Re: High blood pressure in hyperaldosteronism

[Guest guest]

You will find this a good place to get some answers. Do need more information

about your wife's labs. Do you have her renin number. Do you

know what her K (potassium) is.

>

> Hi, I just signed up. According to my wife's primary care doctor, she most

probably has bilateral adrenal hyperplasia (with aldosterone level = about 80

ng/dL). The thing that worries us most at this point is her hypertension.

Spironolactone doesn't seem to help much. She took 50mg (2 x 25mg) daily during

the first week and now she started taking 100mg (2 x 50mg) per day. It's been

almost 2 weeks without any visible changes to her blood pressure. She had

176/115 today. She also takes Carvedilol for her BP. Her blood pressure was

perfect until late August (120/80) and then suddenly it spiked to very high

levels. I wonder how long it might take before we start seeing any more lasting

results of Spironolactone? 

>

[Guest guest]

It will start to work in 2 weeks. Is her K better?Need more details on her story. Age , smoking Hx, renin test # read my art on evolution of PA AND begin to DASH ASAP. This will help a lot. SAlt drives the BP up and the K down. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertensionOn Oct 28, 2009, at 11:11 PM, Jaroslaw SZUREK <jszurek@...> wrote:

Hi, I just signed up. According to my wife's primary care doctor, she most probably has bilateral adrenal hyperplasia (with aldosterone level = about 80 ng/dL). The thing that worries us most at this point is her hypertension. Spironolactone doesn't seem to help much. She took 50mg (2 x 25mg) daily during the first week and now she started taking 100mg (2 x 50mg) per day. It's been almost 2 weeks without any visible changes to her blood pressure. She had 176/115 today. She also takes Carvedilol for her BP. Her blood pressure was perfect until late August (120/80) and then suddenly it spiked to very high levels. I wonder how long it might take before we start seeing any more lasting results of Spironolactone?

[Guest guest]

How was diagnoses of bilateral adrenal hyperplasia made?

> >

> > Hi, I just signed up. According to my wife's primary care doctor, she most

probably has bilateral adrenal hyperplasia (with aldosterone level = about 80

ng/dL). The thing that worries us most at this point is her hypertension.

Spironolactone doesn't seem to help much. She took 50mg (2 x 25mg) daily during

the first week and now she started taking 100mg (2 x 50mg) per day. It's been

almost 2 weeks without any visible changes to her blood pressure. She had

176/115 today. She also takes Carvedilol for her BP. Her blood pressure was

perfect until late August (120/80) and then suddenly it spiked to very high

levels. I wonder how long it might take before we start seeing any more lasting

results of Spironolactone? 

> >

>

[Guest guest]

This may test your evolution of PA. Is it possable that her BP was normal 120/80

intil late August and then was 176/115. Did something else to happen. But then

why is her aldosterone level 80 ng/dL.

>

> > Hi, I just signed up. According to my wife's primary care doctor,

> > she most probably has bilateral adrenal hyperplasia (with

> > aldosterone level = about 80 ng/dL). The thing that worries us most

> > at this point is her hypertension. Spironolactone doesn't seem to

> > help much. She took 50mg (2 x 25mg) daily during the first week and

> > now she started taking 100mg (2 x 50mg) per day. It's been almost 2

> > weeks without any visible changes to her blood pressure. She had

> > 176/115 today. She also takes Carvedilol for her BP. Her blood

> > pressure was perfect until late August (120/80) and then suddenly it

> > spiked to very high levels. I wonder how long it might take before

> > we start seeing any more lasting results of Spironolactone?

> >

>

[Guest guest]

Thank you all for your replies. I'll check all her medical reports and write all the details tonight (I'm at work now). The BP spike also sounded weird to me - I thought in such conditions it's a more gradual process - not 120/80 to 180/120 in a few days. Maybe it has 2 different causes (and only hyperaldosteronism was diagnosed).

