Re: Re: Adrenal tumor vs bilateral hyperplasia

[Guest guest]

Yes, this is what i've still got to work out. I've just started taking Spironolactone in the last few days, and currently feeling quite anxious. Bit like a rabbit in headlights! But hopefully that will settle down and i'll be able to think more clearly about where to go and what to do next, particularly as i am currently pretty unsatisfied with the testing/treatment i've been getting From: Francis Bill SUSPECTED PA <georgewbill@...> hyperaldosteronism

Sent: Sunday, 12 February 2012, 12:41 Subject: Re: Adrenal tumor vs bilateral hyperplasia

Having one adrenal removed of you have bilateral hyperplasia may reduce the amount of meds you need to take. But is the risk of surgery worth it?

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> >My nephrologist insists that based on the results of AVS, I have bilateral hyperplasia, although I have a large adenoma on the left adrenal. Dr. Grim shares the same point of view.

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> >You cannot be sure that the remaining adrenal is completely healthy. How do you feel? It's the only factor, that you have to consider. Who knows, maybe you are lucky!

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> >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.

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> > From: parkinsoniowa <parkinsoniowa@...>

> >hyperaldosteronism

> >Sent: Wednesday, February 8, 2012 9:19 AM

> >Subject: Adrenal tumor vs bilateral hyperplasia

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> >Can someone have an adrenal tumor and bilateral hyperplasia at the same time?

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> >I had an adrenal tumor on the right side that was removed 6 years ago. I did not have AVS. How do I know the remaining adrenal gland is healthy if I did not have the AVS? Thank you.

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[Guest guest]

Yes i have also been looking into the new PET SCAN and i too was going to make contact with Prof. Brown.Can anyone verify what i have posted below? Is this 'postural' test not definitive in diagnosing whether you have an APA or IHA?Meaning that AVS is not necessary?!thanks, Primary hyperaldosteronism can be divided into many subtypes. The most common subtype is Conn syndrome, a unilateral aldosterone-producing adenoma (APA) that is usually small (< 3cm), unilateral, and renin-unresponsive. This means that aldosterone secretion is not affected by changes in posture. Conn syndrome occurs in 50-60% of cases of primary hyperaldosteronism. The remaining 40-50% of cases are due to bilateral adrenal hyperplasia, or idiopathic hyperaldosteronism (IHA), in which aldosterone increases in response to postural studies. (Rarely, aldosterone can be secreted by adrenocortical carcinomas and ovarian tumors.) From: Francis Bill SUSPECTED PA <georgewbill@...> hyperaldosteronism Sent: Sunday, 12 February 2012, 14:01 Subject:

Re: Adrenal tumor vs bilateral hyperplasia

You might find this posting helpful. It is from snow.writer. Re: NEW PET CSAN

I mean NEW PET SCAN.

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> > >My nephrologist insists that based on the results of AVS, I have bilateral hyperplasia, although I have a large adenoma on the left adrenal. Dr. Grim shares the same point of view.

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> > >You cannot be sure that the remaining adrenal is completely healthy. How do you feel? It's the only factor, that you have to consider. Who knows, maybe you are lucky!

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> > >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.

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> > >________________________________

> > > From: parkinsoniowa <parkinsoniowa@>

> > >hyperaldosteronism

> > >Sent: Wednesday, February 8, 2012 9:19 AM

> > >Subject: Adrenal tumor vs bilateral hyperplasia

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> > >Can someone have an adrenal tumor and bilateral hyperplasia at the same time?

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> > >I had an adrenal tumor on the right side that was removed 6 years ago. I did not have AVS. How do I know the remaining adrenal gland is healthy if I did not have the AVS? Thank you.

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[Guest guest]

I can't comment about the wisdom of surgery as I have bi-lateral adenomas so the point is moot for me, but I can tell you that when I started taking Spiro the positive affect was very quick. The reduction in anxiety was not so quick however. Anxiety steadily lessened, but remained with me for many months as my body readjusted to its new reality of low Na and lower BP. Now I'm no longer plagued with waking up at 3AM filled with non-situational random anxiety. For me Atenolol seemed to help the rapid heartbeat and anxious feelings even though according to Dr. Grim it doesn't have much affect on BP when you have PA, it did help the anxiety.Dianne F-69, bilateral adenomas (1 cm and 1.2 cm), 75mg Spiro, 37.5 mg Atenolol.

Yes, this is what i've still got to work out. I've just started taking Spironolactone in the last few days, and currently feeling quite anxious. Bit like a rabbit in headlights! But hopefully that will settle down and i'll be able to think more clearly about where to go and what to do next, particularly as i am currently pretty unsatisfied with the testing/treatment i've been getting From: Francis Bill SUSPECTED PA <georgewbill@...>

Having one adrenal removed of you have bilateral hyperplasia may reduce the amount of meds you need to take. But is the risk of surgery worth it?

> >My nephrologist insists that based on the results of AVS, I have bilateral hyperplasia, although I have a large adenoma on the left adrenal. Dr. Grim shares the same point of view.

