Painful, Swollen Areas Under Clavicles, Lumps In Neck, Breast Pain, Non-alcoholic Fatty Liver, Subcutaneous Lipomas, Diarrhea. What Do You Think?

Posted on Mon, 18 Jun 2012

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Mon, 18 Jun 2012 Answered on

Sun, 15 Jul 2012 Last reviewed on

Question : I have a painful swollen areas under my left and right clavicles (left side swelling is much worse than right) and also there are painful lumps on the left side in my neck above the collar bone. The pain is almost unbearable, at times, and I feel so tired all the time. I was told I probably have panniculitis and I am being sent for a needle biopsy and ultrasound in a couple of days of the swelling and lumps under my left clavicle. I also get pain in my left breast and the recent mammogram and ultrasound suggested (by the breast surgeon) I have a fatty tumors in that breast. I have non alcoholic fatty liver disease and multiple subcutaneous lipomas. One lipoma in my abdomen is sore and looks like it is bruised. I also have unusual fat distribution. (see attached picture) I look like I work out with excess fat across my shoulders and chest with very little weight over my hips and thighs. I get frequent bouts of watery diarrhea, get tingling weakness in my hands and feet and bouts of mental dullness or confusion, including slurring of speech. I am a 55 year old female. I live in a remote area and I have to wait 6 months to see an Endocrinologist (low priority). Bloods show normal Thyroid levels but have picked up episodes of low blood cortisol 103 at 9:00 am (160 bottom of normal range - normal Synactyn response). 2 months ago I had two very large benign polyps removed from my uterus. I do not have diabetes . I am being brushed off as being menopausal. I feel it is more than just menopause. What do you think? Do you have any suggestions for me to give to my local family Dr. for tests etc?

Answered by Dr. Shehzad Topiwala (12 hours later)

Endocrinological evaluation for you would include work up for a few potential conditions. One is Cushing's disease or cortisol excess. The synacthen test you underwent is for the opposite condition ie deficiency of cortisol. Testing for cortisol excess can be done in a few ways. Options include a midnight salivary sample, whereas another test requires you to take a blood test at 8 am after taking a special pill the night before. Another hormonal condition that causes weight gain is called acromegaly. Screening for this requires a simple blood test for IGF1 levels. Frequent watery diarrheal episodes indicate the need to rule out a rare disorder called VIPoma. An endocrinologist will guide you how to test for this too. Sometimes endocrinologists also perform blood tests for FSH, LH, estradiol and prolactin for the sake of completion

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shehzad Topiwala (5 hours later)

I had an MRI of my brain done about 18 months ago because I had nerve conduction studies in my extremities. The Brain MRI showed no abnormality except for some Early Cerebral Atrophic changes. There was no Pituitary abnormality.

I think I forgot to tell you I suffer from fluid retention in my legs, hands, and abdomen. I take Fusemide 40 mg to try to control the fluid retention. I also suffer from asthma.

A suggestion made to me was my abnormal fat distribution fits the profile for Madelung's disease??? Do you think this is a possibility?

Answered by Dr. Shehzad Topiwala (10 hours later)

I am not an expert in the field of Madelung's disease.

Fluid retention can occur in the endocrine conditions I described previously and therefore testing for those is worthwhile.

MRI brain does not always focus on the pituitary closely enough. A special view is needed for that which is performed only upon request. Moreover, the tests I described above are more important and scientifically recommended even before embarking upon MRI studies.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar