Re: Low normal Aldosterone, Low Renin, and Low Cortisol

January 8, 2009

Your renin is low and your aldo is not (low would be below their

normal level). This is not normal. You likely have personal

hyperaldosteronism. See my paper in my files and take to your Card

I would recommend a trial of spironolactone-talk to your Cards if you

have never been on it.

Have your K EVER been low? Any problems with irregular heart beats

etc. Read our guidelines to be sure they are doing a good blood K test.

Do you DASH? If not this will help a lot too.

Salivary Cortison may not be as good an blood levels in some.

Better yet is a 24 hr urine cortisol and while I was doing it I would

do a urine aldosterone.

May your pressure be low!

ï¿¼

CE Grim BS, MS, MD

High Blood Pressure Consulting

Senior Consultant to Shared Care Research and Education Consulting

Inc.(sharedcareinc.com)

Clinical Professor of Internal Medicine Medical and Cardiology

Medical College of Wisconsin

Board certified in Internal Med, Geriatrics and Hypertension.

Interests:

1. Difficult to control high blood pressure.

2. The effect of recent evolutionary forces on high blood pressure

in human populations.

3. Improving blood pressure measurement in the office and out.

On Jan 8, 2009, at 10:20 AM, Steve wrote:

> Last year I tested cortisol (AM/PM) and got low but normal results

> with

> blood serum testing but quite low for each of a 4 sample saliva test

> through out the day using two different labs (saliva collected the

> same

> day within minutes of each other for both labs).

>

> Just received the blood results on Renin and Aldosterone testing and

> obviously I don't have hyperaldosteronism from these results but I

> haven't been able to find a " diagnosis " for low cortisol (or very low

> normal cortisol), low renin, and very low normal aldosterone.

>

> Test took place early morning when Aldosterone is near the peak of

> it's

> diurnal rhythm.

>

> Renin, Plasma 0.52

>

> range for Upright 1.31 - 3.95

> range for Supine 0.15 - 2.33

>

> I need to talk to my cario doctor from whom I requested this blood

> work

> but I had them fax the results today to me and she had underlined the

> Supine and marked OK when in fact this was a sitting test. Obviously,

> the Renin is low. This means?

>

> Aldosterone 7.4

>

> range for Upright 4.0 - 31

> range for Supine 1.0 - 16

>

> Again, this was a " sitting " test - blood draw.

>

> I had to go off an ACE inhibitor blood pressure drug for two weeks

> before the test since this lowers aldosterone so who know what it is

> normally when I'm on the drug. In any case, I'm near the low end of

> their lab reference range.

>

> Any Ideas?

>

> I know there's a drug for bringing up Aldosterone and I'm thinking I

> should have a trial of that but any other suggestions? I'm currently

> taking hydrocortisone for low cortisol.

>

> Most afternoons, I get quite tired in the 4-6 pm time range and if I

> continue to do things, I'll be all right but if I sit down and rest, I

> dose off fitfully while my blood pressure and heart rate will increase

> and I'll get a heart pounding effect, heart rate will increase from a

> normal sitting rate of high 70s during most of the rest of the day

> to a

> mid 90 range. Heart rate will not come down from here unless I take

> some additional non-timed release toprol. Again, if I don't give into

> the overwhelming since of tiredness and keep active this doesn't

> happen.

> Moving around keeps ones aldosterone higher and I wonder if this is

> related.

>

> I also would get the heart pounding effect without the increase in

> blood

> pressure when I wake up in the morning about half the time, but

> cortisol

> replacement has eliminated this problem most of the time.

>

> What should I approach my cardio about?

>

> --

>

> Steve - dudescholar4@...

>

> Take World's Smallest Political Quiz at

> http://www.theadvocates.org/quiz.html

>

> " If a thousand old beliefs were ruined on our march

> to truth we must still march on. " --Stopford

>

January 8, 2009

Thanks so much for your reply. Part of it was expected (aldo is

within the lab reference range defined as 2 standard deviations plus

or minus the sample mean) but then I find that if the same standards

were applied to prescription eye glasses, 95% of the population would

be considered " normal " . I think my aldo is low for my historical

values but I cannot prove that. An aldo of 4.0 would be consider

" normal " and one of 3.9 would be considered low. The difference

between the two is insignificant. I would think that having an aldo

higher would be better than where it currently is.

But, the other points you made were interesting and I'm expanding my

research into this.

