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Cortisol deficiency, but with weight gain
Autoimmune Diseases | Last Active: Sep 15 2:34pm | Replies (50)Comment receiving replies
@tom1970
Does your insurance require a referral to see a specialist? If so, either your PCP or Endo could refer you. Your dose of 15mg total for Secondary adrenal insufficiency is very low and most Endocrinologists recommend taking your largest dose first in the morning because doing so mimics your body's natural circadian rhythm and gives you a cortisol boost to start your day. Also, as Secondary AI , we learn to space out our Hydrocortisone so that a small amount is always in our system. Most Endocrinologists understand this approach and allow their patients to experiment with both the frequency and the dose to fit your needs. I recommend discussing this approach with your Endo on your next visit. There are different types of liver disease, so my initial comment was meant "generally" not knowing what type you may have. I'm going to include a little bit more information but you need more diagnostic testing which is why a Hepatologist is needed.
Fatty liver disease, also known as hepatic steatosis, is a condition characterized by the accumulation of excess fat in liver cells. It can be broadly classified into two categories: alcoholic fatty liver disease (AFLD) and non-alcoholic fatty liver disease (NAFLD). The latter is more common and is often associated with obesity, type 2 diabetes, and metabolic syndrome.
### Types of Fatty Liver Disease
1. **Alcoholic Fatty Liver Disease (AFLD)**: Caused by excessive alcohol consumption.
2. **Non-Alcoholic Fatty Liver Disease (NAFLD)**: Not related to alcohol consumption. It can progress to non-alcoholic steatohepatitis (NASH), which is more severe and can lead to liver fibrosis, cirrhosis, or liver cancer.
### Diagnostic Tests
Several tests can be used to diagnose fatty liver disease:
1. **Blood Tests**:
- Liver function tests (LFTs) to measure levels of liver enzymes (ALT, AST) and assess liver function.
- Tests for viral hepatitis, iron levels, and other metabolic disorders.
2. **Imaging Tests**:
- **Ultrasound**: Most common initial imaging test used to detect fat in the liver.
- **CT Scan or MRI**: Can provide more detailed images of the liver.
- **Elastography**: Measures liver stiffness, which can indicate fibrosis.
3. **Liver Biopsy**: A definitive method to assess the extent of liver damage and inflammation. It is usually performed if there is uncertainty about the diagnosis or if NASH is suspected.
Early detection is key and now that you have a partial diagnosis, it's extremely important that more tests be ordered to determine the extent of your liver disease and then to formulate a treatment plan. Another thought, is to investigate seeing a team of specialists at a Mayo Clinic. They are the best qualified to put all the puzzle pieces together and give you the answers you seek. Each clinic offers their own clinical specialties, so the closest one to where you live may not specialize in the medical conditions you have. You can look this up online or on this site. I'm looking into this myself and there are no Mayo Clinics in Texas so I would have to travel to either Arizona, Florida or Minnesota. Try to keep your spirits up and remember that we can only do our best. (with plenty of rest, lol)
Replies to "@tom1970 Does your insurance require a referral to see a specialist? If so, either your PCP..."
@tom1970 @ladyaceintx1 Tom, your situation sounds just awful and no medical providers to help you! And @ladyaceintx1 , you have a new diagnosis and want more and better information. Have either of you looked into Mayo Clinic’s Care Network? It’s a group of hospitals across the county who meet the high standards that Mayo sets. In return, they have access to all that Mayo has to offer. Here is the link:
https://www.mayoclinic.org/about-mayo-clinic/care-network/network-members
And if you are planning or hoping for an appointment at Mayo Clinic, here is the url used by those on Mayo Clinic Connect: http://mayocl.in/1mtmR63
I wish both of you good luck. If traveling is not an option, you should check into a university/ teaching or major medical center near you. And you won’t need a referral, you can just call the main number and explain the situation. That is what my husband did. I was basically non-responsive in our local ER, but my husband called and the university hospital gave me an appointment with the neuro-immunologist. But first, the university told the local doctors to start heparin so I could wake up. I’m not cured, butI’m doing well!
What do you think could happen if you make some phone calls?
I've made a copy of your info. Thank you Very much.
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@tom1970
I thought I'd share a little bit more information for you, to discuss resulting side effects from having liver disease and maybe help prepare you for a medical discussion with your Hepatologist.
How a Fatty Liver Leads to Ascites (abnormal accumulation of fluid in the abdominal cavity) and the need for a parencentesis for diagnosis or symptom relief:
1. **Progression to Cirrhosis**:
Fatty liver disease can progress to liver fibrosis and eventually cirrhosis if the underlying causes are not addressed. Cirrhosis involves significant scarring of the liver tissue, which disrupts normal liver function and blood flow.
2. **Portal Hypertension**:
As cirrhosis progresses, it can lead to increased pressure in the portal vein (the vein that carries blood from the intestines to the liver), a condition known as portal hypertension. This increased pressure can cause fluid to leak from the blood vessels into the abdominal cavity, leading to ascites.
3. **Hypoalbuminemia**:
The liver produces albumin, a protein that helps maintain oncotic pressure in blood vessels. In cases of liver dysfunction (such as in cirrhosis), there can be a reduction in albumin production, leading to lower levels of albumin in the blood (hypoalbuminemia). This decreases the ability of the blood to retain fluid, contributing further to fluid accumulation in the abdomen.
4. **Sodium and Water Retention**:
Liver disease can also lead to changes in kidney function and hormonal regulation, resulting in increased retention of sodium and water, which can exacerbate ascites.
### Paracentesis###
Paracentesis is a procedure in which a needle is inserted into the abdominal cavity to remove excess fluid. This procedure may be performed for several reasons:
**Symptomatic Relief**: Ascites can cause discomfort, pain, and difficulty breathing (due to pressure on the diaphragm). Removing fluid can relieve these symptoms.
**Diagnostic Purposes**: Analyzing the fluid can help determine the cause of ascites (whether it's due to cirrhosis, infection, malignancy, etc.).
Fatty liver disease can lead to complications such as ascites, particularly when it progresses to cirrhosis. This condition can result in abdominal fluid retention, and a paracentesis may be necessary for symptom relief or diagnostic evaluation.
I want to add that there are several other medical conditions that can cause Ascites, besides Liver Disease, such as Heart Failure, Cancer, Infections and Kidney Disease.
Hope you don't mind the additional information but I know I like to be prepared for my appointments and have as much knowledge as I can, in hope for the best outcome.