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Dr. Sohaib
Dr. Sohaib, Doctor
Category: Medical
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Experience:  MBBS, FCPS Experienced in all Medical Specialities
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Im a 41yo female with adrenal insufficiency. I also have fibromy

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I'm a 41yo female with adrenal insufficiency. I also have fibromyalgia & bacterial overgrowth in the intestines. I have had extreme low back pain not relieved by pain medication or lidocaine injections for 2 weeks. My WBC was low (3.5). I have been vomiting intermittently as well as diarrhea. I have been running a low grade fever off & on since this started. Very painful while sitting or walking but ok when lying down. It has begun to radiate to the lower abdomen...first just left side now both sides. Doc recommended an MRI of the lumbar spine. Any concerns with the other symptoms?
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. Sohaib replied 1 year ago.

Hello and thank you for the question. Answers given are for informational purposes only and are not meant to replace an exam by an in-person.

I am Dr. Sohaib, a practicing Internal Medicine Specialist and i will do my best to help you today.

You need to answer a few questions first which will help me assist you in a better way.

What dose of steroids are you taking currently for adrenal insufficiency?

Do you have vomiting?

Tingling/numbness/burning in the lower back or legs?

Did you have any abdominal scan done?

Taking any antibiotic for fever?

Dr. Sohaib, Doctor
Category: Medical
Satisfied Customers: 4708
Experience: MBBS, FCPS Experienced in all Medical Specialities
Dr. Sohaib and 5 other Medical Specialists are ready to help you
Customer: replied 1 year ago.
Currently I have doubled my hydrocortisone from 20mg in the am to 40mg and 10mg in the afternoon to 20mg for three days. My endocrinologist stated I did not have to increase my fludrocortisone.

I have vomiting intermittently throughout the day.

No tingling or numbness.

No abdo scan.

Was not prescribed any antibiotics since my GP just said to get the MRI done & repeat bloodwork in a month.
Expert:  Dr. Sohaib replied 1 year ago.

Thank you very much for the useful information Karyn.

The first and most important step is to rule out the possibility of an ongoing infection since you have low white cell count (which predisposes to infections); fever (a sign of infection); abdominal pain (which can be due to intra abdominal infections such as infective colitis, parasitic infestation, gall bladder infection, pancreatic inflammation, or infection involving the urinary tract).

I say this because patients with adrenal insufficiency are prone to have infections, and when this happens, they tolerate the infection badly and require not only a prompt infection treatment (in the form of antibiotics); but also the dose of their steroid hormones need to be escalated to bear the period of physical stress (due to infection). If these measures are not taken in time, one can go in to adisson's crisis which is a life threatening and serious situation.

So you have already doubled the dose of steroids, but persistant vomiting and abdominal pain need to be investigated further.

Inflammatory markers (like crp/esr) along with fresh cbc will be helpful along with an abdominal scan to look for any possible pathologies in the abdomen (such as gall stones giving infection, renal stones giving infection, or pancreatic inflammation).

And since you have ongoing fever, you need a course of broad spectrum antibiotics (which we can hold in an otherwise healthy patient but not in a person with pre-existent adisson's disease).

Any physical stress/infection can also trigger fibromyalgia as well which might be contributing to your pain.

And finally, yes, your spine need to be investigated as well by means of an MRI (to look for a possible disc prolapse, vertebral degeneration or collapse).

So the stepwise approach here is;

Look for and treat the infection (tests and treatment).

MRI.

Enhance/start fibromyalgia medications like pregabalin if there is no abnormality (like an infection) found out.

Also, there is no harm to get tested for H.Pylori, a bacterial infection of stomach that can give your persistant stomach symptoms.

You should get back to your doctor, discuss all the details i have mentioned to get a management plan chalked out that suits best to your needs.

My goal is to provide you with Excellent Service - if satisfied with the response, Please do not forget to Rate my service as this is the only way i get credit for my time and expertise on your question.

If you feel you have gotten anything less, please reply back, I am happy to address follow-up questions.

Kindest Regards.

Dr. Sohaib, Doctor
Category: Medical
Satisfied Customers: 4708
Experience: MBBS, FCPS Experienced in all Medical Specialities
Dr. Sohaib and 5 other Medical Specialists are ready to help you
Customer: replied 1 year ago.
C-reactive protein was 0.4
Rbc sed rate was 11


















Expert:  Dr. Sohaib replied 1 year ago.

Thank you Karyn.

So this rules out the infection.

MRI is the next step.

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