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Symptoms of Fatigue. Numbness & Tingling. Muscle Aches. Sweating. Chills. Heart Palpitations. Nausea. Low Blood Pressure. Diarrhea. Excessive Hunger and/or Thirst. All at once?

Diagnoses of Anxiety, Fibromyalgia, Celiacs or MS?!

Thanks to a comment from a reader, I have started investigating adrenal insufficiency.Finally, a diagnosis that makes sense given the fact that I had a year with 5 major life-changing and stressful events preceding my symptoms. (

For my symptoms, check out “Numbness & Tingling on the Right side“).
For my latest theory on what’s happening, check out “Numbness, Tingling & Cold Spots = Stress + Vasoconstriction

Update: interesting relationship between thyroid and adrenaline: Note: http://tiredthyroid.com/feeling-hyper-when-hypo.html Thyroid and adrenaline (epinephrine) have an inverse relationship. [1- 4]

I finally got my doctor to agree (after I did all the research and pieced together a diagnosis), that the likely cause of all of my strange symptoms was “from stress wreaking havoc on my adrenal glands”.  The medical community had already ruled out MS, Lupus, Rheumatoid Arthritis, Celiacs, Ankylosing Spondylitis and more! Plus, there is a correlation between thyroid and adrenal dysfunction! It probably wouldn’t have been so bad if it had ben diagnosed right away. Instead, thinking I had one of those other diseases made me even more stressed. For six months I thought I was dying, and “impending sense of doom” is actually a symptom of adrenal fatigue.

When my cortisol and aldosterone were spiking, I had period numbness, tingling and “silent migraines” throughout my body. I think this may have been from norepinephrine – as they usually happened after something mildly stressful. This is a powerful natural vasoconstrictor. A vasoconstrictor causes the veins in the body to become more narrow. This increases the workload on the heart to pump your blood through your body. It also results in the high blood pressure often seen in people going through stressful situations. While NE can cause hypertension, local vasoconstriction, and tissue hypoxia in any patient, those with hyperthyroidism or who are also taking certain medications are particularly at risk. The drug can produce profound hypertension, local vasoconstriction, and tissue hypoxia. NE-induced hypertension typically presents as headache, photophobia, stabbing chest pain, pallor, intense sweating, and/or vomiting. Typical nervous system responses are anxiety and fear, headache and increased sensitivity to light sources.

Other infrequent side effects may include muscle pain or weakness, numbness or coldness in the arms or legs, trouble breathing or heart rate irregularities.

After several months (3ish) of numbness and tingling, adrenal fatigue set in, which is when my symptoms changed and my doctor thought I was a hypochondriac.  I was tired all the time, super dry hair and mouth, really achy hips and arms, heart palpitations (often at rest or in bed), dizzy spells, nausea, and oh, did I mention super, super tired! I also went through a period of snoring and would wake up feelingl like I was suffocating – never snored before or since. If I got out of the house, I could usually push myself through a day, however, when I stopped moving it was like I was hit by a truck and the whole next day I would be completely useless – seriously, couldn’t get off a couch.

By the end of June (6 months of symptoms), I had:

  • elevated inflammation markers (ESR = 34; CRP = 5)
  • Vitamin B12 deficiency (I wasn’t deficient at the onset (b12 = 270) but after 6 months of symptoms it was 115)
  • Magnesium deficient
  • Anemic
  • Low Ferritin (as low as 10)
  • Hypocalcemic
  • TSH was normal (I’m on PTU for my Graves Disease, although it was higher than normal for me – as high as 3.0 preceding my symptoms)
  • NOTE: these might have been exacerbated by my pregnancy, which happened shortly after the onset of the symptoms. A happy miracle!)