From: Francis Bill <georgewbill@...>Subject: Re: High blood pressure in hyperaldosteronismhyperaldosteronism Date: Thursday, October 29, 2009, 9:01 AM

This may test your evolution of PA. Is it possable that her BP was normal 120/80 intil late August and then was 176/115. Did something else to happen. But then why is her aldosterone level 80 ng/dL. > > > Hi, I just signed up. According to my wife's primary care doctor, > > she most probably has bilateral adrenal hyperplasia (with > > aldosterone level = about 80 ng/dL). The thing that worries us most > > at this point is her hypertension. Spironolactone doesn't seem to > > help much. She took 50mg (2 x 25mg) daily during the first week and > > now she started taking 100mg (2 x 50mg) per day. It's been almost 2 > > weeks without any visible changes to her blood pressure. She had > > 176/115 today. She also takes Carvedilol for her BP. Her blood > > pressure was perfect until late August (120/80) and then suddenly it > > spiked to very high levels. I wonder how long it might take before > > we start seeing any more lasting results of Spironolactone?>

>>

[Guest guest]

Sudden onset in a smoker over one must always suspect renal artery stenosis due to rusting arteries going to the kidneys.

Clarence E. Grim, BS, MS, MD

Specializing in Difficult High Blood Pressure and recent evolutionary forces on high blood pressure in population's today.

On Thursday, October 29, 2009, at 09:31AM, "Jaroslaw SZUREK" <jszurek@...> wrote:

>

Thank you all for your replies. I'll check all her medical reports and write all the details tonight (I'm at work now). The BP spike also sounded weird to me - I thought in such conditions it's a more gradual process - not 120/80 to 180/120 in a few days. Maybe it has 2 different causes (and only hyperaldosteronism was diagnosed).

From: Francis Bill <georgewbill >Subject: Re: High blood pressure in hyperaldosteronismhyperaldosteronism Date: Thursday, October 29, 2009, 9:01 AM

This may test your evolution of PA. Is it possable that her BP was normal 120/80 intil late August and then was 176/115. Did something else to happen. But then why is her aldosterone level 80 ng/dL.

> > > Hi, I just signed up. According to my wife's primary care doctor, > > she most probably has bilateral adrenal hyperplasia (with > > aldosterone level = about 80 ng/dL). The thing that worries us most > > at this point is her hypertension. Spironolactone doesn't seem to > > help much. She took 50mg (2 x 25mg) daily during the first week and > > now she started taking 100mg (2 x 50mg) per day. It's been almost 2 > > weeks without any visible changes to her blood pressure. She had > > 176/115 today. She also takes Carvedilol for her BP. Her blood > > pressure was perfect until late August (120/80) and then suddenly it > > spiked to very high levels. I wonder how long it might take before > > we start seeing any more lasting results of Spironolactone?>

>>

[Guest guest]

If she has beed diagnosed with bilateral adrenal hyperplasia in just two months

she has a really good doctor.

> >

>

[Guest guest]

Can't diagnose hyperplasia vs adenoma without AVS.

>

> If she has beed diagnosed with bilateral adrenal hyperplasia in just two

months she has a really good doctor.

[Guest guest]

If I understand correctly, her renin level seems to be OK: 3.93 ng/mL/hr (maybe

a little bit elevated, if the test was taken in a supine position)

Metabolic panel - everything in the normal range (creatinine a little bit lower

than normal: 0.7 (abn) mg/dL)

Potassium 4.3 mmol/L

She doesn't smoke or drink any alcohol.

She also had a chest X-ray, EKG, echocardiogram, urinalysis, lipid panel,

abdominal ultrasound (which showed that one of her kidneys is smaller than the

other: right 11.04 cm, left 9.47 cm), and abdominal CT scan to evaluate for

renal artery stenosis (everything came up normal). The only result out of the

normal range was her aldosterone level. It came already after her abdominal CT

scan so the doctor couldn't send her for another one to evaluate only her

adrenal glands because he said 2 CT scans in a row might not be very safe. So he

asked the radiologist to check the size of her adrenal glands based on the CT

scan she already had. There were no growths visible and the size and shape of

her adrenals was normal so the doctor assumed it must be hyperplasia in the

beginning stage. I thought there should be some other - more detailed - tests

done to distinguish between hyperplasia or adenoma but this is where we are now.

Her BP is still very high.

She often has migraines (ever since she had a car accident 8 years ago) and they

may now aggravate her hypertension but, as I said in my first e-mail, her BP was

perfect until the end of August (she had it checked during her 2 dental

appointments). Her hypertension came all of a sudden (discovered during her

annual checkup in September).

I think the next step is finding a good endocrinologist (we're in Alabama).

[Guest guest]

And she's 35 -- normal weight (not overweight), no major health problems in the

past (besides the concussion she suffered in an accident 8 years ago - but a

head injury wouldn't drive her aldosterone up, would it?).