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> >You cannot be sure that the remaining adrenal is completely healthy. How do you feel? It's the only factor, that you have to consider. Who knows, maybe you are lucky!

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> >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.

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> >________________________________

> > From: parkinsoniowa <parkinsoniowa@...>

> >hyperaldosteronism

> >Sent: Wednesday, February 8, 2012 9:19 AM

> >Subject: Adrenal tumor vs bilateral hyperplasia

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> >Â

> >Can someone have an adrenal tumor and bilateral hyperplasia at the same time?

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> >I had an adrenal tumor on the right side that was removed 6 years ago. I did not have AVS. How do I know the remaining adrenal gland is healthy if I did not have the AVS? Thank you.

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[Guest guest]

Thanks for sharing your experience with Atenolol . I'd been thinking that perhaps I could start cutting down on Atenolol again, now I'm not so sure. I had been taking 50mg daily, but cut it to 37.5 at least 6 months ago, without adverse effects. Hate to mess with something that's working.I'll be thinking of you during your AVS. I know you'll make sure they do it right!Dianne

Atenolol, a beta blocker, had an effect on me when I stopped it suddenly! (I was on Metoprolol) HR went from ~60 to 118 and I caught "Hell" from Dr. Grim and ! PCP wants me to stay on it even during AVS but I will see what NIH says about it.

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> > >My nephrologist insists that based on the results of AVS, I have bilateral hyperplasia, although I have a large adenoma on the left adrenal. Dr. Grim shares the same point of view.

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> > >You cannot be sure that the remaining adrenal is completely healthy. How do you feel? It's the only factor, that you have to consider. Who knows, maybe you are lucky!

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> > >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.

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> > > From: parkinsoniowa <parkinsoniowa@>

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> > >hyperaldosteronism

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> > >Sent: Wednesday, February 8, 2012 9:19 AM

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> > >Subject: Adrenal tumor vs bilateral hyperplasia

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> > >Can someone have an adrenal tumor and bilateral hyperplasia at the same time?

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> > >I had an adrenal tumor on the right side that was removed 6 years ago. I did not have AVS. How do I know the remaining adrenal gland is healthy if I did not have the AVS? Thank you.

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[Guest guest]

I take Atenolol it has always seemed in the past to be the only BP med that really works my concern is my resting heartbeat is between 37 and 45 a bit too slow really. I am considering talking with PCP to see how can I come off Atenolol. I had a Bi Lateral AVS last week and am awaiting results.On 2012-02-12, at 2:42 PM, Francis Bill SUSPECTED PA wrote:

Beta blockers are also giver to treat PTSD.

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> > > > >My nephrologist insists that based on the results of AVS, I have bilateral hyperplasia, although I have a large adenoma on the left adrenal. Dr. Grim shares the same point of view.

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> > > > >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.

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> > > > >I had an adrenal tumor on the right side that was removed 6 years ago. I did not have AVS. How do I know the remaining adrenal gland is healthy if I did not have the AVS? Thank you.

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[Guest guest]

On Feb 12, 2012, at 4:41 AM, Francis Bill SUSPECTED PA wrote: Having one adrenal removed of you have bilateral hyperplasia may reduce the amount of meds you need to take. But is the risk of surgery worth it? > > > Â > >My nephrologist insists that based on the results of AVS, I have bilateral hyperplasia, although I have a large adenoma on the left adrenal. Dr. Grim shares the same point of view. > > > > > > > >You cannot be sure that the remaining adrenal is completely healthy. How do you feel? It's the only factor, that you have to consider. Who knows, maybe you are lucky! > > > >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: parkinsoniowa <parkinsoniowa@...> > >hyperaldosteronism > >Sent: Wednesday, February 8, 2012 9:19 AM > >Subject: Adrenal tumor vs bilateral hyperplasia > > > > > >Â > >Can someone have an adrenal tumor and bilateral hyperplasia at the same time? > > > >I had an adrenal tumor on the right side that was removed 6 years ago. I did not have AVS. How do I know the remaining adrenal gland is healthy if I did not have the AVS? Thank you. > > > > > > > > >

[Guest guest]

