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Dr Uzair
Dr Uzair, Doctor
Category: Medical
Satisfied Customers: 6416
Experience:  MBBS, FCPS (R) General Surgery. Years of experience in Emergency Medicine.
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About three months ago one day I collapsed and was taken

Resolved Question:

Hi,
About three months ago one day I collapsed and was taken to A&E. It started with feeling spaced out and unreal and then extreme lightheadedness and dizziness. They ran urine and blood tests looking for viral infection, thyroid issues etc and all test came back normal. I have seen my GP several times and was referred to an Endocrinologist, an ENT and now a Neurologist. The Endocrinologist and the ENT have both discharged me. However I had a high level of cortisol in my blood the Dr said it is probably because I am under stress due to your health problem. The Neurologist has now ordered an MRI to rule out any serious issue. In the last three months I have been extremely unwell, no energy, no appetite, even doing the most simple tasks are difficult for me and I feel very tense and shaky. My most debilitating symptom is feeling spacy and out of it which is making me depressed and more tired. My GP suspects that it can all be due to anxiety, but to be honest I was a very energetic, happy and active individual and I managed to cope well with the recent life stressors including the break of my marriage, finishing a thesis at the same time and other life issues so it is sort of hard for me to believe that the lightheadedness, dizziness, feeling lethargic, feeling spacy etc can all be due to anxiety. I desperately need your advice as I am finding it very hard to cope with life which is scaring me alot and make me think will I ever survive this?
Many thanks
Submitted: 1 year ago.
Category: Medical
Expert:  Dr Uzair replied 1 year ago.
Hi and thanks for the query,It is good to have MRI for finding out the cause for your collapsing episode in the first place. What i suggest is you should get your worup for cushing syndrome as you have increased cortisol in your blood and the symptoms of depression, irritability, fatigue also explains this. It is diagnosed by 24 hour urinary cortisol test, midnight plasma cortisol levels and low dose dexamethasone suppresion test. Next time you visit your doctor discuss about this condition so that cause can be found and treated accordingly and timely. If all other causes are negative then you might be suffering from depression and need treatment for that. But first organic causes have to be ruled out.Let me know if you have further questions.Please do leave a positive rating.Best wishes.
Customer: replied 1 year ago.
Dear Dr. Uzair,Thanks for your immediate response. The Endocrinologist initially suspected Addison disease due to my very low blood pressure and extreme fatigue and dizziness. That's why he ran a Synachten test. The results were as:
baseline level of 489.1 nmol/l
30 min of 917 and 1 hour of 1072
So he ruled out Addison's and since I had extreme amount of weight loss and no other physical symptoms for Cushing's he referred me back to my GP for further investigation and possible referral to a Cardiologist due to my pre-syncope episodes and light-headedness.In his letter he has written that:' Your baseline cortisol was a rather stressy 489, at 30 mins 917 and at 60 mins 1072.
The baseline pituitary hormones are normal; certainly the prolactin, FSH and LH are normal. Oestrogen level is approperiate for the stage in your menstrual cycle and thyroid hormones were normal with a TSH of 1.94. IGF-1 which is a growth hormone, again was slightly elevated because of stress response at 37.3 (normal range up to 34) but as I said this is a stress response and I think that would be in keeping with how you are feeling about your health at the present time.''I have wondered whether you should think about seeing a cardiologist in view of the low blood pressure and the sensations you are getting coming up to a collapse in case it was a reflection of a cardiac arrhythmia ''So finally I do not think that there is any endocrine condition that you are suffering from and I am happy to discharge you back to your GP's follow-up'.In the view of this letter I do not think the GP will be convinced to refer me back to the Endocrinologist for further tests.I would really appreciate your further advice.Many thanks
Expert:  Dr Uzair replied 1 year ago.
Hi and thanks for the reply,according to all these tests it seems endocrine problem is ruled out, you are goning to see neurologist as well, consultation from cardiologist would help out to rule out any cardiac issue and if both neurologists and cardiologists declare you clear then depression is one one thing left you should focus on and psychiatrist would help you in this regard.Let me know if you have further questions.Please do leave a positive rating by clicking on stars on top right corner.Best wishes.
Customer: replied 1 year ago.
Thanks again.
Would depression/anxiety cause all these weird physical symptoms? This is something which is really worrying me. I was a very healthy individual and all of a sudden can one be affected by depression/ anxiety to the level that causes such strong physical symptoms? As a teenager I was depressed for a while but the symptoms were totally different. Of course I was tired and lethargic and had bouts of low mood but there was no spacey feeling or shakiness etc. At present I cannot really say that I have low mood although this situation is making me gradually depressed so I am really confused and fed up.
Expert:  Dr Uzair replied 1 year ago.
Hi and thanks for the reply.
Yes, depression/anxiety are now considered as organic conditions causing a wide array of symptoms instead of just causing a change in behavior or mood, as previously thought. However, before labeling anything as depression or anxiety all other conditions that can be a cause of these symptoms should be ruled out. If you feel that all your consultations have yielded a clear bill of health and there is no problems as regards, ***** ***** and cardiology, then it is time to see a Psychiatrist.
Hope this helps.
Please do leave a positive rating for the service.
Best wishes.
Expert:  Dr Uzair replied 1 year ago.
Let me know if you have further questions.
Please do leave a positive rating.
Best wishes.
Customer: replied 1 year ago.
Thanks Dr Uzair,I have more questions that I would like to discuss possibly tomorrow.
Many thanks
Expert:  Dr Uzair replied 1 year ago.
It will be a pleasure to answer more queries.I only get paid for my work here if you rate my answer by clicking on the star system on the top of the screen. I shall be grateful and we can continue the conversation even after the rating.
Dr Uzair, Doctor
Category: Medical
Satisfied Customers: 6416
Experience: MBBS, FCPS (R) General Surgery. Years of experience in Emergency Medicine.
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