[Guest guest]

I think Dr grim made a good guess in saying she may have renal artery stenosis.

Ultrasound that showed that one of her kidneys is smaller than the other: right

11.04 cm, left 9.47 cm Should have been the clue If the information I looked is

right.

>

> If I understand correctly, her renin level seems to be OK: 3.93 ng/mL/hr

(maybe a little bit elevated, if the test was taken in a supine position)

> Metabolic panel - everything in the normal range (creatinine a little bit

lower than normal: 0.7 (abn) mg/dL)

> Potassium 4.3 mmol/L

> She doesn't smoke or drink any alcohol. ultrasound (which showed that one of

her kidneys is smaller than the other: right 11.04 cm, left 9.47 cm)

> She also had a chest X-ray, EKG, echocardiogram, urinalysis, lipid panel,

abdominal , and abdominal CT scan to evaluate for renal artery stenosis

(everything came up normal). The only result out of the normal range was her

aldosterone level. It came already after her abdominal CT scan so the doctor

couldn't send her for another one to evaluate only her adrenal glands because he

said 2 CT scans in a row might not be very safe. So he asked the radiologist to

check the size of her adrenal glands based on the CT scan she already had. There

were no growths visible and the size and shape of her adrenals was normal so the

doctor assumed it must be hyperplasia in the beginning stage. I thought there

should be some other - more detailed - tests done to distinguish between

hyperplasia or adenoma but this is where we are now. Her BP is still very high.

> She often has migraines (ever since she had a car accident 8 years ago) and

they may now aggravate her hypertension but, as I said in my first e-mail, her

BP was perfect until the end of August (she had it checked during her 2 dental

appointments). Her hypertension came all of a sudden (discovered during her

annual checkup in September).

> I think the next step is finding a good endocrinologist (we're in Alabama).

>

[Guest guest]

But she had a CT scan to evaluate for it and it didn't show anything...

> >

> > If I understand correctly, her renin level seems to be OK: 3.93 ng/mL/hr

(maybe a little bit elevated, if the test was taken in a supine position)

> > Metabolic panel - everything in the normal range (creatinine a little bit

lower than normal: 0.7 (abn) mg/dL)

> > Potassium 4.3 mmol/L

> > She doesn't smoke or drink any alcohol. ultrasound (which showed that one of

her kidneys is smaller than the other: right 11.04 cm, left 9.47 cm)

> > She also had a chest X-ray, EKG, echocardiogram, urinalysis, lipid panel,

abdominal , and abdominal CT scan to evaluate for renal artery stenosis

(everything came up normal). The only result out of the normal range was her

aldosterone level. It came already after her abdominal CT scan so the doctor

couldn't send her for another one to evaluate only her adrenal glands because he

said 2 CT scans in a row might not be very safe. So he asked the radiologist to

check the size of her adrenal glands based on the CT scan she already had. There

were no growths visible and the size and shape of her adrenals was normal so the

doctor assumed it must be hyperplasia in the beginning stage. I thought there

should be some other - more detailed - tests done to distinguish between

hyperplasia or adenoma but this is where we are now. Her BP is still very high.

> > She often has migraines (ever since she had a car accident 8 years ago) and

they may now aggravate her hypertension but, as I said in my first e-mail, her

BP was perfect until the end of August (she had it checked during her 2 dental

appointments). Her hypertension came all of a sudden (discovered during her

annual checkup in September).

> > I think the next step is finding a good endocrinologist (we're in Alabama).

> >

>

[Guest guest]

No every low K?Be sure Drd.listens carefully in abd for renal artery bruits due to renal artery stenosis. Common cause of sudden onset in young women. Most can be Dxed with a stethoscope in my experience.What was the renin?CE Grim MDOn Oct 30, 2009, at 12:22 AM, szurcio wrote: And she's 35 -- normal weight (not overweight), no major health problems in the past (besides the concussion she suffered in an accident 8 years ago - but a head injury wouldn't drive her aldosterone up, would it?).

