A Journey Through Unexplained Weight Loss and Medical Discovery

The Unexpected Weight Loss

In the quiet town of Maplewood, New Jersey, a 67-year-old woman found herself at a crossroads with her health. Her bathroom scale revealed a puzzling 25-pound weight loss over a few months, despite no changes in her diet or lifestyle. Initially, she dismissed it as a lingering effect of a recent trip to Morocco, where she contracted COVID-19. However, the virus had only caused mild symptoms akin to a common cold, lasting just a week. The weight loss, while making her look slimmer, worried her, especially since a friend had recently faced a similar situation and was diagnosed with metastatic cancer. Alarmed, she sought answers from her trusted internist, Dr. James Rommer.

The Doctor’s Investigation

Dr. Rommer, who had known the woman for years, approached her case with thoroughness. She had already undergone a colonoscopy and mammogram, both of which were normal, and her ob-gyn had given her a clean bill of health. Despite her apparent well-being—no nausea, stomach pain, or loss of appetite—Rommer was concerned. He ordered lab tests, including blood count, liver and thyroid function, and cortisol levels. He also considered rare tumors that could cause high blood pressure by overproducing stress hormones like cortisol and epinephrine. If these tests were inconclusive, a CT scan would follow to ensure nothing was missed.

A Life-Threatening Diagnosis

The next morning, the woman’s routine at the gym was interrupted by a grave call from Dr. Rommer. Her cortisol levels were dangerously low, a condition known as adrenal insufficiency, which can be life-threatening. Cortisol, crucial for responding to stress, was nearly undetectable in her system. Despite feeling fine and being mid-workout, Rommer urged immediate attention. An endocrinologist, Dr. Marie Nevin, was her next step. Tests confirmed the low cortisol and ACTH levels, pointing to issues with both adrenal glands and the pituitary gland. Further tests ruled out autoimmune diseases, infections like HIV or tuberculosis, and tumors, leaving the cause unknown. An MRI revealed a harmless pituitary tumor, not the culprit.

The Mystery of the Condition

Dr. Nevin, perplexed by the woman’s asymptomatic state despite critical hormone levels, delved into research. She found rare cases linking COVID-19 to adrenal insufficiency. The timing fit, with symptoms emerging months post-infection, though causality remained uncertain. The patient began hydrocortisone treatment, regaining weight and energy. However, she soon faced sleep issues, leading to dose adjustments. A year later, she continued on low doses, her high blood pressure surprisingly improving, allowing her to stop hypertension medication. Dr. Nevin remained baffled by the case, attributing the mild symptoms to early detection.

The Role of COVID-19

Months later, a study revealed that 14% of COVID-19 patients developed adrenal insufficiency, often resolving on its own. This insight gave hope. Though the precise cause remained elusive, the study suggested a possible link. Both the woman and Dr. Nevin were inspired to attempt weaning off the medication, a gradual process with potential benefits.

A Journey of Recovery and Hope

The woman’s journey is a testament to resilience and medical dedication. From unexpected weight loss to a rare diagnosis, she navigated a complex health challenge with courage. The interplay of early detection, effective treatment, and potential viral impact highlights the evolving understanding of COVID-19’s effects. As she and Dr. Nevin explore reducing medication, they embody hope and the pursuit of health, illustrating how patience and perseverance can pave the way to recovery.