Guest guest Posted March 26, 2008 Report Share Posted March 26, 2008 I have most of my problems (sweats/anxiety) early morning until about noon. Is it aldo? Val J Clin Invest. 1973 September; 52(9): 2272-2277. doi: 10.1172/JCI107414. Circadian Rhythm of Plasma Aldosterone Concentration in Patients with Primary Aldosteronism C. Kem, Myron H. Weinberger, Celso Gomez-, Norman J. Kramer, Lerman, Shunsuke Furuyama, and A. Nugent Departments of Internal Medicine, The University of Texas Southwestern Medical School, Dallas, Texas 75235 Indiana University Medical School, Indianapolis, Indiana University of Arizona, College of Medicine, Tucson, Arizona.. Abstract Plasma aldosterone, cortisol, and renin activity were measured in nine recumbent patients with hyperaldosteronism, including seven with adenomas, one with idiopathic hyperplasia, and one with glucocorticoid suppressible hyperplasia. All had peak values of plasma aldosterone concentration from 3 a.m. to noon and lowest values at 6 p.m. or midnight. This rhythm was similar to the circadian pattern of plasma cortisol in the same patients. When these data were normalized to eliminate the wide variation in ranges of plasma aldosterone and cortisol between individuals, there was an excellent correlation (r = + 0.87, P < 0.005) between the two hormones. In contrast, plasma aldosterone concentrations did not correlate with plasma renin activity before or after normalization of data. Short term suppression of ACTH by administration of dexamethasone eliminated the circadian variation of plasma aldosterone in both patients with hyperplasia and in four of five patients with adenomas, while it markedly altered the rhythm in the fifth. Similar doses of dexamethasone were administered to four normal subjects and did not flatten the circadian rhythm of plasma aldosterone. These data suggest that patients with primary aldosteronism have a circadian rhythm of plasma aldosterone mediated by changes in ACTH. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 26, 2008 Report Share Posted March 26, 2008 What this says to me is that, for me, if an over-producing adenoma can be found, I want it gone. Clin Sci (Lond). 2007 Sep;113(6):267-78. Aldosterone and end-organ damage. Marney AM, Brown NJ. MR antagonism improves endothelial function in patients with CHF, reduces circulating biomarkers of cardiac fibrosis in CHF or following myocardial infarction, reduces blood pressure in resistant hypertension and decreases albuminuria in hypertensive and diabetic patients. In contrast, whereas adrenalectomy improves glucose homoeostasis in hyperaldosteronism, MR antagonism may worsen glucose homoeostasis and impairs endothelial function in diabetes, suggesting a possible detrimental effect of aldosterone via non-genomic pathways. PMID: 17683282 Val Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 26, 2008 Report Share Posted March 26, 2008 That is reasonable. I just wish we were better at betting who is going to benefit from having it removed. As you can see from our group you want to be as sure as you can that taking one out will help for a long time. Spiroresponse is one way and AVS is the best (with ACTH). On Mar 26, 2008, at 7:00 PM, Valarie wrote: > What this says to me is that, for me, if an over-producing adenoma can > be > found, I want it gone. > > Clin Sci (Lond). 2007 Sep;113(6):267-78. > > Aldosterone and end-organ damage. > > Marney AM, Brown NJ. > > MR antagonism improves endothelial function in patients with CHF, > reduces > circulating biomarkers of cardiac fibrosis in CHF or following > myocardial > infarction, reduces blood pressure in resistant hypertension and > decreases > albuminuria in hypertensive and diabetic patients. In contrast, > whereas > adrenalectomy improves glucose homoeostasis in hyperaldosteronism, MR > antagonism may worsen glucose homoeostasis and impairs endothelial > function > in diabetes, suggesting a possible detrimental effect of aldosterone > via > non-genomic pathways. > PMID: 17683282 > I think the data is that MR receptor antagonist improve IR so dont know where they are coming from. > Val > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 26, 2008 Report Share Posted March 26, 2008 Not likely. Even normals have diurnal changes in PA and PRA. Search Grim CE and s T for ref in my CV. But if it goes away with spiro or Inspra then that would be suggestive. On Mar 26, 2008, at 6:15 PM, Valarie wrote: > > I have most of my problems (sweats/anxiety) early morning until about > noon. > Is it aldo? > > Val > > > J Clin Invest. 