[Guest guest]

I must have missed this story but Francis is right on.Normally the left kidney is larger. So a smaller L kidney is very suspicious.If she were my patient and her renin was not low I would do a transfemoral angiogram and renal vein renin study.CE Grim MDOn Oct 30, 2009, at 8:23 AM, Francis Bill wrote: I think Dr grim made a good guess in saying she may have renal artery stenosis. Ultrasound that showed that one of her kidneys is smaller than the other: right 11.04 cm, left 9.47 cm Should have been the clue If the information I looked is right. > > If I understand correctly, her renin level seems to be OK: 3.93 ng/mL/hr (maybe a little bit elevated, if the test was taken in a supine position) > Metabolic panel - everything in the normal range (creatinine a little bit lower than normal: 0.7 (abn) mg/dL) > Potassium 4.3 mmol/L > She doesn't smoke or drink any alcohol. ultrasound (which showed that one of her kidneys is smaller than the other: right 11.04 cm, left 9.47 cm) > She also had a chest X-ray, EKG, echocardiogram, urinalysis, lipid panel, abdominal , and abdominal CT scan to evaluate for renal artery stenosis (everything came up normal). The only result out of the normal range was her aldosterone level. It came already after her abdominal CT scan so the doctor couldn't send her for another one to evaluate only her adrenal glands because he said 2 CT scans in a row might not be very safe. So he asked the radiologist to check the size of her adrenal glands based on the CT scan she already had. There were no growths visible and the size and shape of her adrenals was normal so the doctor assumed it must be hyperplasia in the beginning stage. I thought there should be some other - more detailed - tests done to distinguish between hyperplasia or adenoma but this is where we are now. Her BP is still very high. > She often has migraines (ever since she had a car accident 8 years ago) and they may now aggravate her hypertension but, as I said in my first e-mail, her BP was perfect until the end of August (she had it checked during her 2 dental appointments). Her hypertension came all of a sudden (discovered during her annual checkup in September). > I think the next step is finding a good endocrinologist (we're in Alabama). >

[Guest guest]

So does it look more like 2 different problems happening at the same time? Or

can renal artery stenosis in any way influnce the level of aldosterone being

produced by adrenal glands? Once again, a summary of her symptoms: hypertension

(around 170/110), fatigue, her right kidney larger than the left one, her renin

and potassium levels in the normal range, aldosterone too high.

> > >

> > > If I understand correctly, her renin level seems to be OK: 3.93

> > ng/mL/hr (maybe a little bit elevated, if the test was taken in a

> > supine position)

> > > Metabolic panel - everything in the normal range (creatinine a

> > little bit lower than normal: 0.7 (abn) mg/dL)

> > > Potassium 4.3 mmol/L

> > > She doesn't smoke or drink any alcohol. ultrasound (which showed

> > that one of her kidneys is smaller than the other: right 11.04 cm,

> > left 9.47 cm)

> > > She also had a chest X-ray, EKG, echocardiogram, urinalysis,

> > lipid panel, abdominal , and abdominal CT scan to evaluate for

> > renal artery stenosis (everything came up normal). The only result

> > out of the normal range was her aldosterone level. It came already

> > after her abdominal CT scan so the doctor couldn't send her for

> > another one to evaluate only her adrenal glands because he said 2

> > CT scans in a row might not be very safe. So he asked the

> > radiologist to check the size of her adrenal glands based on the CT

> > scan she already had. There were no growths visible and the size

> > and shape of her adrenals was normal so the doctor assumed it must

> > be hyperplasia in the beginning stage. I thought there should be

> > some other - more detailed - tests done to distinguish between

> > hyperplasia or adenoma but this is where we are now. Her BP is

> > still very high.

> > > She often has migraines (ever since she had a car accident 8

> > years ago) and they may now aggravate her hypertension but, as I

> > said in my first e-mail, her BP was perfect until the end of August

> > (she had it checked during her 2 dental appointments). Her

> > hypertension came all of a sudden (discovered during her annual

> > checkup in September).

> > > I think the next step is finding a good endocrinologist (we're in

> > Alabama).

