Re: Re: Lab Order for Blood Tests

[Guest guest]

Good this is a classic story.

1. Drug resistant HTN

2. Low K.

PA is due to high aldo which suppresses renin.

Drugs which don't work well in low renin states are:

ACEs, ARBs(avapro), BB (atenolol), and CCBs (norvasc)

and diuretics (maxzide) will make the K a bigger problem.

Have others in your family had HTN and low K?

In a message dated 1/10/2005 2:46:28 PM Eastern Standard Time, " luv2ozzie "

<luv2ozzie@...> writes:

>

>

>> Give us details on your history and we may be able to help.  Ask

>them what their normal values are when you get the results and what

>valuse they get in pts with PA.  

>

>I've had HTN most of my adult life with only moderate control.  Four

>years ago it just spiked and has been extremely difficult to

>control. I take avapro, maxzide, atenolol, and norvasc and it still

>runs 130-140/75-85.  My K runs low even while taking supplements.  

>I heard about this group from the blood pressure group that Dr. Grim

>moderates.  He suggested that I be tested for aldo and my PCP gave

>me a referral.  

>

>Gloria

>

>

>

>

>

>

>

>

[Guest guest]

It is normal and tells us that your aldo is not high because of a Cushing's

related problem-although it is best tested late in the afternoon or after over

night Dex administration.

I specialize in HTN in African Americans and would suggest that if your K has

been low then it is very likely that you have PA or a variant of that.

One simple way to test for it is to see if your BP and low K get better with

spironolactone. This will take at least a month.

We have evidence that most HTN in AAs is related to excess aldo not excess

renin. This will be published in March. You can search my name on PUBMED (Grim

CE) and find others things I have written about HTN in AAs.

Keep us posted.

--

May your pressure be low!

CE Grim MD

Clinical Professor of Internal Medicine

Professor of Epidemiology

Board Certified in Internal Medicine, Geriatrics and Hypertension

[Guest guest]

In a message dated 1/11/05 17:03:15, dp@... writes:

> I'm asking because the doctor didn't tell me that and since it's a

> very important factor I'm thinking I don't know if I like this

> doctor.  I don't know much about this disease or the testing for

> it.  When I saw 8 AM on the lab order I just started to investigate

> to find out if it was referring to the time or day or just what it

> might mean.  Sorry if I asked a stupid question.

If cortisol is up then a high aldo, low renin might be being drivve by ACTH or stress.

May your pressure be low!

Clarence E. Grim, BS (Chem/Math), MS (Biochem), MD, FACP, FACC, FAHS

Clinical Professor of Medicine and Epidemiology

Director, Hypertension Diagnosis and Treatment Center

Board Certified in Internal Medicine, Geriatrics and Hypertension

Published over 220 scientific papers, book chapters and 220 abstracts in the area of high blood pressure epidemiology, physiology, endocrinology measurement, treatment and how to detect curable causes.

Listed in Best Doctors in America

Specializing in Difficult to Control High Blood Pressure and the History and Physiology of High Blood pressure in the African Diaspora

[Guest guest]

In a message dated 1/11/05 15:44:30, luv2ozzie@... writes:

> Ummm... yeah...  that's why it's called an 8am cortisol.  Cortisol

> levels fluctuate rapidly throughout the day.  8am is around when

they

> peak.

>

> Thanks,

>

> Mike

That's the reason if you are looking for 's you use the am, for Cushing's the pm cortisol. It has its nadir at 5 pm or later.

May your pressure be low!

Clarence E. Grim, BS (Chem/Math), MS (Biochem), MD, FACP, FACC, FAHS

Clinical Professor of Medicine and Epidemiology

Director, Hypertension Diagnosis and Treatment Center

Board Certified in Internal Medicine, Geriatrics and Hypertension

Published over 220 scientific papers, book chapters and 220 abstracts in the area of high blood pressure epidemiology, physiology, endocrinology measurement, treatment and how to detect curable causes.

Listed in Best Doctors in America

Specializing in Difficult to Control High Blood Pressure and the History and Physiology of High Blood pressure in the African Diaspora

[Guest guest]

In a message dated 1/11/05 11:04:42, luv2ozzie@... writes:

Does the blood have to be drawn at 8;00 a.m.??

Only if you want to make sense of it! You can draw it at anytime but then you dont know what is normal. Doesn't have to be exactly at 8 am 8:01 is OK...no just kidding on this. Give or take an hour is OK.

May your pressure be low!

