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Many patients suffer with fatigue and are told that there is nothing to do for it. Here are 7 endocrine causes of fatigue that are often overlooked.
1) Low aldosterone
Aldosterone is a salt-regulating hormone made by the adrenal glands. Patients with low aldosterone have low blood pressure and don’t get enough blood going to the brain causing fatigue. Have your doctor measure your serum aldosterone level. If it’s less than 5 ng/dL, you may have an aldosterone deficiency. Treatment includes consuming more salt or eating licorice or grapefruits, although some patients may need synthetic aldosterone called fludrocortisone.
2) Low ferritin
Ferritin measures iron stores and is a more sensitive marker of low iron stores than either a CBC (complete blood count) or iron levels. Optimal ferritin levels are around 70 ng/mL. Those with low levels often don’t get enough blood going to their brain and they feel tired. Iron is also needed for thyroid hormone biosynthesis. Those with low levels of ferritin should take iron pills.
3) Growth hormone deficiency
Growth hormone (GH) is made by the pituitary and adults need GH as well as children. Adults with low GH have loss of muscle, accumulation of fat, especially in the abdomen, psychological changes, joint pain, poor sleep and pronounced fatigue. Growth hormone deficiency usually occurs in patients with pituitary problems and is diagnosed by a stimulation test to see if the pituitary makes GH such as a glucagon stimulation test.
4) Menopause
Women undergoing a drop in their estrogen levels due to menopause often feel extremely tired. Women with irregular or no menses and hot flashes should have a day 3 FSH and estradiol measured. If the FSH is high and estradiol is low, treatment with estrogen patches or creams plus progesterone can often help the fatigue.
5) Cushing’s syndrome
This relatively rare condition is probably underdiagnosed and occurs in people with either a pituitary or less often an adrenal tumor that causes the body to make too much cortisol. Patients with Cushing’s syndrome have debilitating fatigue yet are wired at night and sleep poorly. The diagnosis is made with imaging tests as well as urine, blood and salivary cortisol tests and the treatment is usually pituitary surgery.
6) Opiate pain pills
Opiate pain pills (also called narcotics), such as Vicodin, oxycodone, Tylenol with codeine are used to treat pain syndromes but when used chronically suppress hormonal function and can lead to low testosterone in men, growth hormone deficiency, low cortisol and other hormone problems all leading to fatigue. The solution is to taper off the opiates.
7) Hashimoto’s thyroiditis
It is well known that hypothyroidism have fatigue. Most patients with symptoms of hypothyroidism and an elevated TSH should be treated with thyroid hormone. The most common reason for hypothyroidism is Hashimoto’s thyroiditis in which the thyroid is attacked by antibodies. A recent study found that patients with elevated TPO antibody titers have more fatigue than those without, even with a normal TSH. There is no clear treatment for those with elevated TPO antibody levels although selenium may lower them.
For more information about Dr. Friedman’s practice or to schedule an appointment, go to www.goodhormonehealth.com.
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