> > >

> >

> >

>

[Guest guest]

the renal artery stenosis (RAS) drops the pressure to the kidney which makes the JG cells in the kidney release renin which raises BP because renin splits off AI from angiotensinogen (AGN) which is converted to AII by ACE. AII stimulate the adrenal to make aldosterone. Before we could measure renin it was hard to separate hyperaldosteronism due to primary cause (Conn's) from secondary causes-most common is RAS.On Oct 30, 2009, at 1:17 PM, szurcio wrote: So does it look more like 2 different problems happening at the same time? Or can renal artery stenosis in any way influnce the level of aldosterone being produced by adrenal glands? Once again, a summary of her symptoms: hypertension (around 170/110), fatigue, her right kidney larger than the left one, her renin and potassium levels in the normal range, aldosterone too high. > > > > > > If I understand correctly, her renin level seems to be OK: 3.93 > > ng/mL/hr (maybe a little bit elevated, if the test was taken in a > > supine position) > > > Metabolic panel - everything in the normal range (creatinine a > > little bit lower than normal: 0.7 (abn) mg/dL) > > > Potassium 4.3 mmol/L > > > She doesn't smoke or drink any alcohol. ultrasound (which showed > > that one of her kidneys is smaller than the other: right 11.04 cm, > > left 9.47 cm) > > > She also had a chest X-ray, EKG, echocardiogram, urinalysis, > > lipid panel, abdominal , and abdominal CT scan to evaluate for > > renal artery stenosis (everything came up normal). The only result > > out of the normal range was her aldosterone level. It came already > > after her abdominal CT scan so the doctor couldn't send her for > > another one to evaluate only her adrenal glands because he said 2 > > CT scans in a row might not be very safe. So he asked the > > radiologist to check the size of her adrenal glands based on the CT > > scan she already had. There were no growths visible and the size > > and shape of her adrenals was normal so the doctor assumed it must > > be hyperplasia in the beginning stage. I thought there should be > > some other - more detailed - tests done to distinguish between > > hyperplasia or adenoma but this is where we are now. Her BP is > > still very high. > > > She often has migraines (ever since she had a car accident 8 > > years ago) and they may now aggravate her hypertension but, as I > > said in my first e-mail, her BP was perfect until the end of August > > (she had it checked during her 2 dental appointments). Her > > hypertension came all of a sudden (discovered during her annual > > checkup in September). > > > I think the next step is finding a good endocrinologist (we're in > > Alabama). > > > > > > > >

[Guest guest]

Thank you for all your help, Dr. Grim! My last question (at least for today) -

would it be possible that a CT scan of that area could miss renal artery

stenosis?

> > > > >

> > > > > If I understand correctly, her renin level seems to be OK: 3.93

> > > > ng/mL/hr (maybe a little bit elevated, if the test was taken in a

> > > > supine position)

> > > > > Metabolic panel - everything in the normal range (creatinine a

> > > > little bit lower than normal: 0.7 (abn) mg/dL)

> > > > > Potassium 4.3 mmol/L

> > > > > She doesn't smoke or drink any alcohol. ultrasound (which showed

> > > > that one of her kidneys is smaller than the other: right 11.04 cm,

> > > > left 9.47 cm)

> > > > > She also had a chest X-ray, EKG, echocardiogram, urinalysis,

> > > > lipid panel, abdominal , and abdominal CT scan to evaluate for

> > > > renal artery stenosis (everything came up normal). The only result

> > > > out of the normal range was her aldosterone level. It came already

> > > > after her abdominal CT scan so the doctor couldn't send her for

> > > > another one to evaluate only her adrenal glands because he said 2

> > > > CT scans in a row might not be very safe. So he asked the

> > > > radiologist to check the size of her adrenal glands based on

> > the CT

> > > > scan she already had. There were no growths visible and the size

> > > > and shape of her adrenals was normal so the doctor assumed it must

> > > > be hyperplasia in the beginning stage. I thought there should be

> > > > some other - more detailed - tests done to distinguish between

> > > > hyperplasia or adenoma but this is where we are now. Her BP is

> > > > still very high.

> > > > > She often has migraines (ever since she had a car accident 8

> > > > years ago) and they may now aggravate her hypertension but, as I

> > > > said in my first e-mail, her BP was perfect until the end of

> > August

> > > > (she had it checked during her 2 dental appointments). Her

> > > > hypertension came all of a sudden (discovered during her annual

> > > > checkup in September).

> > > > > I think the next step is finding a good endocrinologist

> > (we're in

> > > > Alabama).