As to the potassium, I find that I get a high heart rate that cannot

be controlled with beta blockers multiple times a year if I don't

supplement potassium. I've been to the ER over this three times in

the past 4 years and the last time I saw that my potassium blood work

drawn at the ER was right ON the low end of normal. The ER staff sent

me home with a high heart rate and based on my lab work, I took 500 mg

of potassium and my heart rate normalized within 30 minutes, something

it hadn't done is more than a week even doubling my beta blocker. I

worked with the amount of potassium to see how much I would need to

take to prevent the elevated heart rate that occurs seemingly randomly

and found the magic number to be 3000 mg/day of potassium. My blood

work drawn half a dozen times or more since then while on 3000 mg/day

of K shows 3.8-4.3 range, usually lower than higher, with a lab

reference range of 3.5 to 5.0 (or 5.5 depending on when they changed

the ranges).

I wasn't sure which article/file you were referring too so I looked at

the primary hyperaldosteronism and the hyperaldosteronism.doc. Were

those the files you were referring too?

My blood pressure is not difficult to control. I currently take 100

mg/day of toprol xl and 10 mg/day of lisinopril. The combination is

related to a past heart attack since cardio docs tend to prescribe

both a beta blocker and ace to heart attack patients. My controlled

blood pressure runs about 115/75 most of the day with about 10/5 point

raise late afternoon. However, if I take my blood pressure lying down

or just sitting up in bed in the morning, then get up and take it

standing next to the bed without moving around, the systolic will drop

about 15 points and the diastolic will increase about 5-10 points.

Apparently, systolic should increase when moving from lying to

standing. The only way I can tell is to measure it since I get no

dizziness from this temporary drop. My understanding is that aldo is

supposed to rise when you stand up to compensate for one's position in

posture. I'm hypothesizing that if my aldo was higher, I wouldn't

have this postural drop in blood pressure.

Steve

Clarence Grim wrote:

>

> Your renin is low and your aldo is not (low would be below their

> normal level). This is not normal. You likely have personal

> hyperaldosteronism. See my paper in my files and take to your Card

>

> I would recommend a trial of spironolactone-talk to your Cards if you

> have never been on it.

>

> Have your K EVER been low? Any problems with irregular heart beats

> etc. Read our guidelines to be sure they are doing a good blood K test.

>

> Do you DASH? If not this will help a lot too.

>

> Salivary Cortison may not be as good an blood levels in some.

>

> Better yet is a 24 hr urine cortisol and while I was doing it I would

> do a urine aldosterone.

>

> May your pressure be low!

>

> & #65532;

>

> CE Grim BS, MS, MD

>

> High Blood Pressure Consulting

>

> Senior Consultant to Shared Care Research and Education Consulting

> Inc.(sharedcareinc.com)

>

> Clinical Professor of Internal Medicine Medical and Cardiology

> Medical College of Wisconsin

>

> Board certified in Internal Med, Geriatrics and Hypertension.

>

> Interests:

> 1. Difficult to control high blood pressure.

> 2. The effect of recent evolutionary forces on high blood pressure

> in human populations.

> 3. Improving blood pressure measurement in the office and out.

>

> On Jan 8, 2009, at 10:20 AM, Steve wrote:

>

> > Last year I tested cortisol (AM/PM) and got low but normal results

> > with

> > blood serum testing but quite low for each of a 4 sample saliva test

> > through out the day using two different labs (saliva collected the

> > same

> > day within minutes of each other for both labs).

> >

> > Just received the blood results on Renin and Aldosterone testing and

> > obviously I don't have hyperaldosteronism from these results but I

> > haven't been able to find a " diagnosis " for low cortisol (or very low

> > normal cortisol), low renin, and very low normal aldosterone.

> >

> > Test took place early morning when Aldosterone is near the peak of

> > it's

> > diurnal rhythm.

> >

> > Renin, Plasma 0.52

> >

> > range for Upright 1.31 - 3.95

> > range for Supine 0.15 - 2.33

> >

> > I need to talk to my cario doctor from whom I requested this blood

> > work

> > but I had them fax the results today to me and she had underlined the

> > Supine and marked OK when in fact this was a sitting test. Obviously,

> > the Renin is low. This means?

> >

> > Aldosterone 7.4

> >

> > range for Upright 4.0 - 31

> > range for Supine 1.0 - 16

> >

> > Again, this was a " sitting " test - blood draw.

> >

> > I had to go off an ACE inhibitor blood pressure drug for two weeks

> > before the test since this lowers aldosterone so who know what it is

> > normally when I'm on the drug. In any case, I'm near the low end of

> > their lab reference range.

> >

> > Any Ideas?

> >

> > I know there's a drug for bringing up Aldosterone and I'm thinking I

> > should have a trial of that but any other suggestions? I'm currently

> > taking hydrocortisone for low cortisol.

