Re: adrenal vein testing

February 16, 2012

And what do you want to know after reading my Evolution of PA article and our welcome? Welcome to the exciting world of Hyperaldosteronism You are in the right place! I am Dr. CE Grim a retired Professor of Medicine and Endocrinology. I have had a long standing interest is Primary Aldosteronism since medical school days when I saw my first patient with Primary Aldosteronism in 1963 as a 4th year medical student. I did a Nephrology Fellowship at Duke and an Endocrinology and Metabolism Fellowship with Dr. Conn (1969-70). I have been on the faculty of the University of MO, Indiana Univ, UCLA/ R. Drew, and the Medical College of Wisconsin in Divisions of Nephrology, Endocrinology, Hypertension, Cardiology and Epidemiology. I have published over 240 papers and book chapters in most areas of the broad discipline of High Blood Pressure. My CV is in our files for details. The GOAL of our group is to teach you and your health care team about the ins and outs of the causes, diagnosis and control of the many forms of hyperaldosteronism. The steps below will introduce you into the fascinating world of high blood pressure, salt and potassium and the role of the adrenal hormone aldosterone in health and disease. Doing these in sequence will save you time and effort in getting up to speed in taking control of you health and educating your own health care team. While we can’t make you a doctor we will make you into a pretty good BP doctor-a skill that you will have for life. 1. Overview: Read my article in our files on the evolution of PA (Evolution_of_PA-Grim.pdf ) and take to all members of health care team. Tell us what stage you believe you are in. This is a brief review of most causes of hyperaldosteronism, high blood pressure, low potassium (K). Be certain that you and your health care team understand the key role of excess diet salt in HTN and especially in PA. Go to: http://www.worldactiononsalt.com/evidence/treatment_trials.htm For a state of the art and science discussion of salt and health. 2. Other patients with hyperaldosteronism (Conn’s syndrome). Read our Conn's stories in our files and then give us your own in as much detail as you can. Dr. Conn was the first to describe this disease process and the syndrome is named after him. To see others' stories, on the Hyperaldosteronism home page, go to Files/Conn’s Stories. You'll find instructions in "A - How to put your story here.doc "Then send us your story in an email and then we will likely ask more questions and make suggestions before you upload it to our files. 3. Hyperaldosteronism and Salt: The deadly Duo. Eating Plan to control high blood pressure due to hyperaldosteronism and most others with high blood pressure. This will reduce your need for medications and in many will get your BP and K to goal without meds.. Get the DASH diet book by T. et al, read it and use it: $8 in paperback at your local bookstore. If they don’t have it ask them to order it for you. Learning to eat the DASH way will play a major role in your road to good BP and K control and, in many of our folks here, will revolutionize your life. Go to chapter 9 and do the 14 day challenge. Tell your Dr you are doing this as your BP may plummet if you are on other meds in only 2-3 days. or go to http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf download this 64 page booklet free and do the Week on the DASH Diet for 2 weeks. If you are on BP meds be prepared for a large fall in BP and let your Dr. know you are doing this. Or go to (but costs money) DASH Diet for Health ProgramThe DASH Diet for Health Program is designed to help you improve your eating and exercise habits. Twice each week we will provide you with information on our website about food, food preparation, eating out, losing weight, getting fit and much more. In addition to providing new information each week on our website, we create a web page specially for you where you can track progress in areas such as your weight, blood pressure, and exercise.http://www.dashforhealth.com/ I strongly recommend you get the book and read it now! 4. Measure your BP: Measure your BP daily so you can see if it is getting better. If you are taking meds be sure to tell your health care team you are doing this as your BP may plummet to normal quickly. We recommend you use a device you listen to and will help you learn how to do this. If this is not something you want to do we can teach a significant other how to do it. See sharedcareinc.com or email to sharedcare@... to order a video on how to do this. If you already have one we will teach you how to teach your health care team how to validate your device. Your life and health depends on accurate BP measurements. Go to the amricanheart.org and download the Guidelines for Human Blood Pressure Measurement. Insist the your health care team do BP the AHA way. Your life is in the hands of those who measure your BP. Never trust your life to an automatic BP machine unless you know it is accurate on YOU. 5. Genetics and your BP: Go to familyhistory.hhs.gov and do your detailed family medical history so we can review with you to help Dx familial causes of high blood pressure and heart disease. If BP runs in your family you may save lives in your family by checking their BP yourself. There is a brief discussion of this in my Evolution Article. 6. How to DX and treat PA: Go to our file/Conn's Articles of Note/Medications/Bravo spir 1973.pdf and read this article and take to your health care team. It is old but still one of the best in the medical management of PA. Also see our file from the Endocrine Society Guidelines on PA. Dr. Grim's Perfect Primary Aldosteronism Blood and Urine Testing to diagnose PA in one day. 1. Eat a high salt diet for 2 weeks-at least 4000 mg of Na a day.2. No BP meds in last 4-12 weeks depending on meds and Drs advice.3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do not lose a drop of this liquid gold. It is impossible to interpret the renin and aldo without this.4. The morning you finish the 24 hr urine have fasting blood drawn for renin, aldo and K using our guidelines to get an accurate K. Try to get this done about 1-4 hours after you have been out of bed.5. Send us the results with the normal values for your lab.6. If you ever have a salt (saline) infusion test for PA be certain to ask them to measure how much you pee during the 4 hours of the infusion. If it is 1-1.5 liter of urine it strongly suggests that you may have PA. If more tha 1.5 L you almost certainly have PA. I call this Dr. Grim’s “Quick Pee Test” for PA. Our PA Registry: If you have been Dxed with PA already and are on Rx or have had surgery please go to http://www.kwiksurveys.com/online-survey.php?surveyID=HIJIO_f2685379 and complete our survey with as much information as you know. If there is some information you don't know ask us and we will help. If you need to update this as you journey thru the diagnostic/treatment process you can add another entry but label it as Nameyymmdd. For example today 4/20/11 for me would be Grim110420. This way of writing the date is an ever increasing number and will allow us and you to sort your multiple entries into a dated order. We are working on a more extensive database. 8. Learn the language: If you are new to medical lingo then download the acroyms from bloodpressureline/message/291869. Salt and high blood pressure: To learn the state of the science of salt and blood pressure please spend some time looking at http://www.worldactiononsalt.com/evidence/treatment_trials.htm10. Become a HBP expert consumer: Expect that it will take at least several weeks to get all this digested and to learn the new language of high blood pressure health care. As most doctors and nurses in practice have had very little training in high blood pressure you must become an expert yourself. For example most have never had anyone listen with them with a double stethoscope to verify that they can hear BP sounds. We cannot make you a doctor but we will make you a pretty good BP doctor.11. How High Blood Pressure should be managed: Go to nih.gov and download and read the Joint National Commission (JNC) Report 7 to get an overview on current guidelines. I ask all my secretaries to read this so they can communicate the importance of high blood pressure to my patients. JNC 8 will be out soon.Then: get (and study) the Hypertension Primer from americanheart.org. This is the most up-to-date compendium of what is known about high blood pressure and what every Dr. should know when they graduate from Medical School. Every chapter is only 2-3 pages. Read one chapter every week-night and you will finish it in about a year. I am working on a reading guide for lay people for the Primer. Stay tuned.12. Ask us questions: Ask any questions about high blood pressure you want answered. That is what we are here for.13. One-on-one Consulting: I can provide individual consulting if you do not want to go public. If you want individual one-on-one consulting for you and your Doctor contract me directly at lowerbp2@....May your pressure be low!Clarence E. Grim BS, MS, MD, FACP, FACCBoard Certified in Internal Medicine, Geriatrics, and High Blood Pressure Specializing in Primary Aldosteronism and Difficult to Control High Blood Pressure. On Feb 16, 2012, at 2:34 PM, knoxtammy@... wrote: i have been told i have conns and now going through the testing to make sure only one gland has been affected my right adrenal gland has a tumor on it, now they want to do the adrenal vein test and after 2 years of doctors not wanting to do much of anything i have to say i am a bit scared of what is to come has any one had this test done and what am i to expect during and after the test, any information would be great thanks

February 16, 2012

Hi there - I had AVS done twice (incorrectly the first time, a not-uncommon occurrence). You can read my accounts of it here and here . Do you have specific concerns you would like to address?-msmith1928Successful left laparoscopic adrenalectomy 10/13/11>> i have been told i have conns and now going through the testing to make sure only one gland has been affected my right adrenal gland has a tumor on it, now they want to do the adrenal vein test and after 2 years of doctors not wanting to do much of anything i have to say i am a bit scared of what is to come has any one had this test done and what am i to expect during and after the test, any information would be great> thanks>

February 17, 2012

if i read this right cause i am so new to this you have had your left adrenal gland removed? i have a tumor that is or was 2.6 in size and the specialist said at first that it was not the problem and since being put in the hospital for 2 weeks now they have decided that more testing needs to be done and then they will decide if taking the gland is going to be the decision, i guess because i have been so sick for so long that this is the worst roller coaster i have ever been on and my family is having such a hard time watching me get sicker as time goes on now, my doctors in the city are saying that it is a nasty surgery to go through but my doctor at home says it will be done by laperscopy and it should be fine, the more i read the right gland is the hardest to get at and that is the one that has the tumor, how did you

do after the surgery as far as down time and healing and did the bp go to to a normal rate and have you been able to get rid of your bp meds or do you still have to take them , my specialist here at home as said that in 10 years or practise i am his 3rd patient with this and that it is rare so he likes the case , any information you can share would be great as i have no one around me who knows much about this problem. thanks From:

msmith_1928 <janeray1940@...> hyperaldosteronism Sent: Friday, February 17, 2012 2:16 AM Subject: Re: adrenal vein testing

Hi there - I had AVS done twice (incorrectly the first time, a not-uncommon occurrence). You can read my accounts of it here and here . Do you have specific concerns you would like to address?-msmith1928Successful left laparoscopic adrenalectomy 10/13/11>> i have been told i have conns and now going through the testing to make sure only one gland has been affected my right adrenal gland has a tumor on it, now they want to do the adrenal vein test and after 2 years of doctors not wanting to do much of anything i have to say i am a bit scared of what is to come has any one had this test done and

what am i to expect during and after the test, any information would be great> thanks>

February 17, 2012

if i read this right cause i am so new to this you have had your left adrenal gland removed? i have a tumor that is or was 2.6 in size and the specialist said at first that it was not the problem and since being put in the hospital for 2 weeks now they have decided that more testing needs to be done and then they will decide if taking the gland is going to be the decision, i guess because i have been so sick for so long that this is the worst roller coaster i have ever been on and my family is having such a hard time watching me get sicker as time goes on now, my doctors in the city are saying that it is a nasty surgery to go through but my doctor at home says it will be done by laperscopy and it should be fine, the more i read the right gland is the hardest to get at and that is the one that has the tumor, how did you

do after the surgery as far as down time and healing and did the bp go to to a normal rate and have you been able to get rid of your bp meds or do you still have to take them , my specialist here at home as said that in 10 years or practise i am his 3rd patient with this and that it is rare so he likes the case , any information you can share would be great as i have no one around me who knows much about this problem. thanks From:

msmith_1928 <janeray1940@...> hyperaldosteronism Sent: Friday, February 17, 2012 2:16 AM Subject: Re: adrenal vein testing

Hi there - I had AVS done twice (incorrectly the first time, a not-uncommon occurrence). You can read my accounts of it here and here . Do you have specific concerns you would like to address?-msmith1928Successful left laparoscopic adrenalectomy 10/13/11>> i have been told i have conns and now going through the testing to make sure only one gland has been affected my right adrenal gland has a tumor on it, now they want to do the adrenal vein test and after 2 years of doctors not wanting to do much of anything i have to say i am a bit scared of what is to come has any one had this test done and

what am i to expect during and after the test, any information would be great> thanks>

February 18, 2012

Hi Tammy - you are correct, I had my left adrenal removed in October. My BP and potassium normalized immediately and I was home from the hospital the next day. I took two weeks off from work to recover, but was back to my normal non-work activities within a week of the surgery. I can't exactly say it was easy, but it was a lot easier than I thought it would be. My full story can be found here .I stopped all BP meds when I began getting tested for PA in December 2010 (which was when I found out that since I was on all the wrong meds for PA, the stuff I was taking - Diovan and Cardizem - was actually RAISING my BP and not lowering it!). During the time I was getting my testing done, I opted to stay off meds since my BP never went above the low 140s/low 90s; I did have to take potassium pills during that time but haven't needed them since the tumor was removed.> if i read this right cause i am so new to this you have had your left adrenal gland removed? > how did you do after the surgery as far as down time and healing and did the bp go to to a normal rate and have you been able to get rid of your bp meds or do you still have to take them