> > > > >

> > > >

> > > >

> > >

> >

> >

>

[Guest guest]

Yes CTs dont look at renal artries unless injection is done. MRI is better but in your case you want a real arteriogram which is the only way to exclude this as the cause of sudden onset HTN.Assume urine cats have been tested already. Does she have spells of HTN, Headaches and Hyperhidrosis?On Oct 30, 2009, at 2:12 PM, szurcio wrote: Thank you for all your help, Dr. Grim! My last question (at least for today) - would it be possible that a CT scan of that area could miss renal artery stenosis? > > > > > > > > > > If I understand correctly, her renin level seems to be OK: 3.93 > > > > ng/mL/hr (maybe a little bit elevated, if the test was taken in a > > > > supine position) > > > > > Metabolic panel - everything in the normal range (creatinine a > > > > little bit lower than normal: 0.7 (abn) mg/dL) > > > > > Potassium 4.3 mmol/L > > > > > She doesn't smoke or drink any alcohol. ultrasound (which showed > > > > that one of her kidneys is smaller than the other: right 11.04 cm, > > > > left 9.47 cm) > > > > > She also had a chest X-ray, EKG, echocardiogram, urinalysis, > > > > lipid panel, abdominal , and abdominal CT scan to evaluate for > > > > renal artery stenosis (everything came up normal). The only result > > > > out of the normal range was her aldosterone level. It came already > > > > after her abdominal CT scan so the doctor couldn't send her for > > > > another one to evaluate only her adrenal glands because he said 2 > > > > CT scans in a row might not be very safe. So he asked the > > > > radiologist to check the size of her adrenal glands based on > > the CT > > > > scan she already had. There were no growths visible and the size > > > > and shape of her adrenals was normal so the doctor assumed it must > > > > be hyperplasia in the beginning stage. I thought there should be > > > > some other - more detailed - tests done to distinguish between > > > > hyperplasia or adenoma but this is where we are now. Her BP is > > > > still very high. > > > > > She often has migraines (ever since she had a car accident 8 > > > > years ago) and they may now aggravate her hypertension but, as I > > > > said in my first e-mail, her BP was perfect until the end of > > August > > > > (she had it checked during her 2 dental appointments). Her > > > > hypertension came all of a sudden (discovered during her annual > > > > checkup in September). > > > > > I think the next step is finding a good endocrinologist > > (we're in > > > > Alabama). > > > > > > > > > > > > > > > > > > > > >

[Guest guest]

>> Does she have spells of Hypertension, Headaches and Hyperhidrosis?

She now often has headaches and hot flashes (or at least heat intolerance) but

she didn't notice any excessive perspiration

[Guest guest]

This is what he put about her creatinine a little bit lower

than normal: 0.7 (abn) mg/dL) Her renin is 3.93 ng/mL/hr

> > > > > > >

> > > > > > > If I understand correctly, her renin level seems to be

> > OK: 3.93

> > > > > > ng/mL/hr (maybe a little bit elevated, if the test was

> > taken in a

> > > > > > supine position)

> > > > > > > Metabolic panel - everything in the normal range

> > (creatinine a

> > > > > > little bit lower than normal: 0.7 (abn) mg/dL)

> > > > > > > Potassium 4.3 mmol/L

> > > > > > > She doesn't smoke or drink any alcohol. ultrasound (which

> > showed

> > > > > > that one of her kidneys is smaller than the other: right

> > 11.04 cm,

> > > > > > left 9.47 cm)

> > > > > > > She also had a chest X-ray, EKG, echocardiogram, urinalysis,

> > > > > > lipid panel, abdominal , and abdominal CT scan to evaluate for

> > > > > > renal artery stenosis (everything came up normal). The only

> > result

> > > > > > out of the normal range was her aldosterone level. It came

> > already

> > > > > > after her abdominal CT scan so the doctor couldn't send her

> > for

> > > > > > another one to evaluate only her adrenal glands because he

> > said 2

> > > > > > CT scans in a row might not be very safe. So he asked the

> > > > > > radiologist to check the size of her adrenal glands based on

> > > > the CT

> > > > > > scan she already had. There were no growths visible and the

> > size

> > > > > > and shape of her adrenals was normal so the doctor assumed

> > it must

> > > > > > be hyperplasia in the beginning stage. I thought there

> > should be

> > > > > > some other - more detailed - tests done to distinguish between

> > > > > > hyperplasia or adenoma but this is where we are now. Her BP is

> > > > > > still very high.

> > > > > > > She often has migraines (ever since she had a car accident 8

> > > > > > years ago) and they may now aggravate her hypertension but,

> > as I

> > > > > > said in my first e-mail, her BP was perfect until the end of

> > > > August

> > > > > > (she had it checked during her 2 dental appointments). Her

> > > > > > hypertension came all of a sudden (discovered during her

> > annual

> > > > > > checkup in September).