The longest lasting troublesome symptom has been that both my upper arms feel sore all the time, (tight, swollen and achy sensation with mild swelling). Haven’t been able to figure this out except that aldosterone can mess with your electrolytes, which can cause muscle spasms, etc… if calcium, magnesium, potassium and sodium are out of balance. (February 2012, and I still have sore arms, although they aren’t as bad, and it comes and goes now. Waiting to find an equilibrium! Read my latest blog on my vasoconstriction theory here: Numbness & Tingling, Cold spots on skin = stress & vasoconstriction )

Stop the Thyroid Madness explains:

Your adrenals, two small glands that sit on top of your kidneys. The outer cortex of your Adrenals produces the hormones cortisol, aldosterone, testosterone, DHEA, DHEAS, androstenedione and estrogens. And both cortisol (a glucocorticoid) and aldosterone (a mineralcorticoid) are vital and important players in your health and well-being.

When your adrenals become fatigued, they don’t make enough cortisol. And though low cortisol does not always equal low aldosterone, there may be a significant body of thyroid patients who with their low cortisol have low aldosterone!

WHAT IS ALDOSTERONE? Aldosterone is the principal of a group of mineralocorticoids. It helps regulate levels of sodium and potassium in your body–i.e. it helps you retain needed salt, which in turn helps control your blood pressure, the distribution of fluids in the body, and the balance of electrolytes in your blood.

WHAT HAPPENS IF ALDOSTERONE GETS TOO HIGH OR LOW?

When aldosterone gets too high, your blood pressure also gets too high and your potassium levels become too low. You can have muscle cramps, muscle weakness, and numbness or tingling in your extremities.

But when it gets too low, which can be common in some patients with cortisol deficiency, your kidneys will excrete too much salt, and it leads to low blood pressure; low blood volume; a high pulse and/or palpitations, dizziness and or lightheadedness when you stand; fatigue; and a craving for salt. Other symptoms of low aldosterone can also include frequent urination, sweating, a slightly higher body temperature, and a feeling of thirst, besides the craving of salt. Potassium can fall, as well, resulting in muscle cramps and aches.

This is the best article I’ve read on the adrenals: http://www.drlam.com/articles/adrenalexhaustion.asp?page=1

Here’s an explanation for some of my symptoms (in relation to cortisol levels).

Numbness & Tingling: Theory 1

  • Numbness and tingling is caused by a shift in the nerve electrolyte balance. ie water, K, Na, Ca, Mg, etc. Nerves are basically ion pipes that propagate an electric charge.
  • When aldosterone gets too high, your blood pressure also gets too high and your potassium levels become too low. You can have muscle cramps, muscle weakness, and numbness or tingling in your extremities.

Theory 2:

  • Cortisol increases blood pressure by increasing the sensitivity of the vasculature to epinephrine and norepinephrine = vasoconstriction = numbness:
  • Cortisol’s enhancement of epinephrine’s vasoconstrictive effect = reduced blood flow to muscles

Vaso-constriction. Cortisol contracts mid-size arteries.

 Diarrhea
  • Cortisol acts as a diuretic hormone, controlling one-half of intestinal dieresis,
  • Cortisol stimulates gastric-acid secretion.Cortisol’s only direct effect on the hydrogen ion excretion of the kidneys is to stimulate the excretion of ammonium ions by deactivating the renal glutaminase enzyme.

 Insomnia
/ Energy

  • Cortisol increases blood pressure by increasing the sensitivity of the vasculature to epinephrine and norepinephrine.
  • Cortisol production follows a curve from highest levels around 8am, dropping throughout the day until the lowest levels are reached about 11pm. In early stages of adrenal fatigue the body compensates with high night time cortisol. In this case the person finds it difficult to relax from the stress of the day and has trouble going to sleep. High night-time cortisol results in reduced REM sleep which is neither restful nor restorative. This can lead to depression and reduced energy levels the next day. In later stages of adrenal fatigue, the body may produce adrenaline (“fight or flight” hormone) in an attempt to compensate for low cortisol. This too will result in insomnia.
  • Stimulates hepatic detoxification by inducing tryptophan oxygenase (reducing serotonin levels in the brain), glutamine synthase (reducing glutamate and ammonia levels in the brain), cytochrome P-450 hemoprotein (mobilizing arachidonic acid), and metallothionein (reducing heavy metals in the body)[
 Weight / Hunger  Normalizing blood sugar level. Cortisol increases the blood sugar level in the body, thus providing the energy needed for the body to physically escape threat of injury in order to survive. Cortisol works in tandem with insulin from the pancreas to provide adequate glucose to the cells for energy. More energy is required when the body is under stress, from any source, and cortisol is the hormone that makes this happen.As adrenal fatigue progresses, blood glucose levels will tend to fall too low. The body responds to hypoglycemia by causing the person to crave anything that will rapidly raise blood sugar levels, such as a soda, candy bar, a cup of coffee or even cigarettes. Often adrenal fatigue leads to the abuse of alcohol, marijuana, and hard drugs because of the need to “fix” recurrent hypoglycemia. Unfortunately, the rapid rise in blood glucose provided by the “fix” only serves to start the whole cycle over.