February 18, 2012

Hi Tammy - you are correct, I had my left adrenal removed in October. My BP and potassium normalized immediately and I was home from the hospital the next day. I took two weeks off from work to recover, but was back to my normal non-work activities within a week of the surgery. I can't exactly say it was easy, but it was a lot easier than I thought it would be. My full story can be found here .I stopped all BP meds when I began getting tested for PA in December 2010 (which was when I found out that since I was on all the wrong meds for PA, the stuff I was taking - Diovan and Cardizem - was actually RAISING my BP and not lowering it!). During the time I was getting my testing done, I opted to stay off meds since my BP never went above the low 140s/low 90s; I did have to take potassium pills during that time but haven't needed them since the tumor was removed.> if i read this right cause i am so new to this you have had your left adrenal gland removed? > how did you do after the surgery as far as down time and healing and did the bp go to to a normal rate and have you been able to get rid of your bp meds or do you still have to take them

February 19, 2012

The right is trickier to access during adrenal vein sampling, which is why my AVS was done twice. The first time, the interventional radiologist was most likely in my hepatic vein rather than my adrenal vein, so he didn't get an accurate sample. This is why it's really important to have it done by an experienced IR, but even so, they can miss the first time.

On Sun, Feb 19, 2012 at 9:44 AM, Tammy Knox <knoxtammy@...> wrote:

wow that is wonderful , alot of people say that the right adrenal gland is trickier than the left god i hope not , thank you for the information and i am glad that you are no longer on meds .

February 19, 2012

The L adrenal vein usually enterers the L renal vein and I have seen the cath be in it 30 sec after it is in the femoral veinThe R usually has several smaller veins coming into the vena cava. Often lose to the hepatic vein. Unless one measures both Aldo and cortisol you cannot be sure where u are. Also should use 2 Caths so do not have to fiddle getting back and forth. Be sure they use an ACTH protocol as well. Send us the numbers as soon as u get them as some do not really know how to interpret them. Also enter them into our data base so we can accumulate a good number to be better able to advise future folks. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Feb 19, 2012, at 9:48, janeray1940 <janeray1940@...> wrote:

The right is trickier to access during adrenal vein sampling, which is why my AVS was done twice. The first time, the interventional radiologist was most likely in my hepatic vein rather than my adrenal vein, so he didn't get an accurate sample. This is why it's really important to have it done by an experienced IR, but even so, they can miss the first time.

On Sun, Feb 19, 2012 at 9:44 AM, Tammy Knox <knoxtammy@...> wrote:

wow that is wonderful , alot of people say that the right adrenal gland is trickier than the left god i hope not , thank you for the information and i am glad that you are no longer on meds .

February 19, 2012

The L adrenal vein usually enterers the L renal vein and I have seen the cath be in it 30 sec after it is in the femoral veinThe R usually has several smaller veins coming into the vena cava. Often lose to the hepatic vein. Unless one measures both Aldo and cortisol you cannot be sure where u are. Also should use 2 Caths so do not have to fiddle getting back and forth. Be sure they use an ACTH protocol as well. Send us the numbers as soon as u get them as some do not really know how to interpret them. Also enter them into our data base so we can accumulate a good number to be better able to advise future folks. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Feb 19, 2012, at 9:48, janeray1940 <janeray1940@...> wrote:

The right is trickier to access during adrenal vein sampling, which is why my AVS was done twice. The first time, the interventional radiologist was most likely in my hepatic vein rather than my adrenal vein, so he didn't get an accurate sample. This is why it's really important to have it done by an experienced IR, but even so, they can miss the first time.

On Sun, Feb 19, 2012 at 9:44 AM, Tammy Knox <knoxtammy@...> wrote:

wow that is wonderful , alot of people say that the right adrenal gland is trickier than the left god i hope not , thank you for the information and i am glad that you are no longer on meds .

February 20, 2012

so if they dont get a proper reading do they do the test again From: janeray1940 <janeray1940@...> Tammy Knox <knoxtammy@...>; hyperaldosteronism Sent: Sunday, February 19, 2012 1:48 PM Subject: Re: adrenal vein testing

The right is trickier to access during adrenal vein sampling, which is why my AVS was done twice. The first time, the interventional radiologist was most likely in my hepatic vein rather than my adrenal vein, so he didn't get an accurate sample. This is why it's really important to have it done by an experienced IR, but even so, they can miss the first time.