> > > > > > > I think the next step is finding a good endocrinologist

> > > > (we're in

> > > > > > Alabama).

> > > > > > >

> > > > > >

> > > > > >

> > > > >

> > > >

> > > >

> > >

> >

> >

>

[Guest guest]

Actually, she did have a CT scan with an injection of contrast materials.

>

> Yes CTs dont look at renal artries unless injection is done. MRI is

> better but in your case you want a real arteriogram which is the only

> way to exclude this as the cause of sudden onset HTN.

[Guest guest]

Ask how well they saw the renal arteries and and branches. What does the dr see when he looks in her eyes?Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertensionOn Oct 30, 2009, at 4:10 PM, szurcio <jszurek@...> wrote:

Actually, she did have a CT scan with an injection of contrast materials.

>

> Yes CTs dont look at renal artries unless injection is done. MRI is

> better but in your case you want a real arteriogram which is the only

> way to exclude this as the cause of sudden onset HTN.

[Guest guest]

Lower creat is good. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertensionOn Oct 30, 2009, at 2:51 PM, Francis Bill <georgewbill@...> wrote:

This is what he put about her creatinine a little bit lower

than normal: 0.7 (abn) mg/dL) Her renin is 3.93 ng/mL/hr

> > > > > > >

> > > > > > > If I understand correctly, her renin level seems to be

> > OK: 3.93

> > > > > > ng/mL/hr (maybe a little bit elevated, if the test was

> > taken in a

> > > > > > supine position)

> > > > > > > Metabolic panel - everything in the normal range

> > (creatinine a

> > > > > > little bit lower than normal: 0.7 (abn) mg/dL)

> > > > > > > Potassium 4.3 mmol/L

> > > > > > > She doesn't smoke or drink any alcohol. ultrasound (which

> > showed

> > > > > > that one of her kidneys is smaller than the other: right

> > 11.04 cm,

> > > > > > left 9.47 cm)

> > > > > > > She also had a chest X-ray, EKG, echocardiogram, urinalysis,

> > > > > > lipid panel, abdominal , and abdominal CT scan to evaluate for

> > > > > > renal artery stenosis (everything came up normal). The only

> > result

> > > > > > out of the normal range was her aldosterone level. It came

> > already

> > > > > > after her abdominal CT scan so the doctor couldn't send her

> > for

> > > > > > another one to evaluate only her adrenal glands because he

> > said 2

> > > > > > CT scans in a row might not be very safe. So he asked the

> > > > > > radiologist to check the size of her adrenal glands based on

> > > > the CT

> > > > > > scan she already had. There were no growths visible and the

> > size

> > > > > > and shape of her adrenals was normal so the doctor assumed

> > it must

> > > > > > be hyperplasia in the beginning stage. I thought there

> > should be

> > > > > > some other - more detailed - tests done to distinguish between

> > > > > > hyperplasia or adenoma but this is where we are now. Her BP is

> > > > > > still very high.

> > > > > > > She often has migraines (ever since she had a car accident 8

> > > > > > years ago) and they may now aggravate her hypertension but,

> > as I

> > > > > > said in my first e-mail, her BP was perfect until the end of

> > > > August

> > > > > > (she had it checked during her 2 dental appointments). Her

> > > > > > hypertension came all of a sudden (discovered during her

> > annual

> > > > > > checkup in September).

> > > > > > > I think the next step is finding a good endocrinologist

> > > > (we're in

> > > > > > Alabama).

> > > > > > >

> > > > > >

> > > > > >

> > > > >

> > > >

> > > >

> > >

> >

> >

>

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[Guest guest]

Does BP and heart rAte go up at same time. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertensionOn Oct 30, 2009, at 2:35 PM, szurcio <jszurek@...> wrote:

>> Does she have spells of Hypertension, Headaches and Hyperhidrosis?

She now often has headaches and hot flashes (or at least heat intolerance) but she didn't notice any excessive perspiration

[Guest guest]

Most CT are done with contrast materials. But not all CT look for the same

thing. If CT being done to look for blood flow it would be called an Angiography

so should say if they did this.

> >

> > Yes CTs dont look at renal artries unless injection is done. MRI is

> > better but in your case you want a real arteriogram which is the only

> > way to exclude this as the cause of sudden onset HTN.

>