Concerns About an Adrenal Mass
I am a 56-year-old woman diagnosed with ADHD and struggling with my blood pressure management. Currently, I'm on three medications to address my hypertension, along with a low-dose statin. Recently, I've been taking 20 mg of Vyvanse, which has been transformative for me; I’ve managed to shed 17 kg, with an additional 13 to 15 kg left to lose. This achievement has required significant effort on my part, as I’ve entirely overhauled my diet, committed to walking 7 kilometers daily, accumulating over 20,000 steps, and biking for at least 30 minutes. Due to scheduling difficulties with my general practitioner, I had a 24-hour urine test and extensive blood tests done at their suggestion. I also consulted other doctors for a suspected urinary tract infection, and they expressed concerns about my results, both suspecting a possible mass on one of my adrenal glands. My blood tests showed a low Mean Platelet Volume of 9.3 (normal range is 9.5-13). However, my lipid profile has improved significantly: my total cholesterol dropped from 6.5 to 3.6, triglycerides decreased from 1.4 to 1, HDL went from 1.6 to 1.4, LDL fell from 4.3 to 1.8, and non-HDL cholesterol went from 4.9 to 2.2. The ratio of total cholesterol to HDL also improved, changing from 4.1 to 2.6. My white blood cell count experienced a mild increase, rising from 6.23 to 6.84. Interestingly, this upward trend occurred simultaneously with my weight loss efforts. Is there a possible link? Additional blood analysis indicated: - Sodium levels are low at 134, down from previous readings of 135 and 136, as I have eliminated all extra salt from my diet, barring my treasured anchovies, which are quite salty. - Anion Gap is elevated at 18, down from 19. - Creatinine levels are low at 44, decreasing from 46 and then 39 as my weight loss progressed. - Gamma Glutamyl transferase levels are high at 62, previously recorded at 50 and 53. - Lactate Dehydrogenase is also elevated, measured at 377. - Cortisol is at 217 and Adrenocorticotropic Hormone at 8. - Normetanephrine values are high at 955, with a 24-hour urine result of 684. - Direct Renin levels are elevated at 359.3, where the reference range is 10-50. As someone with ADHD, my dopamine levels sit at 1314, well below the reference cap of 3500. I wonder if this correlates with my condition in any way. I am scheduled for a CT scan next month, but after receiving these results yesterday, I’ve asked to be added to the cancellation list to expedite the process. After researching online, I’ve found that many of the symptoms and results mentioned can be associated with adrenal masses. While I understand the unreliability of information found on the internet, I would appreciate any insights on whether my findings and concerns are valid. Thank you in advance for any advice you can provide!
Answers (1)
3/18/2025, 8:30:55 PM
OpenHealth AI
Thank you for sharing your detailed health concerns and achievements. It’s commendable how you've been proactive in managing your weight and blood pressure. Given your situation with a potential adrenal mass, here's a structured response to guide you.
Main Points
- Your recent blood test results and symptoms may indeed be linked to adrenal function, warranting thorough investigation, especially before the upcoming CT scan.
- Ongoing weight loss and changes in your lab results suggest a complex interplay, which may require further evaluation.
Explanation
Your blood work demonstrates some noteworthy changes that may relate to your adrenal glands, particularly the elevation in normetanephrine and cortisol levels, alongside the low sodium. Adrenal masses can secrete hormones that affect blood pressure and electrolyte balance, which could contribute to your hypertension and low sodium levels.
Next Steps
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Monitor Symptoms: Keep track of any new or worsening symptoms such as blood pressure spikes, unusual fatigue, or changes in mood. This information can be valuable for your healthcare team.
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CT Scan Preparation: Since you're on the cancellation list for an earlier CT scan, it’s important to make a note of any persistent symptoms leading up to the appointment. Be sure to communicate these with the imaging team if your symptoms change.
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Maintain Diet and Activity: Continue your healthy dietary choices and physical activities, as they positively impact your cardiovascular health, especially with hypertension. Ensure you stay well-hydrated, considering your low sodium levels.
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Follow-Up on Blood Test Results: Since there are multiple elevated levels in your blood work (e.g., direct renin, lactate dehydrogenase, gamma glutamyl transferase), discuss these results with your healthcare provider during your next visit or prior to the CT scan. This would help clarify their significance and any necessary adjustments to your medication or lifestyle.
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Mental Health Considerations: If you notice heightened anxiety or stress concerning your health and the CT scan, consider mindfulness strategies or relaxation techniques that may help you manage these feelings.
It’s understandable to feel anxious about the upcoming tests and your findings. Acknowledge your concerns, as they are valid, and stay engaged with your healthcare providers for the best outcomes. If you have further questions or need clarification about your findings, feel free to reach out!
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