I’m hungry, I need sugar NOW!
The adrenal glands, which rest on top of your kidneys play a vital role in controlling blood sugar. If the adrenals are exhausted from stress and sugar is the only food that’s fueling your system, you’re going to see a lot of irritability when hunger arises. The solution, besides eating balanced meals: Getting enough Vitamin C, licorice (Opt for the root, which helps slow down cortisol production), Vitamin B5 and adrenal gland supplements.
 Blood pressure, fluid retention, vitamin deficiencies   Stress increases the release of aldosterone, causing sodium retention (leading to water retention and high blood pressure) and the loss of potassium and magnesium in the early stages of Adrenal Fatigue.

  • Swelling & Veins: in the absence of cortisol, widespread vasodilation occurs.

Magnesium is involved in over 300 enzymatic reactions in the body. When the body lacks magnesium, it will suffer from a variety of pathological conditions such as cardiac arrhythmias.

 Elevated ESR or CRP (inflammation)  Cortisol has anti-inflammatory properties, reducing histamine secretion and stabilizing lysosomal membranes. Stabilization of lysosomal membranes prevents their rupture, preventing damage to healthy tissues. Absence of cortisol = increase inflammation
 Dehydration Your adrenals, two small glands that sit on top of your kidneys, secrete aldosterone, a hormone that regulates water levels and the concentration of minerals, like sodium, in your body, helping you stay hydrated. When your body is stressed, more aldosterone and sodium circulate in your system. Once the stress is over, aldosterone levels fall and sodium must leave your bloodstream. The sodium passes through your kidneys and exits your body as urine, taking water with it. If you experience high stress levels on a regular basis, you will weaken your adrenals and dehydrate your body. And even if you drink a lot of water, you may not be getting the hydration you need!
Muscle cramps When aldosterone gets too high, your blood pressure also gets too high and your potassium levels become too low. You can have muscle cramps, muscle weakness, and numbness or tingling in your extremities.
Heart Palpitations
Night Sweats
Fatigue,
Light-headedness
When aldosterone gets too low, your kidneys will excrete too much salt, and it leads to low blood pressure; low blood volume; a high pulse and/or palpitations, dizziness and or lightheadedness when you stand; fatigue; and a craving for salt. Symptoms of low aldosterone can also include frequent urination, sweating, a slightly higher body temperature, and a feeling of thirst, besides the craving of salt. Potassium can fall, as well.
Nausea Abnormally low amounts of cortisol in the body disrupts metabolism, resulting in low blood sugar levels and reduced glycogen in the liver, which is used for providing quick energy. Much like the effects of diabetes, low levels of cortisol can initially cause brain-fog and lethargy, and progress to gastrointestinal symptoms, such as nausea, vomiting and diarrhea. Loss of appetite, weight loss and an inability to tolerate colder temperatures are also common symptoms.
Acne/Dry Skin/Dry Hair
Cortisol increases the production of sebum, a natural oil that lubricates your skin. When too much is produced, however, it can lead to blockages that cause acne. Too little cortisol = reduced sebum = dry skin.Also, low aldosterone can cause excess sweating/urination = dehydration!
Swelling/ Edema As the body tries to keep the ratio of electrolytes and fluid balanced, fluid may pour into the tissues and cause swelling. Most doctors will only see the symptom and not the cause and prescribe a diuretic which further compounds the dehydration and electrolyte imbalance and making the patient worse.
Hemorrhoids / Big Veins Hemorrhoids are basically varicose veins of the rectum and are caused by blood pooling in the abdomen and pelvis. When a person presents with hemorrhoids, it is usually do to adrenal fatigue, but can be caused by liver congestion. Once again, listening to the heart can help determine the cause. If the loud second sound is over the pulmonic valve, it is indicative of adrenal problems, while a loud 2nd sound over the tricuspid valve is indicative of liver congestion.Varicose veins of the lower extremities result from the same pooling of blood in the abdomen and pelvis that causes hemorrhoids.
