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Suggest Treatment For Schmidt Syndrome And Reduced Libido

Posted on Wed, 4 Feb 2015

Question: I suffer with Schmidt syndrom ( type 1 diabetes, addisons disease and hypothyroidism) over the past 6-12 months my energy levels and sexual desire have plumeted with no apparent reason. All my hormone replacement levels appear to be within the normal range and im searching for some reasons and treatments. I am usually highly physically active practising mixed martial arts and playing soccoer. These days however, I cant get up of a morning (despite being an early riser my whole life) and I have no energy or motivation to do anything physical. My GP has put me on anti depressants but i DONT FEEL I REQUIRE THESE

Answered by Dr. Ajish TP (26 minutes later)

Brief Answer:
Rule out other conditions and then start on anti depressants

Detailed Answer:
Hi XXXX,
Welcome to HCM. I have gone through your question and understand your concerns.

Don't worry.

Hope you might have read everything about your condition from internet. As you know Schmidt syndrome is an auto immune endocrine disorder. So unlike in other genetic (chromosomal) syndromes, you may get new auto immune disorders in this condition.

So make sure your other hormones are working normally. Hypogonadism (auto antibodies destroying testes) and pernicious anemia (auto antibodies against intrinsic factor) can rarely develop later in patients with this disorder. Diabetes per say can cause decreased sexual desire and tiredness. Other unrelated conditions like vitamin D deficiency and B12 deficiency can also be present. So in a person with Schmidt's with new onset symptoms of tiredness if all other investigations (blood sugars, HbA1C, renal functions, cortisol, ACTH, Thyroid function tests) are normal what I will do is

1. Do a testosterone (8 am), FSH, LH
2. Peripheral smear, complete blood counts
3, Serum 25 hydroxy vitamin D, Serum B12

Regarding anti depressants:

I am in favor of your GP in the decision of anti depressants if he has ruled out all other conditions. This is because depression in a diabetic can worsen the blood sugar control, and anti depressants can help in improving mood as well as blood sugars.

Hope I have answered your query. If you have any further questions I will be happy to help
With warm regards,
Dr Ajish TP (MD,DM)
Consultant Endocrinologist

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju

Follow up: Dr. Ajish TP (21 minutes later)

Hi thanks for your response. Just to clarify i am already taking the antidepressants and have been for around 4 months but they havent made any didferenve which is why i feel i dont require them

Answered by Dr. Ajish TP (5 minutes later)

Brief Answer:
If it hasn't made a difference, it's better to stop it

Detailed Answer:
Hi XXXXXXX

Welcome back.

If the medications hasn't made a difference in 4 months, there is no point in continuing it. So I think you should be worked up for other causes that I suggested to find out a cause. If there are no reasons that we could find out, it is better to get a specialist psychiatrist opinion before starting on anti depressants again.

Wishing you good health.

Regards,

Dr Ajish. TP

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Ajish TP (30 minutes later)

Thank you. Can i just ask what a 'Peripheral smear' is please

Answered by Dr. Ajish TP (1 hour later)

Brief Answer:
it is a simple blood test

Detailed Answer:
Hi XXXXXXX

Welcome back

Peripheral smear is a simple blood test to see how your blood cells (red blood cells, white blood cells and platelets) look under a microscope.

It is usually done by a pathologist. A drop of you blood is made into a smear in a glass slide, stained with some special dyes, and is examined under a microscope. The results are available in most centers in less than 24 hour period.

This tests will tell you if you have anemia, type of anemia, any infection that changed your white blood cell count or structure etc. In Schmidt syndrome there is a rare type of anemia called megaloblastic anemia due to vitamin B12 deficiency. This can be diagnosed by peripheral smear and serum B12 levels.

Hope the answer is clear now.

Regards
Dr Ajish TP

Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.

Above answer was peer-reviewed by : Dr. Shanthi.E