opinion please...

Long history and very few dx.   I'll try to cut to the chase.

2 fairly normal Brain MRI's...just prominent or convex border to the pituitary.
Many GI issues reflux and gastroparesis (unkown origin)  
Endocrinology work up neg
Rheumatolgy + ANA 1:80 homogenous pattern   neg scleroderma workup
+ Raynauds....but mild
Have had 2 gastric empty studies that dx the gastroparesis
Upper and lower endoscopy just mild esophagitis.
2 head up tilt table test....one borderline+  after isuprel infusion.
Cardiolgy basically neg....just tachycardia.   2 echos, 2 stress and 1 holter.
Had some urinary retention 6-7 years ago that resolved....no dx given.

Recent very fatigued, light headed.....tingling in all extremitied and face...comes and goes over the last week and a half.   Last brain MRI was 2 years ago....the + ANA was just last week.    I feel awful much of the time.    I am nauseous all the time too with abdominal pain.

Meds Prevacid 30-60 mg per day, Reglan 5 mg PRN....    

Work up has been ongoing since 2003.    Going to neuro on Friday as tingling in extremities is new....

Your opinion please....40 year old felmale..   mother to 2 (ages 10 and 14) marrried and live in CT.  

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

Lupus is a multi-organ disease. It can affect the kidneys, skin, heart, lungs, and GI tract. It can also affect the central nervous system (i.e., psychiatric disturbances, seizures, migraines, sensory changes, and even stroke).

The ANA pattern can be seen in many diseases. I would recommend that you have additional tests performed such as a double stranded DNA and SSA/SSB. You may need to see a rheumatologist for the lupus workup but also to rule out other connective tissue disorders such as Sjogrens. Also, if you have not had one performed, an oral glucose tolerance test is necessary to workup the gastroparesis. This is a good test to rule out/in diabetes.

Regarding the symptoms you are experiencing, they all may be related to an underlying disorder such as lupus. The tilt table is not impressive based on your description. You should make sure you are drinking plenty of fluids (as recommended by your physician) and monitor your blood pressure. It is hard to say if you need another MRI of the brain. Were your prior MRI’s with contrast or did you have an MRA of the vessels in the brain?  

I agree that you should see a neurologist to evaluate the sensory changes you are experiencing. However, I highly recommend that you follow up with a rheumatologist. If you do have lupus or another connective tissue disorder, the treatment requires a specialist.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[sue3708]

Thank you for your comment.     The ANA was done by a rheumatologist and she felt Lupus and sjogrens were unlikey based on her exam.  She was more concerned with Scleroderma based upon the gastroparesis and mild reynauds...although I have no skin issues what-so-ever.   She did PFT's which were not perfect but good (past smoker 15 yrs ago) a chest x-ray and bloodwork for scleroderma.   Both MRI's were with contrast.   A glucose tolorance test was performed early on in my work-up.