Excessive Thirst, Frequent Urination, & Salt Cravings The adrenal glands produce many more hormones than just glucocorticoids. One very important hormone is aldosterone, a mineralocorticoid. Aldosterone regulates fluid and electrolytes (sodium, chloride, potassium and magnesium) in the blood, between and in the cells of the body. As adrenal fatigue progresses, the production of aldosterone lessens. This causes “salt-wasting”. As the salt is excreted by the kidneys, water follows leading to electrolyte imbalance and dehydration. Those with adrenal fatigue should always add salt (preferably sea salt with its trace minerals) to their water. Soft drinks and electrolyte drinks like Gatorade are high in potassium and low in sodium, the opposite of what someone with low cortisol needs. Commercial electrolyte drinks are designed for those who produce high cortisol when exercising, not for someone who produces little or no extra cortisol during exercise. You need to add ¼ to 1 teaspoon of salt to a glass of water or eat something salty to maintain fluid/electrolyte balance.A person with low aldosterone may also urinate 15 to 20 times a day and drink excessive quantities of water. Unless salt is added to the water, the fluid/electrolyte balance in the body is further disrupted.
Sensitivity to Light / Dependence on Sunglasses Are you one of those people who can’t stand to be out in the bright, midday sun without your shades? Oversensitivity of the eyes to bright sunlight is a sign of adrenal problems from a chronic sodium-potassium imbalance which prevents the pupils from properly constricting in response to bright light.The good news is that being out in the midday sun with no sunglasses is a way to strengthen the adrenals. When I do errands, I try to leave my sunglasses in the car and walk to and from the stores so that my eyes get a good dose of unobstructed sunlight.I’ve noticed that my eyes have become significantly less sensitive to sunlight over the years as my diet has improved with the general banishment of refined sugars and carbohydrates in my home. While I still wear sunnies for safety reasons to reduce the glare while driving, I frequently find myself forgetting to put them on at all on very sunny days.
Photo Sensitivity Dependence on SunglassesAre you one of those people who can’t stand to be out in the bright, midday sun without your shades? Oversensitivity of the eyes to bright sunlight is a sign of adrenal problems from a chronic sodium-potassium imbalance which prevents the pupils from properly constricting in response to bright light.The good news is that being out in the midday sun with no sunglasses is a way to strengthen the adrenals. When I do errands, I try to leave my sunglasses in the car and walk to and from the stores so that my eyes get a good dose of unobstructed sunlight.I’ve noticed that my eyes have become significantly less sensitive to sunlight over the years as my diet has improved with the general banishment of refined sugars and carbohydrates in my home. While I still wear sunnies for safety reasons to reduce the glare while driving, I frequently find myself forgetting to put them on at all on very sunny days.
Really dry hands / Lines in your fingers and hands Turn your hand over and examine the skin of the fingertips. Do you see nice, plump fingertips or is the skin covered with vertical lines? If they are nice and plump, that is a good sign for your adrenals. Lots of vertical lines in your fingertips indicate adrenal stress.My own fingertips used to be quite lined years ago, but getting off refined sugar plumped them out nicely within a few months.
Balding Lower Legs Do you have bald patcheson your lower arms and legs or sparser hair in those areas than you used to (particularly men)? This could be a sign of adrenal fatigue.Boys entering puberty with sparser beards and leg/arm hair than their peers are frequently those with low adrenal function and an overall lower drive to achieve.
Unexplained Hip or Knee Pain Muscle weakness is a frequent sign of adrenal insufficiency. Unexplained back or knee pain with no accompanying structural defect may indicate weakness of the muscles supporting the pelvis and/or knees.In the case of lower back pain, chronic adrenal stress leads to weakness in the muscles which support the pelvis causing the pelvis to subluxate in a posterior direction. In other words, the lower back pain has nothing to do with the lower back and everything to do with muscular instability in the pelvis

I guess my next step is to reduce stress and maybe try Milk Thistle. Please let me know if you’ve had success with this!

