Thank you for your query at DoctorSpring.com
How's the blood pressure during the episodes? Has it been recorded?
You can check the urinary catecholamines especially during the episodes for a more confirmatory test.
How's the Thyroid function? Has the thyroid profile been done?
If everything is normal, then sedatives/anxiolytics will help.
Feel free to discuss further,
Patient replied :
I had a thyroid panel in September that was normal. The other thing is that my Calcium levels have been 10.2, 10.1, 9.4, 9.6, 9.9 since September. Vit D was 30 and PTH was 32.9. What do you think of parathyroid dx? I recently had a plasma metanephrine test (don't have the results yet). Is that am accurate test for pheochromocytoma? I have not checked my BP during panic times, but heart rate can really shoot up to 130's. The other day at the ER my BP was 149/92 (the highest I have seen it). Also, my fasting blood sugar is 96. Is that a concern? Thank you.
I have reviewed all your reports.
Your parathyroid reports are normal. The plasma Metanephrine is a sufficiently reliable test for pheochromocytoma. Fasting blood sugar is fine. Your symptoms and lab tests do not support a possibility for pheocytochroma.
Only heart rate going up with mild hypertension suggests more of anxiety related disorder. You mentioned that you have a history of anxiety and Panic attacks are known to occur during pregnancy (where your heart rate will increase). I would recommend that you continue the sertraline (Zoloft) prescribed to you. If your current dosage does not provide adeqaute relief, your OBGYN can increase it to one which will provide better relief of symtoms while being safe for your baby.
Hope this helps,
Patient replied :
Can low cortisol produce frequent adrenaline feelings. I had an ASI done that showed low cortisol both day and night. Just feel like I am losing it and just talking with people makes my heart race and I feel like I am going to pass out (which has really gotten worse since pregnancy, but I have also been noticing these increased symptoms for about 5 months). All of symptoms lean towards pheochromocytoma with the increased hr, severe panic and anxiety, cold hands and feet, adrenaline feelings (constant....can't sleep), mid left back pain and LUQ pain (both come and go for the past year). I think I am making myself sick about this. I just don't feel right and wish I could blame a lot it on pregnancy. Is a plasma norepinephrine of 541 too high? Thank you.
I can understand how your anxiety. However, given the description of your symptoms and the normal values from your blood tests, a pheochromocytoma being the reason is not probable.
Whether or not a plasma norepinephrine level of 541 is high or not depends on which lab the test was done and what are their reference values. If you can attach a report of the testing for either plasma metanephrine or 24-hour urinary collection for catecholamines and metanephrines which was done I can look over them and help you understand why it further supports that a pheocytochroma is unlikely.
Low cortisol would not cause such symptoms. As I mentioned, pregnancy is known to cause panic attacks where you feel restless and your heart rate and blood pressure increase, but in light of these normal labs I would like to reassure you that they do not appear to arise from any serious underlying condition.
Hope this helps, feel free to discuss further