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Adrenal or intestinal problem?
Posted by: Barbara
Date: March 17, 2006 2:03 AM

My daughter is 24 years old, a student diagnosed with mono in June 05. By fall, she seemed to have recovered (briefly) but for the last few months has been extremely fatigued. She has diarrhea on and off, temp fluctuates between a 96.8 and a low fever of 99+. Her doctor has done extensive bloodwork but says tests suggest a perfectly healthy person. No problems detected in stool tests. We have ruled out gluten intolerance by going gluten-free.for 2 weeks with no change. She eats fairly healthly for a young person, never eats fish, and has perhaps one or two very small fillings in her teeth. She is not over or underweight, but carries some weight around her waist. She has cut back on her schedule to rest as much as possible. Doc has given a referral to a GI specialist. Wouldn't a deep-wall intestinal infection show in white blood cell counts? What tests are needed to find an infection that hasn't shown up in blood and stool tests?
Should we see an endocrinologist and request the ACTH Challenge test and 24-hour urine test? Does anything above rule out adrenal fatigue?

RE: Adrenal or intestinal problem?
Posted by: Ron Kennedy, M.D.
Date: March 17, 2006 12:07 PM

A chronic infection, if it is to show up in a plain blood count, will be suggested by a low (not high) white cell count. The presence of any chronic infection also suggests at least a minor (compared to , for example AIDS which would be major) defect, deficiency, or depression of the immune system (but with serious consequences nevertheless). Chronic infection and heavy metal overload are the two most common causes of this I see in my practice. While it is possible for a young person to have hypoadrenalism, it is uncommon and if present is almost always provoked by a toxic condition and then we are back to metals and chronic infection with occasional other toxicities. Her chronic diarrhea surely suggests a gut wall infection, but it is unlikely the GI doc will diagnose that unless he/she does an endoscopy and happens to noticed a (perhaps only slightly) inflamed gut wall. Chances are she will receive no meaningful treatment. Endocrinologists, like all specialists have tunnel vision with the tunnel being their own specialty knowledge. It is hard to see the whole person when you are focused on one thing.

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