Hello.
Thank you for posting your query at DoctorSpring.com
I understand your concern.
The darkening that you have described is not very obvious from the images that you have sent. However the most common causes of darkening under eyes can be attributed to excessive fatigue, stress, insomnia, allergies, anemia, and at times it can also indicate liver problems. Are you on any medication for high cortisol?
Paradoxically at times low cortisol levels in the blood lead to insomnia leading to darkening under the eyes. Have you checked your cortisol levels recently? How is your sleep cycle? What are your other symptoms?
This additional history will be helpful. Please reply as a follow up.
Regards.
Patient replied :
Its not very noticable. It is more noticable when I wake, when I exercise and my face turns red. Nobody has checked my cortisol in about a year. No one ever gave me medication for it or and I have recieved mutliple different diagnosis including :"nothings wrong with you". I sleep a normal amount but never in my life have a felt refreshed and awake upon rising. I wake up usually in the middle of the night feeling better than when I wake up in the morning. My kinseologist says my liver isn't functioning well but all the blood work I have had indicated my liver is fine. I was tested for allergies after breaking out in "inflammatory blisters " on my hands , feet, and behind the knees by an allergist/immunologist. The pricks were all negative. I am excessively fatigued all the time. Negative for lymes although I have had it in the past. Anemia shouldnt be a problem because I eat a low sugar/carb diet ( post prandial hypoglycemia) with plenty of organic meats, fish, slighty cooked veggies ( easier to digest) and some nuts . I take a b complex every other day in the morning ( supposedly supposed to help with my need to urniate 30+ times a day. Never had anemia show up in blood work.
Basically I have always had problems but the last two year time line of being disabled went like this...cough ( thought to be bronchitis) w/ syncope...eye swelled....pupils different sizes...pain and fatigue and concentration way way down the drain....inflammatory blisters....stomach pains ....breast pain regularly then leg pain started ( feels like my right side rapidly swells sometimes)....blood in urine....more stomach pain....inflammatory blisters again ( hard. no pus or blood, small) ...leg swelled ( negative for blood clot)...nerve shocks ( widespread can occur anywhere in body but mostly hands and feet)...eye starting to drop....darkening of the skin under eye on side of nose becomes apparent... ringing in ears....hemorragic cyst on ovary... sudden allergic reaciton (maybe) where my whole face turned red like a red mask and was burning hot...vagal attack while waiting on line in a store...still in pain.... numbess in pelvic area and other areas of the body ( leg, feet, even shoulders)....i understand if this is just too much for you to handle, it seems to be the case.
Hello. Thank you for the follow up.
I understand that the symptoms that you have been going through has caused a lot of distress.
For starters you need to get your cortisol levels evaluated. If it is still high it is better to start treatment for the same consulting an endocrinologist.
Persistent high cortisol levels can lead to excessive fatigue, leading to a condition called chronic fatigue syndrome. In your case, it becomes likely because you have never felt refreshed on waking up in the morning, and that is one of the signs. In addition people with CFS, also have darkening under their eyes, even though the sleep is adequate. This in turn leads to difficulty in concentration as in your case.
As per your pupils, 20 % of the population have slightly varying pupil sizes also known as anisocoria. If it is not causing any visual disturbances then there is nothing to worry about. However if one pupil appears drastically big than the other, then a thorough ophthalmic examination becomes necessary.
Since you're taking vitamin b complex, issues with the nerve can be ruled out which again can cause those nerve pain/ shocks that you experience. However you mentioned you need to urinate 30 times a day. Since when have you been having this problem? How was the urine report when you got it evaluated? Have you undergone any random blood sugar check up recently?
In my opinion, it will be better if you get your cortisol levels evaluated as soon as possible and follow it up with an endocrinologist. If you receive appropriate treatment, most of your symptoms will subside. Additionally a step by step approach is required which will need your complete blood count ( CBC ), CT Whole abdomen ( to localise the cause of your increased cortisol levels ), LFT, RFT and urine routine.
Hope this was helpful,
Regards.
Patient replied :
It was very helpful! thank you.
I was theorizing along the same lines....high cortisol for years, but they never gave me medication for it. I am thinking my adrenals are just exhausted. The frequent urination/ feeling the need to "break the seal" with force, I complained to the urologist about who gave my a cystoscopy following a clean cat scan after macroscropia hematuria w. flank pain. He checked for a UTI ( like the third time I was checked) and it was negative and dismissed me after my negative cystoscopy. A gyenocologist told me that my hospital urinalysis indicated I had/have a kidney stone but when I brought it to the urologist he said I was just dehydrated at the time . ( from the hemorragic cyst visit to the ER{more recent} not the hematuria episode to the ER,)
speci grav 1.03 glucose neg clear ketones 15mg/dL ph 5.5 blood urine ( trace) (2 mo's after macroscopic hematuria) protein neg bilirubin neg urobilin .2 ( range .2-1.0) nitrates neg leuko esterase neg bacterial occas, epithelial cells 75-100 ( range 0-4) squamos crystals occas. ca oxalate BUN 32 range 6-20
my glucose has been checked several times over the years old patientand has only been low once ( 1-2 below low end value range) A1c levels were good.
never have had any abnormalities on a CBC except once 8 years old patientago I had an elevated monocyte count ( i had also had reactivated mono and didn't know I had ever even had EBV in the first place)
Anyway thanks for taking this all very seriously and being kind with your answers. I am very distressed to say the least but I think you have been helpful
Hello.
Thank you for your response.
I do understand that this can all be very distressing but please note that as you have been extensively evaluated, and conditions of serious concern have been ruled out.
Now with a step by step, symptom focused approach, you can soon find relief.
So I would suggest the following:
As mentioned earlier, please get your cortisol levels checked again. The CT scan and other tests have been done for you, so as of now there is no need to repeat. Also, do not worry about adrenals being exhausted. That cannot happen.
High blood cortisol levels with negative urine cortisol can also be seen in patients with psychological stress. So if your test result comes back the same way as earlier, it would be best to visit a psychiatrist to treat the stress.
Excessive fatigue, darkening under eye all could be worsened due to stress from all your health issues. For now, I would suggest that you engage in de-stressing measures like meditation, yoga or whatever works for you.
The frequent urination which you have is termed Polydipsia. There are many causes for this and to find that in your case, a plasma sodium concentration and a urine osmolality level should be checked. Both the tests should be done at the same time.
There are a few abnormalities in your urinalysis. Positive ketones, trace blood and high squamous epithelial cells. Ketones in the urine (ketonuria) indicate that your body is metabolizing its fat reserves instead of carbohydrates to obtain energy. This is because of your low carb diet. You need to increase your carb intake and have a balanced diet.
Usually people have very small amounts of red blood cells in their urine. This can be increased with smoking, or due to intense exercise.
The presence of squamous epithelial cells may indicate contamination of the urine specimen.
A repeat urinalysis, with careful collection of the sample, can be done. You can upload this report as well as the plasma sodium and urine osmolality tests for review in the follow-up.
Let me know if I can assist you any further.
Regards.
Patient replied :
okay,
Just wanted to say thanks again!
Hello.
Thank you for your apreciation.
Please get back to me once you get your reports.
Regards.