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Suggest Treatment For Severe Headaches, High BP And Nausea

Posted on Sat, 7 Mar 2015

Question: I was admitted to the hospital five days ago with severe headaches, high blood pressure and severe nausea and vomiting. The doctors say lab results and CT scans show my potassium is high, my sodium level is critically low, and CT shows two thyroid nodules. They put me on IV Methyl prednisone for the persistent headaches, and they referred me to an endocrinologist for the thyroid nodules,low sodium and potassium levels, and they suspect adrenal gland disorder. They also want to do an endoscopy to try to find the reason for my excessive vomiting and nausea, but they have postponed it twice because of the low sodium and high potassium.
Today, the endocrinologist really confused me by saying it may be a pituitary gland problem. My question is "How does low sodium and high potassium affect thyroid glands, pituitary glands and persistent vomiting?

Answered by Dr. Ajish TP (1 hour later)

Brief Answer:
It could be low adrenal hormones

Detailed Answer:
Hi XXXX,

Welcome to HCM.

The thyroid nodule is an incidental finding. Hope your thyroid function tests are normal. If there is hypothyroidism (under functioning thyroid), the sodium levels can go down.

High potassium and low sodium can be due to adrenal hormone deficiency. Pituitary gland regulates adrenal gland function. So this change in sodium and potassium can be due to either adrenal or pituitary hormone deficiencies. So your endocrinologist is thinking in right direction.

Hope I have answered your question. If you have any further questions I will be happy to help.

Regards
Dr Ajish TP
Consultant Endocrinologist

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

Follow up: Dr. Ajish TP (12 hours later)

OK. Thanks for responding to my question. My labs today still show critically low sodium level and high potassium level. However, the endocrinologist did not offer any treatments or medications, they just postponed the GI procedure (EGD with Botox for the vomiting and abdominal pains), and told me that I will have to stay in the hospital another day while they try to make a decision on what to do next.
What do you think is a probable next step in treating "adrenal deficiencies and possible pituitary deficiencies"?
(I am also a dialysis patient, they thought the dialysis would lower the potassium level, but it didn't.) So right now, they are just closely monitoring my low sodium level and high potassium levels and He says I can not go home from the hospital until they get my levels stable. Is there some tests or additional treatment they can do to treat these levels? Can they give sodium or something to lower the potassium in an oral form on an outpatient basis?

Answered by Dr. Ajish TP (1 hour later)

Brief Answer:
It is better to be treated as inpatient

Detailed Answer:
Hi XXXX,

Welcome back. I understand your concerns.

The doctors are waiting for a response to methyl prednisolone given to you. The treatment for pituitary deficiency is steroids which you are already taking. For adrenal insufficiency you may need a drug called fludrocortisone. The doctor's might be waiting for blood reports to assess the adrenal function (Cortisol, ACTH).

Please share with us your lab reports if you have any.

It's better to be in patient and get treated as adrenal disorders can cause hypotension and low sodium can result in giddiness/ loss of consciousness.

Rapid correction of low sodium may sometimes worsen the condition. That may be the reason why your treating endocrinologist is not aggressive with salt replacement.

Wishing you early recovery.

Regards
Dr Ajish TP

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Ajish TP (2 days later)

Thank you for your review of my questions and for your answers. After doing more blood studies, the doctors state their findings are that I do have adrenal insufficiency. They started me on 10 mg Cortef Tablets. I am still inpatient as they are still monitoring my blood levels. My potassium level is down now, but my sodium level is still low at 124. However, my doctor says I may be discharged this weekend and they can manage Oral tablets on an Outpatient basis.
Thanks again for your help.

Answered by Dr. Ajish TP (1 hour later)

Brief Answer:
You can retest once your levels are stable

Detailed Answer:
Hi XXXX,

Welcome back.

Cortef tablets are hydrocortisone tablets for the treatment of low cortisol levels. This is a safe steroid. You can later retest your pituitary adrenal axis once you are stable.

Sodium level above 120 is safe. You can gradually correct it to normal levels in 1-2 weeks.

Wishing you speedy recovery

regards
Dr Ajish TP

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