall bladder diseases.

However, as per the result given in your first query, the alkaline phosphate (ALP) level is raised (The normal range is 44 to 147 IU/L (international units per liter).

Higher-than-normal levels of ALP in your blood may indicate a problem with your liver or bones.
This could include hepatitis, cirrhosis, liver cancer, gallstones, or a blockage in your bile ducts.

Bone diseases associated with high ALP include osteomalacia, Paget’s disease, bone cancer, or an overactive parathyroid gland (hyperparathyroidism).
So, at present the provisional diagnosis is based upon your symptoms as described earlier along with high ALP level which may be due to some sort of bone disease.

Regarding the blood thinner (Coumadin) which is apparently used to prevent clot formation due to Factor V Leiden deficiency, the high INR level is suggestive of some sort of liver impairment which decreases the elimination of Coumadin from the body hence its level gets increased in the blood resulting in high INR.
High INR may cause bleeding hence the dosage of Coumadin needs to be reduced to maintain an acceptable range of 2.5 - 3.5 of INR.

As suggested earlier, the bone mineral density can rule out the possibility of hyperparathyroidism as there is a high ALP level with symptoms suggestive of excess parathyroid hormones.

Hope I could answer your query.

Wishing you best health.

Above answer was peer-reviewed by : Dr. Neel Kudchadkar

Follow up: Dr. Mohammed Taher Ali (4 hours later)

I am just not familiar with parathyroid function. Would thyroid levels be normal with excess parathyroid hormones? Because my thyroid function is normal. My dosage of Coumadin has been reduced also. Would liver disease cause such deep bone pain like I'm having or would your diagnosis lean more toward the hyperparathyroidism or bone disease? I know further testing is needed, I'm just looking for a direction to go and/or possibly avoid needless testing but have needed testing to get a correct diagnosis. Thank you for your help.

Answered by Dr. Mohammed Taher Ali (3 hours later)

Brief Answer:
Yes, Thyroid hormones will be normal with excess of parathyroid hormones

Detailed Answer:
Dear Ma'am,
Good evening!
Thanks for your reply.

Thyroid function tests will be normal with excess of parathyroid hormones.
Parathyroid hormones are responsible for bone turnover or bone remodeling.
Excess of parathyroid hormones increase the bone resorption thus increasing the plasma Calcium & Phosphate levels.

My suggestion is based on the symptoms and lab findings of raised ALT level that the possibility of bone disease or parathyroid excess to be ruled out.

Hope I could answer your query.

Best regards.

Note: For further queries related to kidney problems Click here.

Above answer was peer-reviewed by : Dr. Prasad