On Sun, Feb 19, 2012 at 9:44 AM, Tammy Knox <knoxtammy@...> wrote:

wow that is wonderful , alot of people say that the right adrenal gland is trickier than the left god i hope not , thank you for the information and i am glad that you are no longer on meds .

February 27, 2012

Our record here is 3 x. Hope your team does better. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Feb 20, 2012, at 18:34, Tammy Knox <knoxtammy@...> wrote:

so if they dont get a proper reading do they do the test again From: janeray1940 <janeray1940@...> Tammy Knox <knoxtammy@...>; hyperaldosteronism Sent: Sunday, February 19, 2012 1:48 PM Subject: Re: adrenal vein testing

The right is trickier to access during adrenal vein sampling, which is why my AVS was done twice. The first time, the interventional radiologist was most likely in my hepatic vein rather than my adrenal vein, so he didn't get an accurate sample. This is why it's really important to have it done by an experienced IR, but even so, they can miss the first time.

On Sun, Feb 19, 2012 at 9:44 AM, Tammy Knox <knoxtammy@...> wrote:

wow that is wonderful , alot of people say that the right adrenal gland is trickier than the left god i hope not , thank you for the information and i am glad that you are no longer on meds .

February 27, 2012

In my case they did. No idea if this is standard procedure or not.

>

> wow that is wonderful , alot of people say that the right adrenal gland is

trickier than the left god i hope not , thank you for the information and i am

glad that you are no longer on meds .

>

February 27, 2012

Oh, goody! (Not) My AVS (first, hopefully, last) scheduled second week in March.

> >

> > wow that is wonderful , alot of people say that the right adrenal gland is

trickier than the left god i hope not , thank you for the information and i am

glad that you are no longer on meds .

> >

>

February 27, 2012

Question regarding avs testing. I had an adenoma on my left gland removed Feb 2nd. Potassium has since returned to normal range 5.0 actually. BP remains on the high side, around 160/105. I never was offered AVS test. Having severe bouts with anxiety, irritability, like PMS times 10, most of the time! My family is fed up, I'm frustrated! Is it posible I had bilateral aldosterone over production? I have endo appt. March 1st. I've requested aldo renin tests again. Anything else I should ask the Endo? Still taking hctz 50 mg. Took myself off Amlodipine10 mg, Lisinopril 20 mg, and Atenolol 50 mg.Thanks guys

February 27, 2012

That is a lot of HCTZ. Give us your complete story and we can help better and faster. If K still normal on that much HCTZ THEN they must have gotten the big source. In the best of hand long term cure-off all Bp meds and K normal is ~ 40%. But time will tell. Till BP IS NORMAL I would DASH now. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Feb 27, 2012, at 18:02, Kalthoum Abdallah <kattabdallah77@...> wrote:

Question regarding avs testing. I had an adenoma on my left gland removed Feb 2nd. Potassium has since returned to normal range 5.0 actually. BP remains on the high side, around 160/105. I never was offered AVS test. Having severe bouts with anxiety, irritability, like PMS times 10, most of the time! My family is fed up, I'm frustrated! Is it posible I had bilateral aldosterone over production? I have endo appt. March 1st. I've requested aldo renin tests again. Anything else I should ask the Endo? Still taking hctz 50 mg. Took myself off Amlodipine10 mg, Lisinopril 20 mg, and Atenolol 50 mg.Thanks guys

February 27, 2012

I would discuss w/Endo but also suggest you have patience What was your BP

prior to surgery? Are you taking it daily and tracking it and if so is it

trending down?

I did some research on it a while back and posted this on another site to

address the question of BP dropping, hope it helps:

I will quote from: " Case Detection, Diagnosis, and Treatment of Patients with

Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline "

Source: http://jcem.endojournals.org/content/93/9/3266.full#xref-ref-122-1

Postoperative management

Plasma aldosterone and renin activity levels should be measured shortly after

surgery as an early indication of biochemical response (114), and on

postoperative d 1, potassium supplementation should be withdrawn, spironolactone

discontinued, and antihypertensive therapy reduced, if appropriate (122).

