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Suggest Treatment For Persistent Nausea And Vomiting

Posted on Fri, 24 Jul 2015

Question: For the past month, I have experienced constant nausea, sometimes with vomiting, which seems to be mostly gas. It starts when I get up, and continues through the day, sometimes relieving in the evenings. I have panhypopituitarism, with diabetes insidipus. I take hydrocortisone to replace my cortisol, and desmopressen acetate for the D.I.

Answered by Dr. Shehzad Topiwala (1 hour later)

Brief Answer:
Panhypopituitarism

Detailed Answer:
Sorry to note your medical problem.

When I see someone like you, I order the following tests in addition to a thorough physical examination:

CBC
CMP
TSH
Free T4
Prolactin

Are your menstrual cycles regular? Obviously if you have complete panhypopituitarism then you would have lost your menstrual cycles too from the time of diagnosis.

Are you not on thyroid medication?

If the thyroid is not adequately replaced it can cause the symptoms you have.

The same applies to the hydrocortisone as well and I see you are increasing the dose of the same. How much are you taking?

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

Follow up: Dr. Shehzad Topiwala (46 hours later)

I lost my menstrual cycles the day of my transphenoidal procedure to remove a benign pit tumor in September 1994. The surgeon cut through the stalk between the hypothalmus and pit gland, but it did not reconnect post surgery. I am on thyroid medication (.137/day), hydrocortisone (10mg/day), and desmopressen acetate spray due to secondary condition diabetes insipidus. Due to lack of work, I am on Anthem Blue Cross Medi-Cal (CA medicaid), and have not been able to see an Endo, but hope to remedy this situation in the near future. (I recently discovered that all endos in my area do not accept organized healthcare, but only straight Medi-Cal.) I do have a PCP, but he knows nothing about panhypopit.

Answered by Dr. Shehzad Topiwala (1 hour later)

Brief Answer:
Follow up

Detailed Answer:
I see.

Now your hydrocortisone is clearly on the lower side of the typical dose replacement......ie 15 mg daily, best taken as 10 mg in the morning and 5 mg in the evening. Try not to take the evening dose later 5 pm or it tends to cause insomnia.

Keeping the Free T4 in target range is also important

And the other tests I recommended are also helpful.

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

Follow up: Dr. Shehzad Topiwala (28 minutes later)

Ok, thank you. I will up my hydrocortisone dose up to 15 mg/day.

Answered by Dr. Shehzad Topiwala (7 hours later)

Brief Answer:
Follow up

Detailed Answer:
My advice was based on what I would do when someone like you presented to my office and after I had the opportunity to perform a comprehensive physical examination.
I suggest you undergo a complete evaluation in-person by an endocrinologist before you make any treatment changes.

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. Chakravarthy Mazumdar