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Neck Pain Concerns
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Neck Pain Concerns

I am an 18 year old male, 130, 6'0. For the past 2 months I have been having strange, painful episodes in my neck area which seem to intensify by swallowing, and with movement. I call it strange because it's nothing like I've ever experienced before. I've had the pleasure of having strep throat approximately 5 times in my life, and it's nothing like that because it doesn't appear to be my throat causing the problems (there is no pain in that particular region, and my throat does not appear to be inflamed). The pain is localized internally around the center of my collarbone and adam's apple.

The pain lasts about 15-20 minutes at a time, and is at most times only evident when I swallow or make sudden movements. It seems to be much worse at night when I am lying down. Rest (if I can manage to get to sleep) appears to treat it as I have never woken up with this pain, however, it haunts me 'every' night.

When I saw my family doctor, he was worried it might be a problem with my thyroid, but I don't have any noticable nodules. He ran some blood tests and the only abnormality that I was told of was an extreme excess of cortisol (a level of 875 at around 2:00 PM), to which I don't 'think' is tied with the neck pain. I am scheduled to see an endocrinologist for that in late March, and I am taking a 24 hour urine test for that as well.

The reason I am worried is because I did some research, and cortisol is tied in with the adrenal glands, which are near the kidneys, which shouldn't be causing my aforementioned pain, so I believe that my main concern was overshadowed with the development of this new problem, or cannot be detected (the cause of the pain is unknown).

So, My main questions are...

- What could be the possible causes of this pain? It's unbearable at times, and I need to have something to compare and contrast with to bring to my doctor since it is so hard to describe if not in writing.

- What is a normal level of cortisol? I'm not too worried about this since it's not an obvious emergency if the specialist I'm seeing is 1 1/2 months away. What could be some derrogatory effects of having too much? How is it treated? Also, I am slightly underweight, though I eat like a horse (usually 4 meals a day with plenty of snacks), could an elevated level of this hormone be the cause of my inability to gain weight?

Thanks, I look forward to hearing your opinion.
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To answer your questions:
1) There are several causes of neck pain.  Of course, there are the musculosckeletal causes like cervical strain and thoracic outlet syndrome.  Thyroid masses can also be considered - a thyroid ultrasound is a good test if this is suspected.

Less common causes of neck pain include rheumatoid arthritis, spondyloarthropathy, diffuse idiopathic skeletal hyperostosis (DISH), and congenital spinal stenosis (which may preferentially involve the upper cervical segments and produce symptoms beginning in early adulthood).

2) Cortisol is a steroid hormone released from the adrenal cortex in response to ACTH. Normally, cortisol levels rise and fall during the day repeating on a 24 hour cycle (diurnal variation); highest levels are at about 6 to 8 A.M. and lowest levels are at about midnight.  Normal levels at  8 A.M. is 6 to 23 mcg/dl.

Greater than normal levels may indicate an adrenal tumor, Cushing's syndrome, or other pre-cortisol secreting tumors.  The treatment of this depends on what the cause is.  Typically Cushing's syndrome causes a weight gain - not an inability to gain weight.  The endocrine referral is the reasonable next step for further evaluation.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.
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