Guest guest Posted December 28, 2009 Report Share Posted December 28, 2009 Adrenal vein catheterization is the AVS test. If your question is money, have your endo refer your case to NIH. It is free there. Bindner Web Directory (links to my sites and blogs): http://www.geocities.com/mikeybdc/index.html http://mikeybdc.blogspot.com From: MaxJasper <maxjasper@...>Subject: Posture Testhyperaldosteronism Date: Monday, December 28, 2009, 11:33 PM Hi all,I found the following statement regarding Posture Test which indicates that there is 20% chance that I can skip AVS: In addition, the posture test is used as a dynamic test to differentiate between an aldosterone- producing adenoma and bilateral adrenal hyperplasia. If the posture test shows decreased aldosterone and imaging demonstrates a circumscribed adrenal mass, an aldosterone producing adenoma can be assumed. If the findings of the function test and diagnostic imaging are incongruentâ€"as is the case in over 80% of patientsâ€"the next step is adrenal vein catheterization, the gold standard for differential diagnosis of the various subtypes (12, 14â€"16). [-The Diagnosis and Treatment of Primary Hyperaldosteronism in Germany ]Question:What is Posture Test? Details or a link to detailed description is very much appreciated. Thanks.Max. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2009 Report Share Posted December 28, 2009 No, I am trying to avoid AVS for now unless I find it absolutely necessary and that there is no alternative for it. Then, I need to find an old British or German experienced radiologist with a minimum of 50 AVS under his belt PLUS he must be diagnosed with severe case of psychological OCD! I've found an experienced one with those attributes but he is a dermatologist!How about "Posture Test", what is it?Max.>> Adrenal vein catheterization is the AVS test.> > If your question is money, have your endo refer your case to NIH. It is free there.> > Bindner> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2009 Report Share Posted December 28, 2009 We abandoned this test in about 1976 or so but you can try it if you want to spend the time and money and run the risk of having surgery that will not help your condition. How old is this reference?After over night fast you measure P aldo before getting out of bed and they after 4 hours of standing. In PA it tends to go down. What is the date of this test. Maybe if you are German it works better. CE Grim MD On Dec 28, 2009, at 10:33 PM, MaxJasper wrote:Hi all,I found the following statement regarding Posture Test which indicates that there is 20% chance that I can skip AVS:In addition, the posture test is used as a dynamic test to differentiate between an aldosterone-producing adenoma and bilateral adrenal hyperplasia. If the posture test shows decreased aldosterone and imaging demonstrates a circumscribed adrenal mass, an aldosterone producing adenoma can be assumed. If the findings of the function test and diagnostic imaging are incongruentâ€"as is the case in over 80% of patientsâ€"the next step is adrenal vein catheterization, the gold standard for differential diagnosis of the various subtypes (12, 14â€"16). [-The Diagnosis and Treatment of Primary Hyperaldosteronism in Germany ]Question:What is Posture Test? Details or a link to detailed description is very much appreciated. Thanks.Max. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2009 Report Share Posted December 28, 2009 We abandoned this test in about 1976 or so but you can try it if you want to spend the time and money and run the risk of having surgery that will not help your condition. How old is this reference?After over night fast you measure P aldo before getting out of bed and they after 4 hours of standing. In PA it tends to go down. What is the date of this test. Maybe if you are German it works better. CE Grim MD On Dec 28, 2009, at 10:33 PM, MaxJasper wrote:Hi all,I found the following statement regarding Posture Test which indicates that there is 20% chance that I can skip AVS:In addition, the posture test is used as a dynamic test to differentiate between an aldosterone-producing adenoma and bilateral adrenal hyperplasia. If the posture test shows decreased aldosterone and imaging demonstrates a circumscribed adrenal mass, an aldosterone producing adenoma can be assumed. If the findings of the function test and diagnostic imaging are incongruentâ€"as is the case in over 80% of patientsâ€"the next step is adrenal vein catheterization, the gold standard for differential diagnosis of the various subtypes (12, 14â€"16). [-The Diagnosis and Treatment of Primary Hyperaldosteronism in Germany ]Question:What is Posture Test? Details or a link to detailed description is very much appreciated. Thanks.Max. