### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
I have suffered with what has been blown off as panic attacks since my early 20 s so for about 20 years now. I have at one point or another been put on every SSRI on the market and not a on e of them has ever helped me. My episodes start out of the blue when I am perfectly calm or at rest. It usually starts with a few PVC s(feel like my heart does 3 or 4 flips) then I get dizzy and its off to the races...my heart will start beating very hard and fast(up to 180BPM)...I never feelanxious til after this has been going on for several minutes. I have made several trips to the ER,some by ambulance over the last 10 years and the tachycardia and PVC s have been documented.but in the end I am always told panic attack but I really feel like there is more to this.. My question is this...I had some blood work come back abnormal 3 years ago while I was hospitalized for a flare of duverticulitis it was discovered that my Cortisol levels are way low and after a MRI/ MRA of my brain they found a pituitary microadrnoma that was the cause for the low cortisol and my HGH is deficient as well. Due to lack of insurance for a few years I have had no dither work up or treatment for this...could this be the culprit of my heart symptoms? I am not on board with the panic/ anxiety diagnosis ...just feels like something is being over looked. Thanks for your time. Missy

### output:

Hi, As in your previous ER visits panic attacks had been diagnosed. It is usually diagnosed when symptoms (like yours) occur without cardiac illness. SSRIs are very effective treatment for panic attacks. But few patients do not respond due to some of the following reasons:-Hormonal imbalance (like low cortisol in your case)-Medical illness (like pituitary fibroadenoma in your case)-Thyroid dysfunction (possible in your case so get it investigated) So continue SSRIs and get concurrent management of above issues for solution. I hope this information has been both informative and helpful for you. Wish you Good Health. 