OpenHealth Q&A

Exploring Other Causes Beyond Adrenal Insufficiency

A 33-year-old female with a history of uveitis and ankylosing spondylitis (positive HLA-B27) is currently undergoing treatment. Her regimen includes Humira administered at 40mg subcutaneously every week, along with Diclofenac 50mg taken orally twice daily as needed and Vitamin D at a daily dose of 1000 IU. She is not currently on any multivitamins, collagen, greens, or branched-chain amino acids despite regular workouts. From 2019 to 2022, while on Humira, she experienced no flare-ups related to her uveitis or ankylosing spondylitis (AS). However, after being transitioned to a biosimilar medication, Idacio, she immediately suffered a severe episode of uveitis followed by a significant flare of AS. The switch to Amgevita brought some relief though it was still not ideal. In 2023, during a twin pregnancy, she requested an early delivery at 36.5 weeks due to debilitating AS pain, leading to a c-section with no labor signs. Her newborns were placed in the NICU, and she was unable to see them for hours post-surgery, but successfully breastfed for a year. Two weeks postpartum, she developed an infection at her c-section site, which was treated with showers rather than antibiotics. Four weeks postpartum, she anticipated typical uveitis flare-ups and switched to Durezol due to inadequate responses to Predforte, requiring increasingly frequent doses. By eight weeks postpartum, she attempted to resume running, only to find herself severely fatigued for several days after each session, which she attributed to breastfeeding. Fast forward to April 2024, seven months postpartum, she faced keratitis—a diagnosis that initially left her providers puzzled, leading to antibiotic and antiviral prescriptions. After two weeks, the condition deteriorated, and it was finally identified as HSV1-related inflammation. Despite this, she questioned this diagnosis, considering her history of autoimmune uveitis. In the months following, she continued to struggle, feeling extreme fatigue after workouts, and began experiencing recurrent uveitis issues alongside various viral infections, including Flu B and Flu A, without skipping doses of her medication. By April 2025, she tested positive for COVID-19 without detrimental effects on her treatment plan. Her continuous struggle with uveitis persisted, requiring frequent adjustments to her medication regimen, during which she felt increasingly exhausted. Visiting her rheumatologist in January 2026, she raised concerns about her symptoms and asked for hormone testing. Results indicated slightly low Vitamin D levels and a cortisol level at 149 mol/L, prompting a referral to an endocrinologist. The endocrinologist conducted further tests, revealing mixed results—her cortisol levels indicated potential adrenal involvement but not conclusive adrenal insufficiency. Despite her active lifestyle, including CrossFit, a sudden wave of extreme fatigue left her unable to maintain her exercise routine. Additionally, she started experiencing symptoms like low blood pressure and tachycardia, prompting her to monitor her condition more closely. During her follow-up visit, the endocrinologist dismissed the possibility of an adrenal issue without conducting an ACTH stimulation test, suggesting that her symptoms were likely due to inflammatory fatigue or low blood pressure typical for someone her age. However, as a nursing professional, she remains convinced that something larger is at play. She believes that the frequent occurrences of atypical uveitis are signals indicating an underlying issue, especially considering her two borderline cortisol results. Given that cortisol plays a crucial role in managing inflammation and blood pressure, she is seeking insight into what additional tests might identify the root cause of her symptoms, urging for a thorough investigation beyond simple inflammatory fatigue.

Answers (1)

3/6/2026, 7:10:45 PM

OpenHealth AI

Your situation is understandably complex, and it's clear you're managing a variety of interrelated health issues, including autoimmune conditions, hormonal fluctuations, and fatigue. You've already shown great insight into your health needs, especially as a nursing professional. Let's explore your concerns and possible next steps.

Main Points

1. Chronic Fatigue and Autoimmune Symptoms: Your persistent fatigue and recurrent uveitis may stem from a combination of factors, including hormonal imbalances, inflammation, and possibly ongoing autoimmune activity.
2. Testing and Monitoring: It's essential to explore additional testing that can help identify underlying causes beyond what has already been evaluated.

Explanation

Your diagnosis of ankylosing spondylitis (AS) and uveitis, along with the medication changes, suggests that your immune system is responding variably, potentially leading to symptoms like fatigue and frequent infections. Elevated cortisol levels and symptoms like low blood pressure and tachycardia are also significant, pointing to possible adrenal involvement or other systemic issues.

Given your concern about adrenal health and the mixed results from previous tests, it's reasonable to pursue further evaluations. Stress and chronic inflammation can impact adrenal function, and conditions like autoimmune disorders can sometimes lead to secondary adrenal insufficiency, particularly following major life events like pregnancy.

Next Steps

1. Request Comprehensive Hormonal Testing:

   • Ask for a full adrenal panel, including an ACTH stimulation test. This can help clarify whether there is any significant adrenal insufficiency or dysfunction.
   • Consider testing for other hormones such as thyroid hormones (TSH, Free T3, Free T4) and sex hormones, as they may also influence energy levels and overall well-being.

2. Explore Autoimmune Screening:

   • Since you are experiencing atypical uveitis, it could be beneficial to test for other related autoimmune markers (e.g., ANA, rheumatoid factor) to ensure there are no underlying conditions contributing to your symptoms.

3. Vitamin D Supplementation:

   • Given your slightly low Vitamin D levels, discuss with your healthcare provider about adjusting your Vitamin D dosage. Maintaining adequate levels is crucial for immune function and bone health.

4. Monitor Hydration and Nutrition:

   • Ensure you're well-hydrated and consider a balanced diet rich in fruits, vegetables, and whole grains to support your overall immune health and energy levels. As an active individual, you might also benefit from incorporating protein-rich foods to help with muscle recovery.

5. Rest and Recovery:

   • Listen to your body. If you're feeling fatigued after workouts, consider modifying the intensity of your exercises or incorporating more rest days into your routine to aid recovery.

6. Document Symptoms:

   • Keep a detailed symptom diary that notes your fatigue levels, uveitis episodes, and any new or recurring symptoms. This can provide valuable insight for your healthcare team.

7. Seek a Second Opinion:

   • If you feel unsatisfied with the responses from your current endocrinologist, consider seeking a second opinion. A specialist in autoimmune conditions or a functional medicine practitioner may offer additional perspectives.

Your concerns are valid, and pursuing a thorough investigation is a proactive approach to understanding your health better. Remember, you’re not alone on this journey, and seeking comprehensive insight is an important step toward finding relief and improving your quality of life.