For some additional insight, check out this thread on the topic: Symptoms of Adrenal Insufficiency.

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So, I’m not sure how long I’ve had pernicious anemia, but my weird symptoms started in January.  I wasn’t tested for b12 deficiency until June! I was diagnosed with fibromyalgia by a rheumatologist (no blood test, told me tight muscles and insomnia were fibromyalgia), a neurologist didn’t know what I had (and didn’t do a blood test), and my family doctor thought I was anxious and a hypochondriac.

I am writing about it because I researched my symptoms obsessively for months and never came across a detailed description of what I was feeling. I always came across those overly vague and generalized pages that didn’t sound like what I was going through. No one mentions the veins, but they were one of my first signs!

Note: autoimmune diseases and thyroid disease put us at increased risk for B12 deficiency! If you feel tingly or “different” it might be worth it to ask your doctor to test your levels. 300-400 is borderline and you should start supplementing. Under 300 will cause symptoms and you should be treated immediately. If you’ve lost blood or had surgery, make sure you’re tested for B12 and anemia right away, symptoms or no symptoms. I also now think I have adrenal insufficiency! Too much cortisol (from stress) causes vasoconstriction, which can lead to numbness. Too little cortisol (adrenal insufficiency) causes widespread vasodialtion!

When my family doctor finally tested my levels, my B12 level was 115, I was severely anemic with extremely low ferritin, and hypocalcemic. After 2 weeks of supplementation, these were my blood results (green numbers are better than the red ones):

  • Calcium: 2.15 up from 2.08 (2.15-2.60)
  • B12: 215 up from 115 PMOL/L  after B12 injection (>200, although most recommend over 400)
  • Anemic (low iron),
    • hemoglobin: 113 down from  117 G/L (115-165)
    • hematocrit:  0.33 down from 0.38 L/L (0.37-0.47) &
    • RBC count: 3.46 down from 3.7 (3,8-5.8)
    • Ferritin: 13 up from 10 (11-145 UG/L)
    • MCH: 32.6 up from 31.6 (27-32) (macrocytic)
  • Low Albumin 34 down from 36.0 G/l (35-50)
  • Low Creatine: 52 up from 46 UMOL/L (60-115)
  • High ESR (inflammation): 20 down from 34 MM/H (0-12)

My main symptoms were numbness and tingling. However, some of my own weirder symptoms included:

