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A cautionary tale for doctors and those training to be doctors: The story of @zoeimogen

About 15 years ago, Zoe was in the army reserves and very fit, She left, and around that time started to put on weight. The weight gain continued even as she stayed fit (and by stayed fit, I mean we were climbing actual mountains in the Alps and suchlike).

Around 10 years ago, Zoe's health started to suffer a lot. She started getting increasingly fatigued. It was sufficiently bad, that she started looking for medical advice.

Lots of tests done. None of them turned up anything conclusive. Maybe Lyme disease? maybe now? Zoe was getting to the point where she was thinking of having to stop work.

Then, around 6 years ago, a friend happened to say, "you have western Irish ancestry. Have you been tested for coeliac disease?"

She had not. Zoe asked her doctor for a coeliac blood test. It came back positive. A biopsy subsequently confirmed that Zoe had coeliac disease.

"Ah-ha!", said the doctors. "We now understand why your health has been deteriorating! You have coeliac disease! Adopt a strict gluten free diet and all will be well":

This was 2019. Zoe adopted a strict gluten free diet. There was some small improvement, but overall her health continued to deteriorate.

Zoe started paying for private blood tests to find out WHY. The coeliac was under control. her gut was recovered. Her numbers were good. But she was getting more and more unwell.

Finally the tests started to show something. Her prolactin was off.

The NHS sent her to an endocrinologist. He confirmed her prolactin was off, but decided it was not worth treating.

Frustrated, Zoe paid to see a private endocrinologist. An MRI subsequently confirmed that Zoe has a 14mm wide benign tumour in her pituitary: a prolactinoma.

Based on the size, it probably started growing around the time her health started to deteriorate.

Zoe has been on drugs to shrink the tumour for a month now. She is seeing the most rapid health improvement in years (she doesn't think so, but to an external observer the improvement is very very obvious).

Doctors: beware of diagnostic overshadowing. Yes, she had coeliac disease, but that was not why her health was so utterly screwed.

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