Postoperative iv fluids should be normal saline without potassium chloride

unless serum potassium levels remain very low (i.e. <3.0 mmol/liter), and during

the first few weeks after surgery, a generous sodium diet should be recommended

to avoid the hyperkalemia that can develop from hypoaldosteronism due to chronic

contralateral adrenal gland suppression (122). In rare instances, temporary

fludrocortisone therapy may be required.

Blood pressure typically normalizes or shows maximal improvement in 1–6 months

after unilateral adrenalectomy for unilateral APA but can continue to fall for

up to 1 yr in some patients. Some investigators have employed postoperative FST

(performed at least 3 months after surgery to permit recovery of the

contralateral gland) to assess whether the PA has been cured from a biochemical

perspective (123).

Hope this helps, keep the faith! And keep us posted.

….

>

> Question regarding avs testing. I had an adenoma on my left gland removed Feb

2nd. Potassium has since returned to normal range 5.0 actually. BP remains on

the high side, around 160/105. I never was offered AVS test. Having severe

bouts with anxiety, irritability, like PMS times 10, most of the time! My

family is fed up, I'm frustrated! Is it posible I had bilateral aldosterone

over production? I have endo appt. March 1st. I've requested aldo renin tests

again. Anything else I should ask the Endo? Still taking hctz 50 mg. Took

myself off Amlodipine10 mg, Lisinopril 20 mg, and Atenolol 50 mg.

>

> Thanks guys

>

February 27, 2012

Dash and Spiro/Inspra! Don't take hctz! Unfortunately, probably you are right : you have bilateral PA. Read as much as you can in our files. And no sodium/ high potassium food! Natalia Kamneva 67 Russian F with 2 cm left adrenal adenoma, diabetic; on 100 mg eplerenone, 80 mg Micardis, 2000 mg metformin, 60 mg Dexilant and 2 mg Lorazepam; Dashing; still have some occasional problems with BP, K and Na; on private consultation with Dr Grim. From: Kalthoum Abdallah <kattabdallah77@...>

"hyperaldosteronism " <hyperaldosteronism > Sent: Monday, February 27, 2012 8:02 PM Subject: Re: adrenal vein testing

Question regarding avs testing. I had an adenoma on my left gland removed Feb 2nd. Potassium has since returned to normal range 5.0 actually. BP remains on the high side, around 160/105. I never was offered AVS test. Having severe bouts with anxiety, irritability, like PMS times 10, most of the time! My family is fed up, I'm frustrated! Is it posible I had bilateral aldosterone over production? I have endo appt. March 1st. I've requested aldo renin tests again. Anything else I should ask the Endo? Still taking hctz 50 mg. Took myself off Amlodipine10 mg, Lisinopril 20 mg, and Atenolol 50 mg.Thanks guys

February 27, 2012

The rise in K is a good sign that at least the low K will be gone for a long time. As the Endo for a copy of the path report on the adrenal. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Feb 27, 2012, at 19:21, Natalia Kamneva <natalia_kamneva@...> wrote:

Dash and Spiro/Inspra! Don't take hctz! Unfortunately, probably you are right : you have bilateral PA. Read as much as you can in our files. And no sodium/ high potassium food! Natalia Kamneva 67 Russian F with 2 cm left adrenal adenoma, diabetic; on 100 mg eplerenone, 80 mg Micardis, 2000 mg metformin, 60 mg Dexilant and 2 mg Lorazepam; Dashing; still have some occasional problems with BP, K and Na; on private consultation with Dr Grim. From: Kalthoum Abdallah <kattabdallah77@...>

"hyperaldosteronism " <hyperaldosteronism > Sent: Monday, February 27, 2012 8:02 PM Subject: Re: adrenal vein testing

Question regarding avs testing. I had an adenoma on my left gland removed Feb 2nd. Potassium has since returned to normal range 5.0 actually. BP remains on the high side, around 160/105. I never was offered AVS test. Having severe bouts with anxiety, irritability, like PMS times 10, most of the time! My family is fed up, I'm frustrated! Is it posible I had bilateral aldosterone over production? I have endo appt. March 1st. I've requested aldo renin tests again. Anything else I should ask the Endo? Still taking hctz 50 mg. Took myself off Amlodipine10 mg, Lisinopril 20 mg, and Atenolol 50 mg.Thanks guys

February 27, 2012

Natlia, that is not what the experts recommend: " Postoperative iv fluids should

be normal saline without potassium chloride unless serum potassium levels remain

very low (i.e. <3.0 mmol/liter), and during the first few weeks after surgery, a

generous sodium diet should be recommended to avoid the hyperkalemia that can

develop from hypoaldosteronism due to chronic contralateral adrenal gland

suppression (122). "

Refer to the study referenced in my post (2 posts back).