1973 September; 52(9): 2272-2277. > doi: 10.1172/JCI107414. > Circadian Rhythm of Plasma Aldosterone Concentration in Patients with > Primary Aldosteronism > C. Kem, Myron H. Weinberger, Celso Gomez-, Norman J. > Kramer, > Lerman, Shunsuke Furuyama, and A. Nugent > > Departments of Internal Medicine, The University of Texas Southwestern > Medical School, Dallas, Texas 75235 > Indiana University Medical School, Indianapolis, Indiana > University of Arizona, College of Medicine, Tucson, Arizona.. > > Abstract > > Plasma aldosterone, cortisol, and renin activity were measured in nine > recumbent patients with hyperaldosteronism, including seven with > adenomas, > one with idiopathic hyperplasia, and one with glucocorticoid > suppressible > hyperplasia. All had peak values of plasma aldosterone concentration > from 3 > a.m. to noon and lowest values at 6 p.m. or midnight. This rhythm was > similar to the circadian pattern of plasma cortisol in the same > patients. > When these data were normalized to eliminate the wide variation in > ranges of > plasma aldosterone and cortisol between individuals, there was an > excellent > correlation (r = + 0.87, P < 0.005) between the two hormones. In > contrast, > plasma aldosterone concentrations did not correlate with plasma renin > activity before or after normalization of data. > > Short term suppression of ACTH by administration of dexamethasone > eliminated > the circadian variation of plasma aldosterone in both patients with > hyperplasia and in four of five patients with adenomas, while it > markedly > altered the rhythm in the fifth. Similar doses of dexamethasone were > administered to four normal subjects and did not flatten the circadian > rhythm of plasma aldosterone. > > These data suggest that patients with primary aldosteronism have a > circadian > rhythm of plasma aldosterone mediated by changes in ACTH. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2008 Report Share Posted March 27, 2008 I believe I've had a profound response to 50 mg spiro. My BP is running at about 126/79. Pulse has dropped from mid 80's to high 60's. That's on extremely low sodium (~800 mg/day). If I eat more than that, BP rises back up. After having lower BP for a few days, I ate about 1,000 mg of sodium last night. I'd had about 400 mg during the day. Within a few hours, BP was 143/80, anxiety was considerably heightened, heart pounding. I have been aware for at least four years that I am very sensitive to salt. Only recently, however, have I been carefully keeping it less than 800 mg. Before, I just didn't eat obviously salty food and never used the salt shaker. ly, I don't want to have to maintain on less than 800 mg. so I guess I need a bit more spiro. I am thinking more and more about getting AVS at Mayo. I want the chance to be well. If I don't at least try, I'll spend the rest of my years wondering if I could have felt really well, just once. I've spent so many years being sick (hyperparathyroid, hypothyroid). Still having sweats. Maybe my doc can figure them out. I'm going to pursue MEN 1 genetic testing. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Clarence Grim That is reasonable. I just wish we were better at betting who is going to benefit from having it removed. As you can see from our group you want to be as sure as you can that taking one out will help for a long time. Spiroresponse is one way and AVS is the best (with ACTH). On Mar 26, 2008, at 7:00 PM, Valarie wrote: > What this says to me is that, for me, if an over-producing adenoma can > be > found, I want it gone. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2008 Report Share Posted March 27, 2008 I dont recall if you have had a recent adrenal scan. On Mar 27, 2008, at 9:37 AM, Valarie wrote: > I believe I've had a profound response to 50 mg spiro. My BP is > running at > about 126/79. Pulse has dropped from mid 80's to high 60's. That's on > extremely low sodium (~800 mg/day). If I eat more than that, BP rises > back > up. After having lower BP for a few days, I ate about 1,000 mg of > sodium > last night. I'd had about 400 mg during the day. Within a few hours, > BP > was 143/80, anxiety was considerably heightened, heart pounding. I > have > been aware for at least four years that I am very sensitive to salt. > Only > recently, however, have I been carefully keeping it less than 800 mg. > Before, I just didn't eat obviously salty food and never used the salt > shaker. ly, I don't want to have to maintain on less than 800 > mg. so I > guess I need a bit more spiro. > > I am thinking more and more about getting AVS at Mayo. I want the > chance to > be well. If I don't at least try, I'll spend the rest of my years > wondering > if I could have felt really well, just once. I've spent so many years > being > sick (hyperparathyroid, hypothyroid). > > Still having sweats. Maybe my doc can figure them out. I'm going to > pursue > MEN 1 genetic testing. > > Val > > From: hyperaldosteronism > [mailto:hyperaldosteronism ] On Behalf Of Clarence Grim > > That is reasonable. I just wish we were better at betting who is going > to benefit from having it removed. As you can see from our group you > want to be as sure as you can that taking one out will help for a long > time. > > Spiroresponse is one way and AVS is the best (with ACTH). > > On Mar 26, 2008, at 7:00 PM, Valarie wrote: > > > What this says to me is that, for me, if an over-producing adenoma > can > > be > > found, I want it gone. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2008 Report Share Posted March 27, 2008 I had a CT about three years ago. Normal. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Clarence Grim I dont recall if you have had a recent adrenal scan. On Mar 27, 2008, at 9:37 AM, Valarie wrote: > I believe I've had a profound response to 50 mg spiro. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2008 Report Share Posted March 27, 2008 That was what I recalled but was not sure. Techniques are not any better now I don't think. On Mar 27, 2008, at 4:42 PM, Valarie wrote: > I had a CT about three years ago. Normal. > > Val > > From: hyperaldosteronism > [mailto:hyperaldosteronism ] On Behalf Of Clarence Grim > > I dont recall if you have had a recent adrenal scan. > > On Mar 27, 2008, at 9:37 AM, Valarie wrote: > > > I believe I've had a profound response to 50 mg spiro. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2008 Report Share Posted March 27, 2008 I don't know if it was thin slice. I need to unpack and find my records. Exercised today! Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Clarence Grim That was what I recalled but was not sure. Techniques are not any better now I don't think. On Mar 27, 2008, at 4:42 PM, Valarie wrote: > I had a CT about three years ago. Normal. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2008 Report Share Posted March 27, 2008 Val, For what it's worth, I had a CT scan of the abdomen done that was read as normal. Three months later I had an MRI done that showed small bilateral adrenal adenomas. The CT scan was done for something else so maybe they weren't focusing on the adrenals and missed them. Or perhaps some adenomas show up better on MRI, I don't know. a --- Valarie <val@...> wrote: > I had a CT about three years ago. Normal. > > Val > > From: hyperaldosteronism > [mailto:hyperaldosteronism ] On > Behalf Of Clarence Grim > > > I dont recall if you have had a recent adrenal scan. > > On Mar 27, 2008, at 9:37 AM, Valarie wrote: > > > I believe I've had a profound response to 50 mg > spiro. > > > [Non-text portions of this message have been > removed] > > -Lord, keep your arm around my shoulder and your hand over my mouth.- Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2008 Report Share Posted March 27, 2008 CT has better discrimination. They probably were not looking. This is the reason that when you send an imaging request you need to be sure you mention that the patient has high blood pressure and low K. On Mar 27, 2008, at 7:26 PM, a Hall wrote: > Val, > For what it's worth, I had a CT scan of the abdomen > done that was read as normal. Three months later I > had an MRI done that showed small bilateral adrenal > adenomas. The CT scan was done for something else so > maybe they weren't focusing on the adrenals and missed > them. Or perhaps some adenomas show up better on MRI, > I don't know. > > a > > --- Valarie <val@...> wrote: > > > I had a CT about three years ago. Normal. > > > > Val > > > > From: hyperaldosteronism > > [mailto:hyperaldosteronism ] On > > Behalf Of Clarence Grim > > > > > > I dont recall if you have had a recent adrenal scan. > > > > On Mar 27, 2008, at 9:37 AM, Valarie wrote: > > > > > I believe I've had a profound response to 50 mg > > spiro. > > > > > > [Non-text portions of this message have been > > removed] > > > > > > -Lord, keep your arm around my shoulder and your hand over my mouth.- > May your pressure be low! CE Grim BS, MS, MD High Blood Pressure Consulting Specializing in Difficult to Manage High Blood Pressure Consult the following at for details bloodpressureline hyperaldosteronism Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2008 Report Share Posted March 27, 2008 there are thin slices and there are very thin slices. On Mar 27, 2008, at 7:13 PM, Valarie wrote: > I don't know if it was thin slice. I need to unpack and find my > records. > Exercised today! > > Val > > From: hyperaldosteronism > [mailto:hyperaldosteronism ] On Behalf Of Clarence Grim > > That was what I recalled but was not sure. > Techniques are not any better now I don't think. > > On Mar 27, 2008, at 4:42 PM, Valarie wrote: > > > I had a CT about three years ago. Normal. > > Quote Link to comment Share on other sites More sharing options...
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