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2009 Report Share Posted December 28, 2009 Thanks for the info on Posture Test. It appears that Germans are still using it as part of their recommended diagnostic procedure in suspected PA as shown in page 2 of the following doc dated 2009: The Diagnosis and Treatment of Primary Hyperaldosteronism in GermanyResults on 555 Patients From the German Conn RegistryCaroline Schirpenbach, Felix Segmiller, Sven Diederich, Stefanie Hahner, Reinhard Lorenz,Lars C. Rump, Jochen Seufert, Marcus Quinkler, Bidlingmaier, Felix Beuschlein, Stephan Endres, Reinckehttp://ukpmc.ac.uk/picrender.cgi?artid=1769079 & blobtype=pdf I was hoping that based on this doc, Posture Test (PT) can directly take me to APA (20% chance) when PT indicates that PAC is lowered or stayed the same; but if PT indicates that PAC is raised (80% chance) then I move to AVS. Max. -----Original Message-----From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Clarence GrimSent: Monday, December 28, 2009 23:11hyperaldosteronism Subject: Re: Posture TestWe abandoned this test in about 1976 or so but you can try it if you want to spend the time and money and run the risk of having surgery that will not help your condition. How old is this reference? After over night fast you measure P aldo before getting out of bed and they after 4 hours of standing. In PA it tends to go down. What is the date of this test. Maybe if you are German it works better. CE Grim MD On Dec 28, 2009, at 10:33 PM, MaxJasper wrote: Hi all,I found the following statement regarding Posture Test which indicates that there is 20% chance that I can skip AVS: In addition, the posture test is used as a dynamic test to differentiate between an aldosterone-producing adenoma and bilateral adrenal hyperplasia. If the posture test shows decreased aldosterone and imaging demonstrates a circumscribed adrenal mass, an aldosterone producing adenoma can be assumed. If the findings of the function test and diagnostic imaging are incongruentâ€"as is the case in over 80% of patientsâ€"the next step is adrenal vein catheterization, the gold standard for differential diagnosis of the various subtypes (12, 14â€"16). [-The Diagnosis and Treatment of Primary Hyperaldosteronism in Germany ]Question:What is Posture Test? Details or a link to detailed description is very much appreciated. Thanks.Max. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2009 Report Share Posted December 28, 2009 Thanks for the info on Posture Test. It appears that Germans are still using it as part of their recommended diagnostic procedure in suspected PA as shown in page 2 of the following doc dated 2009: The Diagnosis and Treatment of Primary Hyperaldosteronism in GermanyResults on 555 Patients From the German Conn RegistryCaroline Schirpenbach, Felix Segmiller, Sven Diederich, Stefanie Hahner, Reinhard Lorenz,Lars C. Rump, Jochen Seufert, Marcus Quinkler, Bidlingmaier, Felix Beuschlein, Stephan Endres, Reinckehttp://ukpmc.ac.uk/picrender.cgi?artid=1769079 & blobtype=pdf I was hoping that based on this doc, Posture Test (PT) can directly take me to APA (20% chance) when PT indicates that PAC is lowered or stayed the same; but if PT indicates that PAC is raised (80% chance) then I move to AVS. Max. -----Original Message-----From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Clarence GrimSent: Monday, December 28, 2009 23:11hyperaldosteronism Subject: Re: Posture TestWe abandoned this test in about 1976 or so but you can try it if you want to spend the time and money and run the risk of having surgery that will not help your condition. How old is this reference? After over night fast you measure P aldo before getting out of bed and they after 4 hours of standing. In PA it tends to go down. What is the date of this test. Maybe if you are German it works better. CE Grim MD On Dec 28, 2009, at 10:33 PM, MaxJasper wrote: Hi all,I found the following statement regarding Posture Test which indicates that there is 20% chance that I can skip AVS: In addition, the posture test is used as a dynamic test to differentiate between an aldosterone-producing adenoma and bilateral adrenal hyperplasia. If the posture test shows decreased aldosterone and imaging demonstrates a circumscribed adrenal mass, an aldosterone producing adenoma can be assumed. If the findings of the function test and diagnostic imaging are incongruentâ€"as is the case in over 80% of patientsâ€"the next step is adrenal vein catheterization, the gold standard for differential diagnosis of the various subtypes (12, 14â€"16). [-The Diagnosis and Treatment of Primary Hyperaldosteronism in Germany ]Question:What is Posture Test? Details or a link to detailed description is very much appreciated. Thanks.Max. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2009 Report Share Posted December 28, 2009 I would see if they require an overnight stay in a hospital for this to proper time the supine and upright sampling. My guess is is most useful in advanced PA. If they do it is not likely that you can get insurance to pay for hospitalization-unless your are German.On Dec 29, 2009, at 12:55 AM, MaxJasper wrote:Thanks for the info on Posture Test. It appears that Germans are still using it as part of their recommended diagnostic procedure in suspected PA as shown in page 2 of the following doc dated 2009:The Diagnosis and Treatment of Primary Hyperaldosteronism in GermanyResults on 555 Patients From the German Conn RegistryCaroline Schirpenbach, Felix Segmiller, Sven Diederich, Stefanie Hahner, Reinhard Lorenz,Lars C. Rump, Jochen Seufert, Marcus Quinkler, Bidlingmaier, Felix Beuschlein, Stephan Endres, Reinckehttp://ukpmc.ac.uk/picrender.cgi?artid=1769079 & blobtype=pdf I was hoping that based on this doc, Posture Test (PT) can directly take me to APA (20% chance) when PT indicates that PAC is lowered or stayed the same; but if PT indicates that PAC is raised (80% chance) then I move to AVS. Max. Re: Posture TestWe abandoned this test in about 1976 or so but you can try it if you want to spend the time and money and run the risk of having surgery that will not help your condition. How old is this reference?After over night fast you measure P aldo before getting out of bed and they after 4 hours of standing. In PA it tends to go down. What is the date of this test. Maybe if you are German it works better. CE Grim MD On Dec 28, 2009, at 10:33 PM, MaxJasper wrote:Hi all,I found the following statement regarding Posture Test which indicates that there is 20% chance that I can skip AVS:In addition, the posture test is used as a dynamic test to differentiate between an aldosterone-producing adenoma and bilateral adrenal hyperplasia. If the posture test shows decreased aldosterone and imaging demonstrates a circumscribed adrenal mass, an aldosterone producing adenoma can be assumed. If the findings of the function test and diagnostic imaging are incongruentâ€"as is the case in over 80% of patientsâ€"the next step is adrenal vein catheterization, the gold standard for differential diagnosis of the various subtypes (12, 14â€"16). [-The Diagnosis and Treatment of Primary Hyperaldosteronism in Germany ]Question:What is Posture Test? Details or a link to detailed description is very much appreciated. Thanks.Max. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2009 Report Share Posted December 28, 2009 I would see if they require an overnight stay in a hospital for this to proper time the supine and upright sampling. My guess is is most useful in advanced PA. If they do it is not likely that you can get insurance to pay for hospitalization-unless your are German.On Dec 29, 2009, at 12:55 AM, MaxJasper wrote:Thanks for the info on Posture Test. It appears that Germans are still using it as part of their recommended diagnostic procedure in suspected PA as shown in page 2 of the following doc dated 2009:The Diagnosis and Treatment of Primary Hyperaldosteronism in GermanyResults on 555 Patients From the German Conn RegistryCaroline Schirpenbach, Felix Segmiller, Sven Diederich, Stefanie Hahner, Reinhard Lorenz,Lars C. Rump, Jochen Seufert, Marcus Quinkler, Bidlingmaier, Felix Beuschlein, Stephan Endres, Reinckehttp://ukpmc.ac.uk/picrender.cgi?artid=1769079 & blobtype=pdf I was hoping that based on this doc, Posture Test (PT) can directly take me to APA (20% chance) when PT indicates that PAC is lowered or stayed the same; but if PT indicates that PAC is raised (80% chance) then I move to AVS. Max. Re: Posture TestWe abandoned this test in about 1976 or so but you can try it if you want to spend the time and money and run the risk of having surgery that will not help your condition. How old is this reference?After over night fast you measure P aldo before getting out of bed and they after 4 hours of standing. In PA it tends to go down. What is the date of this test. Maybe if you are German it works better. CE Grim MD On Dec 28, 2009, at 10:33 PM, MaxJasper wrote:Hi all,I found the following statement regarding Posture Test which indicates that there is 20% chance that I can skip AVS:In addition, the posture test is used as a dynamic test to differentiate between an aldosterone-producing adenoma and bilateral adrenal hyperplasia. If the posture test shows decreased aldosterone and imaging demonstrates a circumscribed adrenal mass, an aldosterone producing adenoma can be assumed. If the findings of the function test and diagnostic imaging are incongruentâ€"as is the case in over 80% of patientsâ€"the next step is adrenal vein catheterization, the gold standard for differential diagnosis of the various subtypes (12, 14â€"16). [-The Diagnosis and Treatment of Primary Hyperaldosteronism in Germany ]Question:What is Posture Test? Details or a link to detailed description is very much appreciated. Thanks.Max. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 29, 2009 Report Share Posted December 29, 2009 MaxI think it is just best to have an AVS - it is a straight forward procedure if done by experts. The real issue is to try and find people who are expert at doing AVS. I was in and out back at work within hours. Hi all,I found the following statement regarding Posture Test which indicates that there is 20% chance that I can skip AVS:In addition, the posture test is used as a dynamic test to differentiate between an aldosterone- producing adenoma and bilateral adrenal hyperplasia. If the posture test shows decreased aldosterone and imaging demonstrates a circumscribed adrenal mass, an aldosterone producing adenoma can be assumed. If the findings of the function test and diagnostic imaging are incongruentâ€"as is the case in over 80% of patientsâ€"the next step is adrenal vein catheterization, the gold standard for differential diagnosis of the various subtypes (12, 14â€"16). [-The Diagnosis and Treatment of Primary Hyperaldosteronism in Germany ]Question:What is Posture Test? Details or a link to detailed description is very much appreciated. Thanks.Max. See what's on at the movies in your area. Find out now. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 29, 2009 Report Share Posted December 29, 2009 Where did you go? It looks like MN or TX are the only places with experts from what I see. Is it really worth flying there to have the test if you live somewhere else? (I live in Ohio) > Hi all, > > I found the following statement regarding Posture Test which indicates that there is 20% chance that I can skip AVS: > > In addition, the posture test is used as a dynamic test to differentiate between an aldosterone- producing adenoma and bilateral adrenal hyperplasia. If the  posture test shows decreased aldosterone and imaging demonstrates a circumscribed adrenal mass, an aldosterone producing adenoma can be assumed. If the findings of the function test and diagnostic imaging are incongruent†" as is the case in over 80% of patients†" the next step is adrenal vein catheterization, the gold standard for differential diagnosis of the various subtypes (12, 14†" 16). [-The Diagnosis and Treatment of Primary Hyperaldosteronism in Germany ] > > Question: > > What is Posture Test? Details or a link to detailed description is very much appreciated. Thanks. > > Max. > > > > > > > > > > > > > > > > > > > > > > > ________________________________________________________________________________\ __ > See what's on at the movies in your area. Find out now: http://au.movies./session-times/ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 29, 2009 Report Share Posted December 29, 2009 I'm about an hour east of Cleveland, so UofM would definitely be closer than MN - about a 4 hour drive. thanks. > > > Hi all, > > > > > > I found the following statement regarding Posture > > Test which indicates that there is 20% chance that I can > > skip AVS: > > > > > > In addition, the posture test is used as a > > dynamic test to differentiate between an aldosterone- > > producing adenoma and bilateral adrenal hyperplasia. If > > the  posture test shows decreased aldosterone and > > imaging demonstrates a circumscribed adrenal mass, an > > aldosterone producing adenoma can be assumed. If the > > findings of the function test and diagnostic imaging > > are incongruent†" as is the case in > > over 80% of patients†" the next step > > is adrenal vein catheterization, the gold standard for > > differential diagnosis of the various subtypes (12, > > 14†" 16). [-The Diagnosis and Treatment of > > Primary Hyperaldosteronism in Germany ] > > > > > > Question: > > > > > > What is Posture Test? Details or a link to detailed > > description is very much appreciated. Thanks. > > > > > > Max. > > > > > > > > > > > > > > >    > > >   > > > > > >    > > >    > > > > > > > > > > > > > > > > > > > > >   > > > > > > > > > > > > > > > > > > > > >  > >    __________________________________________________________________________\ ________ > > > See what's on at the movies in your area. Find out > > now: http://au.movies./session-times/ > > > > > > > > > > > > > ------------------------------------ > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 30, 2009 Report Share Posted December 30, 2009 Thank-you, Dr. Grim! I will look them up. Saw my endo today and they didn't have the results from the salt loading test yet, but I told him about the urine output and he seemed to be aware of the salt dumping in PA. He is trying me on Spiro to see if I tolerate it before doing any more testing. I think I would like to switch to someone with more experience in PA at this point in time and it looks like that is one of Dr. Bravo's specialties. He's only 45 minutes from me - even better! > > > > > Hi all, > > > > > > > > > > I found the following statement regarding Posture > > > > Test which indicates that there is 20% chance that I can > > > > skip AVS: > > > > > > > > > > In addition, the posture test is used as a > > > > dynamic test to differentiate between an aldosterone- > > > > producing adenoma and bilateral adrenal hyperplasia. If > > > > the  posture test shows decreased aldosterone and > > > > imaging demonstrates a circumscribed adrenal mass, an > > > > aldosterone producing adenoma can be assumed. If the > > > > findings of the function test and diagnostic imaging > > > > are incongruent†" as is the case in > > > > over 80% of patients†" the next step > > > > is adrenal vein catheterization, the gold standard for > > > > differential diagnosis of the various subtypes (12, > > > > 14†" 16). [-The Diagnosis and Treatment of > > > > Primary Hyperaldosteronism in Germany ] > > > > > > > > > > Question: > > > > > > > > > > What is Posture Test? Details or a link to detailed > > > > description is very much appreciated. Thanks. > > > > > > > > > > Max. > > > > > > > > > > > > > > > > > > > > > > > > >    > > > > >   > > > > > > > > > >    > > > > >    > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >   > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >  > > > >    __________________________________________________________ > > > > > See what's on at the movies in your area. Find out > > > > now: http://au.movies./session-times/ > > > > > > > > > > > > > > > > > > > > > > > > > ------------------------------------ > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 30, 2009 Report Share Posted December 30, 2009 If I read this correctly then, very small doses of Spiro in combination with HCTZ or low sodium diet are more effective than large doses of Spiro alone. My current orders are to gradually increase Spiro to 400mg per day while cutting back and then eliminating HCTZ and Verapamil. There is an obvious difference of philosophy/treatment here between Dr. Bravo and my endo. > > > > > > > Hi all, > > > > > > > > > > > > > > I found the following statement regarding Posture > > > > > > Test which indicates that there is 20% chance that I c > > an > > > > > > skip AVS: > > > > > > > > > > > > > > In addition, the posture test is used as a > > > > > > dynamic test to differentiate between an aldosterone- > > > > > > producing adenoma and bilateral adrenal hyperplasia. If > > > > > > the  posture test shows decreased > > aldosterone and > > > > > > imaging demonstrates a circumscribed adrenal mass, an > > > > > > aldosterone producing adenoma can be assumed. If the > > > > > > findings of the function test and diagnostic > > imaging > > > > > > are incongruentÃÆ'¢â‚¬ " as is the case in > > > > > > over 80% of patientsÃÆ'¢â‚¬ " the > > next step > > > > > > is adrenal vein catheterization, the gold standard for > > > > > > differential diagnosis of the various subtypes (12, > > > > > > 14ÃÆ'¢â‚¬ " 16). [-The Diagnosis and > > Treatment of > > > > > > Primary Hyperaldosteronism in Germany ] > > > > > > > > > > > > > > Question: > > > > > > > > > > > > > > What is Posture Test? Details or a link to detailed > > > > > > description is very much appreciated. Thanks. > > > > > > > > > > > > > > Max. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >    > > > > > > >   > > > > > > > > > > > > > >    > > > > > > >    > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >   > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >  > > > > > >    > > __________________________________________________________ > > > > > > > See what's on at the movies in your area. Find out > > > > > > now: http://au.movies./session-times/ > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > ------------------------------------ > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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