  1. I actually think the weird sleep patterns were my first sign. I would wake up every night at 3am. Eventually I wouldn’t be able to nap despite extreme fatigue and would wake up a thousand times at night. Currently, I get hot flashes and sweating at night – I’ve always been cold at night so this is totally new.
  2. Tinnitus: I would read before bed and would often notice ringing in my ears
  3. Mild incontinence. Sudden urges to pee with mild “leaking”, even before the tingling started.
  4. Suddenly, I had right-sided numbness and tingling and muscle spasms. First my right thigh, then my right jaw, with tight spots on my right neck, left trapezius, and right side of my middle back. I wasn’t in much pain at first. It was mostly numbness
  5. Bright blue, tender, swollen veins throughout body, especially chest, thighs, hands and feet. This was one of my first signs that started around the same time as the numbness. Perhaps related to elevated homocysteine levels caused by low B12. (Big, blue, tender veins)
  6. Diarrhea that came and went in bouts (of weeks or months). The first two months of symptoms I had watery stools every day.
  7. Complex/silent/hemiplegic migraines – a wave of numbness in my face, thigh, or stomach for 15 minutes to 2 hours. During this time the area would be very heat/cold sensitive. After it was over I would have a wave of chills and severe headache and fatigue.
  8. I would often crash at 7pm at night. I never really slept soundly, but would lay in a comatose-like state. At night I would wake up a million times and never felt comfortable.
  9. I had achy hips and sciatica-like symptoms. At one point I had “heavy leg syndrome”. A massage of my numb thigh made my whole leg ache for 2 days. I shoveled the driveway and got severe sciatica symptoms – pain down my right leg and it felt like the circulation was poor.
  10. Finally, I had numbness and tingling on both sides of my body (after 2 months of mostly right-sided symptoms). My upper arms and hip/thigh regions were the worst. At times it felt like I had ties around my shoulders cutting off circulation in my upper arms, although my lower arms and hands were fine!  It also felt like tight bands of muscle or nerves running down my upper arm.  My hips and legs were often tingly. Again, it almost felt like circulation problems and I kept researching “vein inflammation” (mostly because my veins were big, blue and tender from the outset)
  11. During this time I also had severe photosensitivity, with wavy peripheral vision. Sometimes I would close my eyes and still see the waves.  I still need to wear sunglasses even on overcast days. My eyes were very bloodshot. Driving at night-time, I noticed that street lights and car lights looked like flares (almost like when you have too much chlorine in your eyes from swimming).
  12. My feet are always tender in the morning and it takes a while for them to feel normal. They can feel swollen, burning, or just tender.
  13. My symptoms are worse at rest. The second I stop moving, everything seizes up. Night time is the worst. Tingling, restless legs, crawling sensations down my arms and legs. Fatigue. Heart palpitations.
  14. Edema: The areas where I had severe nerve inflammation would be mildly swollen. My upper arms were a little jiggly, like they were full of water. My legs would feel weird to bend because they were swollen and it really brought out the cellulite in my upper thighs. I also noticed it in my right jaw, where I often got severe pain and tightness. I have read this could be caused by iron-deficiency anemia, which often occurs with B12 deficiency.
  15. I got floaters in my vision
  16. L’hermitte’s sign: an electrical zap feeling, like you’ve been electrocuted (which is supposedly really rare, but my mom gets it too)
  17. Muscle fatigue. Maybe it’s the nerve inflammation or the anemia, but my arms would tire blow-drying my hair and stairs were difficult to climb (easily fatigued, not really weak).
  18. Severe heart palpitations and sudden weakness/light-headedness for apparently no reason. Sometimes it was so severe I felt I could hardly breath despite laying down.
  19. My mom has also had balance issues and vertigo, as well as brain fog (forgot her own phone number once and couldn’t remember how to get home from work on another occasion)
  20. Dry mouth: My lips were peeling and I often felt like my mouth was dehydrated
  21. Course, dry hair that started to fall out.
  22. Tight calves. I also had muscle cramps in my calves at night. I became hypocalcemic, which I’m sure contributed to this!
  23. Heartburn and acid reflux. This started of mildly and got worse.
  24. Weird muscle spasms in my sleep that would wake me up. They wouldn’t be the really painful calf cramps, these were more spastic.
  25. As my B12 came into the 200 levels, my numbness and tingling moved from my core (upper arms, spine, hips) down to the lower half of of my arms and hands, and my calves and feet, which hadn’t really been affected before the first B12 shot.
  26. Hives: While I didn’t have this symptoms myself, I have read that it is related to B12 and have a friend with both low B12 and occasional outbreaks of hives. (updated 2012 – I got hives!  Not sure if it’s related to low b12, but started getting them several months after this post)
  27. Severely dry hair and hands.
  28. Bloating in the tummy area after stress – like seriously jiggly, like I was retaining a bucket of water. Would wake up with a flat stomach but after the slightest stress, would bloat again! Weird.

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January 2011: So when my right thigh felt a little numb, I attributed it to the long walk in the snow I did the night before. “Must have a muscle spasm” I thought.  When the next day I got numbness in my face (twitching of the muscle between my jaw and eyes with a knot/hard ball on the jaw), yes, momentary panic, and then, “I have a really big knot in my back, leading to my neck. That must be it.”  When the symptoms continued overnight and I awoke with my entire right side feeling tingly, I freaked and went to the emergency room. Autoimmune disorders run in my family. I have a cousin with MS and to be honest, it is my biggest fear.

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