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Endocrine and anxiety




I have an semi endocrine related question and was hoping it could be answered here. I suffer from adrenaline type anxiety. It started about a year ago, I suffered panic attacks and sensations of rushes of adrenaline through my body, increased heart rate, burning sensations all over my arms and shoulders. It was horrible, I lost about 25 pounds, my appetite. I was treated for panic disorder and put on Remeron and Xanx as needed 9 months ago. I was doing great for nearly a year. I began having heart palpitations and PVC`s about a month ago which kind of started the cycle again. I feel like my body is constantly buzzing and shaking from the inside. I`m not going into full panic mode, but I`m uncomfortable and anxious again. I was talking to my Aunt who is an RN and she was wondering if perhaps there was a hormonal/endocrine thing going on, that my body was producing too much adrenaline, thus causing a lot of my physical symptoms. I am naturally a worried type of person, but I was wondering what role blood sugar or any other type of endocrine disorder could play in my problems, (most recently it is ONLY heart palps and flutters and the vibrating sensation). My last physical, my Dr. ordered normal blood work ups and said the results were fine, my EKG was normal. That was about 7 months ago. Would further tests be warranted? Up till now my Dr. attributes everything to anxiety and will not refer me to a cardiologist or an endocrinologist.

Thanks for any help.


The major endocrine differential diagnoses to consider are thyroid disease and an overproduction of the "fight or flight" hormones (catecholamines, epinephrine, norepinephrine, adrenaline - all different names for components of this system) in a rare hormone producing tumor called a pheochromocytoma.  the thyroid screening tests can easily be done by your primary care doctor (my guess is that the complaints you describe may have led the doctor to do those already).  It is much harder to diagnose a pheochromocytoma and they are fairly rare - the symptoms you describe are far more likely to be due to anxiety than to a pheochromocytoma and the challenge is to decide when to do the evaluation to rule that out, and when it should be done by a primary care doctor and when by an endocrinologist.  It doesn't sound a cardiologist would be the appropriate specialty for what you describe.

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Response by:

Robert M Cohen, MD Robert M Cohen, MD
Professor of Clinical Medicine
College of Medicine
University of Cincinnati