middle of night nausea

Hello,
Before I was diagnosed with my prolactin producing pituitary tumor, hasimotos, diabetes and high blood pressure (just to name a few) I was experiencing middle of the night nausea, very similar to morning sickness.  After a few weeks of treatment with Dostinex for the tumor my prolactin levels went back to normal and my middle of the night nausea stopped.  It has since resumed and it wakes me up... often I even incorporate how I feel into my dreams before I wake up.  

Anyone else with this problem?  Could my prolactin have spiked again, even though I am still on Dostinex?  Something else maybe?  

Thanks,
Sarah

[WendyG]

I'm not sure about the prolactin, but I was very queasy (the type that makes you salivate) when I low cortisol episodes.  Apparently it's one of the symptoms.  If you get night sweats, vivid dreams, and/or headache when waking, it could be a sign of hypoglycemia (caused by low cortisol - which is where the nausea comes in).  I swing back between prediabetic & hypoglycemic - so the two can go hand in hand.  I have a pituitary adenoma that is "supposedly" non-functional & am on cortisol replacement.  I occasionally get bouts of nausea when my hydrocortisone is wearing off because I'm tapering down.

[rumpled]

Does your doctor test other hormones besides prolactin? I would go in for a check up.

[SarahB79]

thanks WendyG and rumpled. :-)

I went to lab Wednesday for my 8 week test.  Let me see if I can remember what was on it... full CBC panel, TSH, T3, T4, Prolactin, Vitamin D.  I think I am probably missing a few.  If there is something you think I should have her add, I see her Tuesday. :-)

[SarahB79]

You know I do have all the things you just mentioned.  night sweats (I freeze my husband out of the room because of it), VERY vivid dreams, headaches every morning when I wake up and the middle of the night nausea which is generally around 2-5 am.  

I told my primary Dr. about it a few months ago and she was concerned my blood sugar was dropping really low middle of the night and suggested a night time 100 calorie snack before bed.  I began checking it in the middle of the night and it never was very low like suggested it could be.  

I will bring this up and the tests that rumpled suggested to my Endocrinologist on Tuesday.

[WendyG]

My blood sugar never gets really low either (never below 70).  But I do get hypoglycemic symptoms when my glucose is dropping rapidly and when cortisol is low when it is even in the 80s.   The best snack I have found to help is 1 slice of 100% whole wheat bread with peanut butter & 4-8oz of milk right before bed.  Everyone is different though in what helps!  I'd definately keep an eye on your cortisol & have it rechecked over & over.  Alot of times murphy's law will dictate it will only act up on the days it's not tested!

Good luck!

[enzymelover]

    My son just had another attack of severe 2 AM nausea last night. This hasn't happened in many months. He did say he was very hungry at 1 AM, but he hasn't been falling asleep before 3 or 4 AM for many months, so I made him go right to bed without eating anything more. I will reconsider this ( especially after last night!) if hypoglycemia is likely to be a cause.
He does have a pituitary cyst\tumor, causing adrenal insufficiency, and he did have more hydrocortisone at 10 PM, but sometimes, it just isn't enough I guess. I gave him another 5mgs. during the nausea episode last night, and he was better within 15 minutes, and asleep in another 30 minutes. He didn't eat very well yesterday, maybe this contributed to the problem.  He does seem to have trouble falling asleep due to low cortisol, rather than a problem with high cortisol. Raising his evening hydrocortisone dose usually helps.
Oh, and he also has very vivid dreams.

Enzy

[rumpled]

For those that are insufficient, are you taking florinef? Are you taking salt tablets too? A lot of times, the salt will stave off the vomiting.

I take a salt tablet at night or my heart will race race race...

I keep a bucket near my bed.. *sigh* Also my doc routinely gives me a script for zofran (generic) so that as soon as things get iffy, I can take action as vomiting can get out of hand.

[WendyG]

Rumpled,

I didn't even think to mention the salt factor - good point.  For me though, I'm finding I need less & less salt.  For awhile there, I was drinking alot of water - perhaps too much & maybe I was watering down my sodium levels, then I had the insufficiency, started with adding the salt, and the past week since cutting back on water consumption, I haven't had to do much salt.  In fact, I've been tapering down HC because my glucose is coming up & the dizzy spells are gone as well as my bp coming up too.  I only just made the connection that maybe too much water was contributing to adrenal insufficiency the whole time.   Would that make sense?

Is florinef  synthetic rx?  Or is it just electrolytes?

[rumpled]

The florinef is the mineral corticosteroid part - it helps balance the potassium and sodium. It is an rx and I do believe it is synthetic.

You need to stay hydrated. That is important. Unless you drink so much that your urine is super clear, you are not really washing it all out. Being dehdyrated will put your body at stress.

It could be that you need the florinef to hold the balance on the K and Na - many find that it is the key to their crisis' and not the hydro (cortisol).

How much hydro are you on that it is effecting your glucose?

[WendyG]

I started at 25mg, and am now down to about 10 mg.  I am guessing that @25mg my adrenals were suppressed, and that once I got down to a certain dose my adrenals kicked back in & the HC is now adding to my own cortisol?  I have noticed I started putting on weight when I started tapering down.  When I was on 25mg I was actually losing a little weight - probably because my blood sugar was more stable.  I'm still suspicious this is a cushings tumor though.  Albeit not putting out a ton of cortisol when it's active.

[rumpled]

Yes, anything over 20mg is a suppressive dose and so now what you are taking is adding - and some people are very sensitive to even small changes. I know that even when I am not feeling well, I can just take a 5mg or 2.5mg and it may make a change. After talking to my doctor though, he advised me to go for salt and fluids first, then the steroids - and use steroids if I get sick to my stomach. He also wants me to go to the emergency room if I toss my cookies but no way that is happening as the last time I was in the hospital, I almost died. No, thank you!

My cushing's tumor used to cycle up and down - I had years of being fine and days of being in agony - it just was not predictable until finally the cycles got shorter and I never could get better. But the doctors were bizarre - it was as if a normal test wiped out all the abnormal ones, and they ceased to see how I looked. I even used to say to them - can you just look at me and really tell me I am fine? I look at pictures of me at that time (I should put them up) and I was half dead, yet they would just dismiss me, tell me to come back in 6 months. Thank goodness I did not listen.

[SarahB79]

Hello again!  Well I met with my endocrinologist today.  She has ordered the following tests for my next 8 week round. :-)

dex suppression: Cortisol Serum(to be done seperately)

ACTH
Aldosterone, Serum
CBC w/ auto diff
Cortisol Serum
DHEA Sulfate
Ferritin
FSH
17-Hydroxyprogesterone, Serum
IGF-I (Somatomedin-C)
LH
Plasma Renin Activity
Prolactin
Testosterone, Free and Total
Vitamin D, 25-hydroxy
T4, Free
TSH
Comprehensive Metabolic Panel
Hemoglobin A1C
Lipid Panel
Microalbumin/Creatinine Ratio
T3, Free

24 hour urine Cortisol to be done seperate

She upped my daily dosage of vitamin D. And suggested I go back on Metformin for probable PCOS.  She said she would be ordering another pituitary MRI with contrast and a CAT scan of my adrenals during my next visit in April.