.....

>

> Dash and Spiro/Inspra! Don't take hctz! Unfortunately, probably you are right

: you have bilateral PA. Read as much as you can in our files. And no sodium/

high potassium food!

>

> Â

> Natalia Kamneva 67 Russian F with 2 cm left adrenal adenoma, diabetic; on 100

mg eplerenone, 80 mg Micardis, 2000 mg metformin, 60 mg Dexilant and 2 mg

Lorazepam; Dashing; still have some occasional problems with BP, K and Na; on

private consultation with Dr Grim.

>

> ________________________________

> From: Kalthoum Abdallah <kattabdallah77@...>

> " hyperaldosteronism " <hyperaldosteronism >

> Sent: Monday, February 27, 2012 8:02 PM

> Subject: Re: adrenal vein testing

>

> Â

> Question regarding avs testing.Â I had an adenoma on my left gland removed

Feb 2nd. Potassium has since returnedÂ to normalÂ range 5.0 actually. BP

remains on the high side, around 160/105.Â I never was offered AVS test.Â

Having severe bouts with anxiety, irritability, like PMS times 10, most of the

time! Â My family is fed up, I'm frustrated!Â Is it posible I had bilateral

aldosterone over production?Â I have endo appt. March 1st. I've requested aldo

renin tests again.Â Anything else I should ask the Endo? Still taking hctz 50

mg. Took myself off Amlodipine10 mg, Lisinopril 20 mg, and Atenolol 50 mg.

>

> Thanks guys

>

February 27, 2012

Female 34 first onset of symptoms at age 23. Low K for years treated with several meds, two premature deliveries due to what was called preeclampsia that never resolved. I had no symptoms of preeclampsia exceptsevery high bp and protein in urine. History anxiety, depression, seizures. Bp never fully controlled. Finally was dx this past Jan.. Through also renin ratio. Sodium suppression and cat scan showing 1.7 cm on left adrenal. No AVS sampling. Bp before surgery nearly the same around 150/110 as Hugh as 180/120.K used to be around 2.5 now 5.0 . No one advised me on dietary changes. Thanks for the heads up!Katt On Feb 27, 2012, at 6:43 PM, Clarence Grim <lowerbp2@...> wrote:

That is a lot of HCTZ. Give us your complete story and we can help better and faster. If K still normal on that much HCTZ THEN they must have gotten the big source. In the best of hand long term cure-off all Bp meds and K normal is ~ 40%. But time will tell. Till BP IS NORMAL I would DASH now. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Feb 27, 2012, at 18:02, Kalthoum Abdallah <kattabdallah77@...> wrote:

Question regarding avs testing. I had an adenoma on my left gland removed Feb 2nd. Potassium has since returned to normal range 5.0 actually. BP remains on the high side, around 160/105. I never was offered AVS test. Having severe bouts with anxiety, irritability, like PMS times 10, most of the time! My family is fed up, I'm frustrated! Is it posible I had bilateral aldosterone over production? I have endo appt. March 1st. I've requested aldo renin tests again. Anything else I should ask the Endo? Still taking hctz 50 mg. Took myself off Amlodipine10 mg, Lisinopril 20 mg, and Atenolol 50 mg.Thanks guys

=

February 27, 2012

Female 34 first onset of symptoms at age 23. Low K for years treated with several meds, two premature deliveries due to what was called preeclampsia that never resolved. I had no symptoms of preeclampsia exceptsevery high bp and protein in urine. History anxiety, depression, seizures. Bp never fully controlled. Finally was dx this past Jan.. Through also renin ratio. Sodium suppression and cat scan showing 1.7 cm on left adrenal. No AVS sampling. Bp before surgery nearly the same around 150/110 as Hugh as 180/120.K used to be around 2.5 now 5.0 . No one advised me on dietary changes. Thanks for the heads up!Katt On Feb 27, 2012, at 6:43 PM, Clarence Grim <lowerbp2@...> wrote:

That is a lot of HCTZ. Give us your complete story and we can help better and faster. If K still normal on that much HCTZ THEN they must have gotten the big source. In the best of hand long term cure-off all Bp meds and K normal is ~ 40%. But time will tell. Till BP IS NORMAL I would DASH now. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Feb 27, 2012, at 18:02, Kalthoum Abdallah <kattabdallah77@...> wrote:

Question regarding avs testing. I had an adenoma on my left gland removed Feb 2nd. Potassium has since returned to normal range 5.0 actually. BP remains on the high side, around 160/105. I never was offered AVS test. Having severe bouts with anxiety, irritability, like PMS times 10, most of the time! My family is fed up, I'm frustrated! Is it posible I had bilateral aldosterone over production? I have endo appt. March 1st. I've requested aldo renin tests again. Anything else I should ask the Endo? Still taking hctz 50 mg. Took myself off Amlodipine10 mg, Lisinopril 20 mg, and Atenolol 50 mg.Thanks guys

=

February 28, 2012

Katt,

I had an adx last September after a CT scan showed a 7 mm adenoma in my left

adrenal an AVS showed that the aldosteronism was lateralized in my left adrenal.

I was taking 175 MEQ of K before & my K is now normal; however my systolic BP

has been ranging from 105 to 160, averaging around 127. My diastolic pressure

averages around 70 & does not vary much. I still have fatigue & migraines which

have plaqued me for over 10 years. I also struggle with depression & anxiety

which run in my family.

At this point, I think I may have some underlying hypertension. (i am 59 yrs

old) I eat mostly fresh whole foods with a minimum of salt. I find that my

pressure frequently rises when I eat out, but sometimes, like when the one time

it went to 160, I cannot explain it.

I also think my system has become predisposed to migraines & fatigue, but I keep

hoping I will find a way to minimize the HAs & fatigue. I am participating in

study @ Hopkins to look @ the impact of intense meditation on migraines.

In April, I will be participating in a 10 day silent retreat with @ least 8.5

hours of sitting meditation a day! I hope I can sustain it.

Good luck to you on your journey to better health & wellness.

Lucy

Please forgive brevity & typos

Sent from my droid

Katt Abdallah <kattabdallah77@...> wrote:

>Female 34 first onset of symptoms at age 23. Low K for years treated with

several meds, two premature deliveries due to what was called preeclampsia that

never resolved. I had no symptoms of preeclampsia exceptsevery high bp and

protein in urine. History anxiety, depression, seizures. Bp never fully

controlled. Finally was dx this past Jan.. Through also renin ratio. Sodium

suppression and cat scan showing 1.7 cm on left adrenal. No AVS sampling. Bp

before surgery nearly the same around 150/110 as Hugh as 180/120.

>K used to be around 2.5 now 5.0 . No one advised me on dietary changes. Thanks

for the heads up!

>Katt

>

>On Feb 27, 2012, at 6:43 PM, Clarence Grim <lowerbp2@...> wrote:

>

>> That is a lot of HCTZ. Give us your complete story and we can help better and

faster. If K still normal on that much HCTZ THEN they must have gotten the big

source. In the best of hand long term cure-off all Bp meds and K normal is ~

40%. But time will tell. Till BP IS NORMAL I would DASH now.

>>

>> May your pressure be low!

>>

>> CE Grim MS, MD

>> Specializing in Difficult

>> Hypertension

>>

>> On Feb 27, 2012, at 18:02, Kalthoum Abdallah <kattabdallah77@...>

wrote:

>>

>>>

>>> Question regarding avs testing. I had an adenoma on my left gland removed

Feb 2nd. Potassium has since returned to normal range 5.0 actually. BP remains

on the high side, around 160/105. I never was offered AVS test. Having severe

bouts with anxiety, irritability, like PMS times 10, most of the time! My

family is fed up, I'm frustrated! Is it posible I had bilateral aldosterone

over production? I have endo appt. March 1st. I've requested aldo renin tests

again. Anything else I should ask the Endo? Still taking hctz 50 mg. Took

myself off Amlodipine10 mg, Lisinopril 20 mg, and Atenolol 50 mg.

>>> Thanks guys

>>

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February 28, 2012