> >

> > Most afternoons, I get quite tired in the 4-6 pm time range and if I

> > continue to do things, I'll be all right but if I sit down and

rest, I

> > dose off fitfully while my blood pressure and heart rate will

increase

> > and I'll get a heart pounding effect, heart rate will increase from a

> > normal sitting rate of high 70s during most of the rest of the day

> > to a

> > mid 90 range. Heart rate will not come down from here unless I take

> > some additional non-timed release toprol. Again, if I don't give into

> > the overwhelming since of tiredness and keep active this doesn't

> > happen.

> > Moving around keeps ones aldosterone higher and I wonder if this is

> > related.

> >

> > I also would get the heart pounding effect without the increase in

> > blood

> > pressure when I wake up in the morning about half the time, but

> > cortisol

> > replacement has eliminated this problem most of the time.

> >

> > What should I approach my cardio about?

> >

> > --

> >

> > Steve - dudescholar4@...

<mailto:dudescholar4%40basicmail.net>

--

Steve - dudescholar4@...

Take World's Smallest Political Quiz at

http://www.theadvocates.org/quiz.html

" If a thousand old beliefs were ruined on our march

to truth we must still march on. " --Stopford

January 8, 2009

The most likely thing you have is early primary aldosteronism and

look for Dr. Grim's article in our files. Can some one relabel this

article as The evolution of PA to make it easier for me to remember.

How can we set up a standard reply to newbies that would include some

of my usual recommendations and links etc?

May your pressure be low!

ï¿¼

CE Grim BS, MS, MD

High Blood Pressure Consulting

Senior Consultant to Shared Care Research and Education Consulting

Inc.(sharedcareinc.com)

Clinical Professor of Internal Medicine Medical and Cardiology

Medical College of Wisconsin

Board certified in Internal Med, Geriatrics and Hypertension.

Interests:

1. Difficult to control high blood pressure.

2. The effect of recent evolutionary forces on high blood pressure

in human populations.

3. Improving blood pressure measurement in the office and out.

On Jan 8, 2009, at 1:36 PM, dudescholar wrote:

> Thanks so much for your reply. Part of it was expected (aldo is

> within the lab reference range defined as 2 standard deviations plus

> or minus the sample mean) but then I find that if the same standards

> were applied to prescription eye glasses, 95% of the population would

> be considered " normal " . I think my aldo is low for my historical

> values but I cannot prove that. An aldo of 4.0 would be consider

> " normal " and one of 3.9 would be considered low. The difference

> between the two is insignificant. I would think that having an aldo

> higher would be better than where it currently is.

>

> But, the other points you made were interesting and I'm expanding my

> research into this.

>

> As to the potassium, I find that I get a high heart rate that cannot

> be controlled with beta blockers multiple times a year if I don't

> supplement potassium. I've been to the ER over this three times in

> the past 4 years and the last time I saw that my potassium blood work

> drawn at the ER was right ON the low end of normal. The ER staff sent

> me home with a high heart rate and based on my lab work, I took 500 mg

> of potassium and my heart rate normalized within 30 minutes, something

> it hadn't done is more than a week even doubling my beta blocker. I

> worked with the amount of potassium to see how much I would need to

> take to prevent the elevated heart rate that occurs seemingly randomly

> and found the magic number to be 3000 mg/day of potassium. My blood

> work drawn half a dozen times or more since then while on 3000 mg/day

> of K shows 3.8-4.3 range, usually lower than higher, with a lab

> reference range of 3.5 to 5.0 (or 5.5 depending on when they changed

> the ranges).

>

> I wasn't sure which article/file you were referring too so I looked at

> the primary hyperaldosteronism and the hyperaldosteronism.doc. Were

> those the files you were referring too?

>

> My blood pressure is not difficult to control. I currently take 100

> mg/day of toprol xl and 10 mg/day of lisinopril. The combination is

> related to a past heart attack since cardio docs tend to prescribe

> both a beta blocker and ace to heart attack patients. My controlled

> blood pressure runs about 115/75 most of the day with about 10/5 point

> raise late afternoon. However, if I take my blood pressure lying down

> or just sitting up in bed in the morning, then get up and take it

> standing next to the bed without moving around, the systolic will drop

> about 15 points and the diastolic will increase about 5-10 points.

> Apparently, systolic should increase when moving from lying to

> standing. The only way I can tell is to measure it since I get no

> dizziness from this temporary drop. My understanding is that aldo is

> supposed to rise when you stand up to compensate for one's position in

> posture. I'm hypothesizing that if my aldo was higher, I wouldn't

> have this postural drop in blood pressure.

