Help with labs related to Adrenal Adenoma?

[mschfmngd]

I am a 44 year old female needing help deciphering labs etc
In Oct of 2015 I went to my GP for left side rib pressure/pain, fatigue and weight gain.
Labs completed at that time showed Hypothyroid and I was prescribed 75 mcg of Synthroid.
Was told rib issue was most likely inflammatory or muscular and that I could start PT to see if that helped, along with a prescription of Naproxen.  In December I had a severe migraine( I have suffered from these since my 30's when i had a mini stroke) , along with high BP and dizziness.  I was down for a week, they gave me a Toradol shot and told me to see my GP for BP meds.  Went to GP told him of symptoms and he put me on Lisinopril, which made the dizziness worse and I didn't stay on it.  In January still was not feeling well and still had rib issue.  Called GP who had me go in for CT.  Was told everything normal and I should see a sports med Dr to start PT.  When i picked up the report from CT for the sports med Dr, I found that a Incidentaloma had been found.  I asked the sports med Dr what that was and she mentioned , I should probably see my endochrinologist for a work up.  I see an endo due to being in Trial Net for a Type 1 diabetes study, to which I carry one of the auto antibodies.  When I called him, I was told to do an MRI  and more blood work.  When those came back the Adrenal Adenoma was  presented as benign and non active, 1.7 cm ,28 hounsfield units.
Blood work showed low Vitamin D.    After being on Vitamin D for 6 months and still not feeling well, went back to endo. ( new Dr. as my previous Dr. had retired )  She did new blood work , a 24 Urine catch (kept cool) and the next day a Dexamethosone Test.
Urine Cortisol Free came back <1.00
Creatinine 122
After Dexamethasone test ( took pill at 11 p.m. , woke up at 1:30 am to use restroom and upon standing became extremly dizzy, lost balance and could not feel my legs so I fell.  Hubby had to help me to restroom and put me back in bed.  I felt fine next morning for 8 a.m. blood draw)
Results
Cortisol  < 0.8

Was  told these were normal and put me on Qsymia to lose weight which would result in decreasing fatigue, dizziness and eventually lower BP.  
I am so tired of Migraines , fatigue, dizziness and general unwellness feeling.
Anyone have thoughts and recommendations?

[tacolino]

Hi there. Im a 50 year old guy from Ireland. I had no real health issues till 2 years ago. Then I had a Hypertensive crisis with BP 280/ 160 !  I was in hospital for 10 days, had ct scan, mri and cardio angio. Diagnosis LVH and strain with EF 15%.
Started bp meds, built up to 12 a day, 2 moths later bp was 180/100 still.
Urine and bloods were elevated for Metanephrines(Adrenaline)
I had a dex test and this  was normal. The adonomata you describe can often be so small they are missed on ct.

There can be more than one! and they can effect both glands. There are a number of tests to confirm if they are active. One I had is a saline infusion test, where you are given a drip of a large saline infusion, with bloods taken a few times throughout the 4 hours to confirm diagnosis.
Another test is the Captopril challenge test. You get a dose of Captopril (Its a BP med) and the effect it has can determine whether there is an aldosterone issue going on. (Again a number of blood tests are taken )
Both tests are about only 80% accurate.
There is also some test which is done using Aldactone medication ( I was prescribed Aldactone and when I took it my BP went down by 100, which is a strong indicator of Hyperaldosteronisim). This med is horrid for sides.

There is a test that can be good at diagnosing aldosterone  levels as a result of the adonomata.
Its known as adrenal vein sampling. I understand its a bit like a heart cath, and both samples must be drawn simultaneously. One from each Adrenal vein.  I believe doctors hate doing it as its complicated.

It might be good to look up professor Morris Brown in the UK and to read some of his work/ papers on the net. Its his area of specialty and I believe he has developed a pet scan he uses to examine them. (It was known as Conns Syndrome for a long time up to this)
Morris Brown was at the Cambridge university health facility but I hear he is now attached to Barts hospital in london. He is worth looking up for valuable insight. Hope this helps you a bit. Kindest regards