Clarence E. Grim, BS (Chem/Math), MS (Biochem), MD, FACP, FACC, FAHS

Clinical Professor of Medicine and Epidemiology

Director, Hypertension Diagnosis and Treatment Center

Board Certified in Internal Medicine, Geriatrics and Hypertension

Published over 220 scientific papers, book chapters and 220 abstracts in the area of high blood pressure epidemiology, physiology, endocrinology measurement, treatment and how to detect curable causes.

Listed in Best Doctors in America

Specializing in Difficult to Control High Blood Pressure and the History and Physiology of High Blood pressure in the African Diaspora

[Guest guest]

In a message dated 1/11/05 11:01:36, luv2ozzie@... writes:

Most endos have no idea how to treat cushings, and most poeple

don't

> get diagnosed until they ar 800 lbs and are irreversably damaged

by

> the delays.

>

> Thanks,

>

> Mike

One of my old aphorisms that I was taught is that it is very rare to see a person with Cushing's who weighs over 250 lbs. But that was when people were thinner.

May your pressure be low!

Clarence E. Grim, BS (Chem/Math), MS (Biochem), MD, FACP, FACC, FAHS

Clinical Professor of Medicine and Epidemiology

Director, Hypertension Diagnosis and Treatment Center

Board Certified in Internal Medicine, Geriatrics and Hypertension

Published over 220 scientific papers, book chapters and 220 abstracts in the area of high blood pressure epidemiology, physiology, endocrinology measurement, treatment and how to detect curable causes.

Listed in Best Doctors in America

Specializing in Difficult to Control High Blood Pressure and the History and Physiology of High Blood pressure in the African Diaspora

[Guest guest]

In a message dated 1/11/05 11:01:36, luv2ozzie@... writes:

Most Endos have no idea how to treat Cushing's, and most people

don't

> get diagnosed until they are 800 lb. and are irreversibly damaged

by

> the delays.

>

> Thanks,

>

> Mike

Don't know the data on this but Cushing's is the prototypical endocrine disease and an Endo who does not understand this disease well should be distended.

May your pressure be low!

Clarence E. Grim, BS (Chem/Math), MS (Biochem), MD, FACP, FACC, FASH

Clinical Professor of Medicine and Epidemiology

Director, Hypertension Diagnosis and Treatment Center

Board Certified in Internal Medicine, Geriatrics and Hypertension

Published over 220 scientific papers, book chapters and 220 abstracts in the area of high blood pressure epidemiology, physiology, endocrinology measurement, treatment and how to detect curable causes.

Listed in Best Doctors in America

Specializing in Difficult to Control High Blood Pressure and the History and Physiology of High Blood pressure in the African Diaspora

[Guest guest]

No question about the renin/angiotensin system is stupid because the

bad news is medicine doesn't know much either. The folks in this

group, among them, know as much as most doctors. It is starting to

look like the governing component in all hypertension, and if so, we

may be in the forefront of a new day in treatment.

Lifestyle elements appear to gather, and play as much a part as

genetics (surprize, surprize).

As Dr Grim said, midnight is an awkward time to do a bloodtest, but if

medicine takes its oath seriously this would be a part of the practicum

already. Now, with the medical industry economy and liability lawyers

running things in the absence of regulatory mechanisms that served

medicine and education gone along with much else that used to make

corporations accountable, can you IMAGINE the cost accounting hurdles?

The dexamethasone suppression test would be good to bracket at midnight

too for similar reasons, no?

The fact that your doctor is testing for cortisol says that he/she is

looking for evidence from multiple angles. Added to the usual

aldo/renin blood & urines. The Na & K watches. Let us know what

happens, as I have not had this test yet.

Best,

Dave

On Jan 11, 2005, at 11:40 AM, luv2ozzie wrote:

>

>

> I'm asking because the doctor didn't tell me that and since it's a

> very important factor I'm thinking I don't know if I like this

> doctor. I don't know much about this disease or the testing for

> it. When I saw 8 AM on the lab order I just started to investigate

> to find out if it was referring to the time or day or just what it

> might mean. Sorry if I asked a stupid question.

>

>

>

>>>

>>> Does the blood have to be drawn at 8;00 a.m.??

>>>

>>

>> Ummm... yeah... that's why it's called an 8am cortisol. Cortisol

>> levels fluctuate rapidly throughout the day. 8am is around when

> they

>> peak.

>>

>> Thanks,

>>

>> Mike

>

>

>

>

>

>

>

>

[Guest guest]

I cant find much in the lit about recurrent Cushing's after bilat adx. Would seem to be very rare. The HTN might come back as the replacement of steroids is very tricky and these folks are very salt sensitive.

CE Grim MD