instruction: hello doctor I am a 25 year old male my bum is 31 during physical and mental exhaustion but my bum is high of about 178 during hyperventilation and has pointless frustration my bum from rest to stand increases by at least 30 points but averages a 50 point increase my resting bum is 40 and upon standing it increases to 90 and peaks up to 10 I had done an echo cardiogram and ekg I feel light headed upon standing along with sudden pulsation headache and muscle spasms I feel blackout syncope and fainting I had spontaneous jolt breathless palpitations flutters fatigue chills and skin rash on the back of hands my mental disturbances include confusion inability to maintain thoughts I also feel pointless random irritability ankle pain random lapse of balance throbbing extremities vibrating vision burning sensation social anxiety depression irritating bowl movements no appetite and chest discomfort I wast told to mention the possibility of autonomic dysfunction as its often times overlooked
output: hello the symptoms you have been suffering from seem to point to a number of possibilities one would initially suspect a cardiac abnormality given the drastic fluctuations in your pulse rate but that would show up on an egg or echo tests since your egg and echo tests are normal I would advise you to get some blood work done like a serum electrolytes test to see if there is any hyponatremia or hyperkalemia also a urine test for 24 hours urinary collection of catecholamines both of these tests would indicate a disorder of the adrenal gland addison disease with the electrolyte abnormalities or phaeochromocytoma diagnosed by the 24 hours urinary catecholamines please get these tests done as both these probable conditions if present need to be treated sooner rather than later I hope this helps 24 hours urinary catecholamines serum electrolytes addison disease adrenal insufficiency phaeochromocytoma