>

> Steve

>

> Clarence Grim wrote:

> >

> > Your renin is low and your aldo is not (low would be below their

> > normal level). This is not normal. You likely have personal

> > hyperaldosteronism. See my paper in my files and take to your Card

> >

> > I would recommend a trial of spironolactone-talk to your Cards if

> you

> > have never been on it.

> >

> > Have your K EVER been low? Any problems with irregular heart beats

> > etc. Read our guidelines to be sure they are doing a good blood K

> test.

> >

> > Do you DASH? If not this will help a lot too.

> >

> > Salivary Cortison may not be as good an blood levels in some.

> >

> > Better yet is a 24 hr urine cortisol and while I was doing it I

> would

> > do a urine aldosterone.

> >

> > May your pressure be low!

> >

> > & #65532;

> >

> > CE Grim BS, MS, MD

> >

> > High Blood Pressure Consulting

> >

> > Senior Consultant to Shared Care Research and Education Consulting

> > Inc.(sharedcareinc.com)

> >

> > Clinical Professor of Internal Medicine Medical and Cardiology

> > Medical College of Wisconsin

> >

> > Board certified in Internal Med, Geriatrics and Hypertension.

> >

> > Interests:

> > 1. Difficult to control high blood pressure.

> > 2. The effect of recent evolutionary forces on high blood pressure

> > in human populations.

> > 3. Improving blood pressure measurement in the office and out.

> >

> > On Jan 8, 2009, at 10:20 AM, Steve wrote:

> >

> > > Last year I tested cortisol (AM/PM) and got low but normal results

> > > with

> > > blood serum testing but quite low for each of a 4 sample saliva

> test

> > > through out the day using two different labs (saliva collected the

> > > same

> > > day within minutes of each other for both labs).

> > >

> > > Just received the blood results on Renin and Aldosterone

> testing and

> > > obviously I don't have hyperaldosteronism from these results but I

> > > haven't been able to find a " diagnosis " for low cortisol (or

> very low

> > > normal cortisol), low renin, and very low normal aldosterone.

> > >

> > > Test took place early morning when Aldosterone is near the peak of

> > > it's

> > > diurnal rhythm.

> > >

> > > Renin, Plasma 0.52

> > >

> > > range for Upright 1.31 - 3.95

> > > range for Supine 0.15 - 2.33

> > >

> > > I need to talk to my cario doctor from whom I requested this blood

> > > work

> > > but I had them fax the results today to me and she had

> underlined the

> > > Supine and marked OK when in fact this was a sitting test.

> Obviously,

> > > the Renin is low. This means?

> > >

> > > Aldosterone 7.4

> > >

> > > range for Upright 4.0 - 31

> > > range for Supine 1.0 - 16

> > >

> > > Again, this was a " sitting " test - blood draw.

> > >

> > > I had to go off an ACE inhibitor blood pressure drug for two weeks

> > > before the test since this lowers aldosterone so who know what

> it is

> > > normally when I'm on the drug. In any case, I'm near the low

> end of

> > > their lab reference range.

> > >

> > > Any Ideas?

> > >

> > > I know there's a drug for bringing up Aldosterone and I'm

> thinking I

> > > should have a trial of that but any other suggestions? I'm

> currently

> > > taking hydrocortisone for low cortisol.

> > >

> > > Most afternoons, I get quite tired in the 4-6 pm time range and

> if I

> > > continue to do things, I'll be all right but if I sit down and

> rest, I

> > > dose off fitfully while my blood pressure and heart rate will

> increase

> > > and I'll get a heart pounding effect, heart rate will increase

> from a

> > > normal sitting rate of high 70s during most of the rest of the day

> > > to a

> > > mid 90 range. Heart rate will not come down from here unless I

> take

> > > some additional non-timed release toprol. Again, if I don't

> give into

> > > the overwhelming since of tiredness and keep active this doesn't

> > > happen.

> > > Moving around keeps ones aldosterone higher and I wonder if

> this is

> > > related.

> > >

> > > I also would get the heart pounding effect without the increase in

> > > blood

> > > pressure when I wake up in the morning about half the time, but

> > > cortisol

> > > replacement has eliminated this problem most of the time.

> > >

> > > What should I approach my cardio about?

> > >

> > > --

> > >

> > > Steve - dudescholar4@...

> <mailto:dudescholar4%40basicmail.net>

>

> --

>

> Steve - dudescholar4@...

>

> Take World's Smallest Political Quiz at

> http://www.theadvocates.org/quiz.html

>

> " If a thousand old beliefs were ruined on our march

> to truth we must still march on. " --Stopford

>

January 8, 2009

again when renin is very low aldo should be very low. Yours is not.

So you have too much aldo for your renin. You did not mention(as I

recall) your ethnicity as we need different cut offs for African

Americans and most labs dont have them.