Managing Adrenal Insufficiency: Addressing Dizziness and Bloating Issues

Adrenal insufficiency

I have adrenal insufficiency and recently visited the endocrinology department, where I mentioned issues with dizziness and bloating.
The doctor suggested that it might be postural hypotension, but after measuring my blood pressure consistently for five days, my diastolic pressure ranged from 50 to 60 mmHg, systolic pressure from 95 to 116 mmHg, and my heart rate was between 72 and 86 bpm.
I've also been experiencing nausea, a reduced appetite, and persistent bloating (I underwent an endoscopy which showed only mild gastroesophageal reflux, but the bloating is quite severe).
The dizziness worsens after running, and I need to squat down to recover.
Is there anything I can do besides taking steroids?

Hsieh Hsin-Yi, 40~49 year old female. Ask Date: 2020/11/13

Dr. Lin Jianliang reply Internal Medicine

Adrenal insufficiency, in addition to medication, can be managed by incorporating regular exercise, maintaining a normal daily routine, and following a balanced diet, among other healthy lifestyle choices.

Reply Date: 2020/11/13

More Info

Managing adrenal insufficiency can be a complex process, especially when symptoms like dizziness and bloating arise. Your experience with low blood pressure readings and gastrointestinal discomfort indicates that you may be facing multiple interconnected issues that require careful management.

Adrenal insufficiency, whether primary (Addison's disease) or secondary (due to pituitary dysfunction), results in inadequate production of adrenal hormones, particularly cortisol. Cortisol plays a crucial role in regulating metabolism, blood pressure, and the body's response to stress. When cortisol levels are insufficient, patients often experience symptoms such as fatigue, dizziness, and gastrointestinal disturbances.

Dizziness and Low Blood Pressure
Your blood pressure readings suggest that you may be experiencing orthostatic hypotension, which is a drop in blood pressure upon standing or changing positions. This condition can lead to dizziness, especially after physical exertion like running. The low diastolic pressure (50-60 mmHg) you reported is concerning, as it may not provide adequate perfusion to vital organs, leading to symptoms like dizziness and fatigue.

To manage this, consider the following strategies:
1. Hydration: Ensure you are well-hydrated, as dehydration can exacerbate low blood pressure. Increasing your fluid intake, particularly with electrolyte solutions, may help stabilize your blood pressure.

2. Salt Intake: Increasing dietary salt can help raise blood volume and blood pressure. However, consult your healthcare provider before making significant changes to your salt intake, especially if you have other health conditions.

3. Medication Adjustment: If you are on corticosteroids, discuss with your doctor the possibility of adjusting your dosage or timing. Some patients benefit from splitting their doses throughout the day to maintain more stable cortisol levels.

4. Compression Garments: Wearing compression stockings can help improve venous return and reduce symptoms of orthostatic hypotension.

Gastrointestinal Symptoms: Bloating and Nausea
Your gastrointestinal symptoms, including bloating and nausea, can be particularly challenging. While you mentioned a diagnosis of mild gastroesophageal reflux disease (GERD), the severity of your bloating suggests that there may be additional factors at play.

1. Dietary Modifications: Consider keeping a food diary to identify any specific foods that may trigger bloating. Common culprits include high-fiber foods, carbonated beverages, and dairy products. A low-FODMAP diet may also be beneficial, as it reduces fermentable carbohydrates that can cause gas and bloating.

2. Small, Frequent Meals: Eating smaller, more frequent meals can help reduce bloating and nausea. This approach can prevent overwhelming your digestive system and may improve your overall comfort.

3. Prokinetic Agents: Discuss with your doctor the possibility of using medications that promote gastric motility, which can help alleviate bloating and nausea.

4. Stress Management: Since stress can exacerbate gastrointestinal symptoms, consider incorporating stress-reduction techniques such as mindfulness, yoga, or cognitive-behavioral therapy into your routine.

Follow-Up and Monitoring
Given the complexity of your symptoms, it is essential to maintain regular follow-ups with your healthcare provider. Continuous monitoring of your blood pressure, symptoms, and overall health status will allow for timely adjustments to your treatment plan. If your symptoms persist or worsen, further evaluation may be necessary to rule out other underlying conditions.

In conclusion, managing adrenal insufficiency requires a multifaceted approach that addresses both hormonal replacement and symptom management. By working closely with your healthcare team and implementing lifestyle modifications, you can improve your quality of life and better manage the symptoms of dizziness and bloating. Always consult your healthcare provider before making any changes to your treatment plan.

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