She felt good. So why did she lose so much weight?

The 67-year-old woman slipped her shoes, then entered the doctor. In her house, in Maplewood, NJ, the bathroom scale documented the same 25-pound weight loss, which now and her internist. It has suddenly happened in the last few months. Initially, she blamed the Covid-19 fight, which she chose while traveling with friends to Morocco three months earlier. But it seemed unlikely: the disease seemed more than a bad frosty and lasted only a week.

It wasn’t that she was wasted and rather liked the way she looked at this up-to-date weight. Still, there was no diet, so it worried her. Just a few weeks earlier, a friend lost its weight inadvertently in this way and he was diagnosed with metastatic cancer.

Before she reached this meeting with her basic doctor, a woman, an emergency doctor, already conducted an investigation. She saw her Ob-Gyn, who gave her completely tidy. Recently colonoscopy and mammogram were normal. Despite this, she wanted to hear what her internist, Dr. James Rommer, would have done her unintentional weight loss.

Rommer has known a woman for many years. He saw her before the replacement surgery to the left last year; Soon after, she called to tell him that her blood pressure was high. He started her with blood pressure and increased her during each of her subsequent visits.

She didn’t feel unwell, the patient told Rommer. She had no nausea, abdominal pain. Her appetite was good. Maybe she was a little more tired than usual, but you can stay from vacation, she said.

Her blood pressure was increased, but her exam was normal. Rommer agreed that weight loss concerned; Patients usually do not lose weight by accident. He presented his plan: in the event of weight loss, he would order basic laboratory tests – the number of blood, chemistry, liver and thyroid tests. And in the case of its up-to-date and persistent high blood pressure, he would look for a few unusual tumors that can escalate blood pressure, issuing excessive cortisol or epinephrine, combat hormones or flight produced by the adrenal glands. If all this were normal, he would get a CT tomography of her chest, abdomen and pelvis to make sure that nothing is missing.

Life -threatening deficiency

The patient was in the gym the next morning when the phone rang. Rommer’s voice was solemn when he explained the unexpected discovery of her laboratory tests. Her liver and kidney results and the number of blood were normal. But her cortisol, who thought Rommer could be elevated, was practically undetectable. It can be perilous. He asked if he was unthreatening to lead.

Cortisol is one of the most powerful stress hormones in the body. It works on almost every organ in the body, helping to maintain a normal function after episodes of physiological stress, such as illness or surgery. When the body is not able to create the right amounts of cortisol, recovering from any type of stress can be arduous and sometimes impossible. Hormone deficiencies can threaten life.

Hearing this unexpected result, the patient’s first thought was that there was a mistake in the laboratory. She felt good, she told Rommer. Patients with adrenal insufficiency, as it is called, usually notice muscle weakness and wasting. They have nausea and vomiting. She had no such symptoms and was in the process of her ordinary training. Rommer insisted that she had to see her. It was a sudden accident.

The patient took a shower and changed from sweaty gym clothes and arranged for an endocrinologist, Dr. Marie Nevin, who worked with a close friend and was in nearby Morristown, Nj

Nevin joyfully greeted the patient. She said that the first business order was twice checking the incorrect laboratory result. Again, the woman’s cortisol level was dangerously low. Another hormone, called the adrenocorticotropic hormone (ACTH), which releases cortisol release, was also low. They would have to find out why these two hormones were not hit so much and the patient would have to start daily doses of hydrocortisone to replace cortisol her body in the right quantities.

But before starting treatment, it was significant to find out if the cortisol was low, because the adrenal glands simply does not do it, or whether it was because of low ACTH. The patient was given an injection of ACTH, which should encourage the adrenal glands to release a very high level of cortisol. An hour later, the level of cortisol was higher, but still not as high as it should. This suggested that both the adrenal glands and the pituitary gland that means that ACTH did not work properly.

Nevin sent tests to see if other pituitary or adrenal hormones were affected. They were not. She was also looking for the most common causes of this type of disorder. Was it any kind of autoimmune problem? She sent tests to look for types of autoantibodies that are known to attack these parts of the body. All negative. There were diseases that could affect the adrenal glands or pituitary glands: HIV, tuberculosis and tumors, which due to their size or unregulated hormone secretion may interfere with the functions of these organs. Dozens of blood pipes were filled and sent to various laboratories. She had no disorders that could cause this dramatic decline.

MRI of the brain showed a pituitary tumor, but it was tiny. Further tests have shown that he does not produce hormones at all. It was known as an accidental incident, too tiny and inert cause of its symptoms.

The drug works

Nevin was surprised. She saw some patients with adrenal insufficiency. They looked like patients: tired and lackluster with delicate and painful muscles; Their blood pressure was sometimes so low that they could hardly get up. None of this was true for this patient. She looked physically effective. Her blood pressure was high, not low. It is true that she lost weight, but the overall picture did not fit. Still, she believed that the laboratory.

She scanned literature with other possible causes of the patient’s tardy glands. She found several cases of patients who developed adrenal insufficiency after Covid-19 infection. Can the culprit be the fight against Covid with Covid? Time was right, but at that moment there was no way to say.

The patient did well during hydrocortisone treatment twice a day. She began to regain weight loss, and her gentle fatigue gave way. She asked the doctor if she would have to be on this drug forever. Nevin told her that he would probably do it. At least this concerned most patients with adrenal insufficiency.

After two weeks on the hydrocortisone, the patient began to have sleep problems. She reduced the dose and suddenly she could sleep again. When insomnia returned a few weeks later, she overflowed the dose again. All this happened almost a year ago. The patient takes a tiny dose of hydrocortisone every day. Surprisingly, her high blood pressure has improved and was able to stop hypertension. Nevin tells me he still doesn’t understand why.

Nevin also did not understand why this patient was not as unwell as most who have adrenal insufficiency. Her hypothesis is that the deficiency has been previously discovered. Because the symptoms are unclear, patients with critically low levels of stress hormones can avoid diagnosis for months, sometimes years.

A few months after this diagnosis, newly published test He showed that 14 percent of people from Covid-19 developed adrenal insufficiency, which often improved over time. As in the case of this virus, why there is a deficiency or why the solutions are still not well understood.

Although there is no way to find out if this Covid infection caused the patient’s adrenal insufficiency, both she and Nevin, inspired by recent studies, plan to try to leave her from the drug this year. It will be a tardy process – but from the patient’s point of view it is completely worth it.