Hop out of the lights.How much spiro and what else are you taking?DASHing yet?CE Grim MDOn Feb 12, 2012, at 5:20 AM, Chambers wrote: Yes, this is what i've still got to work out. I've just started taking Spironolactone in the last few days, and currently feeling quite anxious. Bit like a rabbit in headlights! But hopefully that will settle down and i'll be able to think more clearly about where to go and what to do next, particularly as i am currently pretty unsatisfied with the testing/treatment i've been getting From: Francis Bill SUSPECTED PA <georgewbill@...> hyperaldosteronism Sent: Sunday, 12 February 2012, 12:41 Subject: Re: Adrenal tumor vs bilateral hyperplasia Having one adrenal removed of you have bilateral hyperplasia may reduce the amount of meds you need to take. But is the risk of surgery worth it? > > > Â > >My nephrologist insists that based on the results of AVS, I have bilateral hyperplasia, although I have a large adenoma on the left adrenal. Dr. Grim shares the same point of view. > > > > > > > >You cannot be sure that the remaining adrenal is completely healthy. How do you feel? It's the only factor, that you have to consider. Who knows, maybe you are lucky! > > > >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: parkinsoniowa <parkinsoniowa@...> > >hyperaldosteronism > >Sent: Wednesday, February 8, 2012 9:19 AM > >Subject: Adrenal tumor vs bilateral hyperplasia > > > > > >Â > >Can someone have an adrenal tumor and bilateral hyperplasia at the same time? > > > >I had an adrenal tumor on the right side that was removed 6 years ago. I did not have AVS. How do I know the remaining adrenal gland is healthy if I did not have the AVS? Thank you. > > > > > > > > >

[Guest guest]

I know Dr. Brown. Good physician and investigator. CE Grim MDOn Feb 12, 2012, at 6:01 AM, Francis Bill SUSPECTED PA wrote: You might find this posting helpful. It is from snow.writer. Re: NEW PET CSAN I mean NEW PET SCAN. > > > > > >  > > >My nephrologist insists that based on the results of AVS, I have bilateral hyperplasia, although I have a large adenoma on the left adrenal. Dr. Grim shares the same point of view. > > > > > > > > > > > >You cannot be sure that the remaining adrenal is completely healthy. How do you feel? It's the only factor, that you have to consider. Who knows, maybe you are lucky! > > > > > > > > >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: parkinsoniowa <parkinsoniowa@> > > >hyperaldosteronism > > >Sent: Wednesday, February 8, 2012 9:19 AM > > >Subject: Adrenal tumor vs bilateral hyperplasia > > > > > > > > > > > >Can someone have an adrenal tumor and bilateral hyperplasia at the same time? > > > > > >I had an adrenal tumor on the right side that was removed 6 years ago. I did not have AVS. How do I know the remaining adrenal gland is healthy if I did not have the AVS? Thank you. > > > > > > > > > > > > > > >

[Guest guest]

We abandoned the posture test in about 1983 as I recall at Indiana. First you need to be in the hospital overnight flat. Then get up at 6 or 8 and stand or walk till noon. CE Grim MDOn Feb 12, 2012, at 7:10 AM, Chambers wrote: Yes i have also been looking into the new PET SCAN and i too was going to make contact with Prof. Brown.Can anyone verify what i have posted below? Is this 'postural' test not definitive in diagnosing whether you have an APA or IHA?Meaning that AVS is not necessary?!thanks, Primary hyperaldosteronism can be divided into many subtypes. The most common subtype is Conn syndrome, a unilateral aldosterone-producing adenoma (APA) that is usually small (< 3cm), unilateral, and renin-unresponsive. This means that aldosterone secretion is not affected by changes in posture. Conn syndrome occurs in 50-60% of cases of primary hyperaldosteronism. The remaining 40-50% of cases are due to bilateral adrenal hyperplasia, or idiopathic hyperaldosteronism (IHA), in which aldosterone increases in response to postural studies. (Rarely, aldosterone can be secreted by adrenocortical carcinomas and ovarian tumors.) From: Francis Bill SUSPECTED PA <georgewbill@...> hyperaldosteronism Sent: Sunday, 12 February 2012, 14:01 Subject: Re: Adrenal tumor vs bilateral hyperplasia You might find this posting helpful. It is from snow.writer. Re: NEW PET CSAN I mean NEW PET SCAN. > > > > > >  > > >My nephrologist insists that based on the results of AVS, I have bilateral hyperplasia, although I have a large adenoma on the left adrenal. Dr. Grim shares the same point of view. > > > > > > > > > > > >You cannot be sure that the remaining adrenal is completely healthy. How do you feel? It's the only factor, that you have to consider. Who knows, maybe you are lucky! > > > > > > > > >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: parkinsoniowa <parkinsoniowa@> > > >hyperaldosteronism > > >Sent: Wednesday, February 8, 2012 9:19 AM > > >Subject: Adrenal tumor vs bilateral hyperplasia > > > > > > > > > > > >Can someone have an adrenal tumor and bilateral hyperplasia at the same time? > > > > > >I had an adrenal tumor on the right side that was removed 6 years ago. I did not have AVS. How do I know the remaining adrenal gland is healthy if I did not have the AVS? Thank you. > > > > > > > > > > > > > > >

[Guest guest]

Excellent. I forgot if the getting up to night to pee was a problem for you? and if that got better. Glad to hear you are doing better. On Feb 12, 2012, at 9:07 AM, Dianne strong wrote: I can't comment about the wisdom of surgery as I have bi-lateral adenomas so the point is moot for me, but I can tell you that when I started taking Spiro the positive affect was very quick. The reduction in anxiety was not so quick however. Anxiety steadily lessened, but remained with me for many months as my body readjusted to its new reality of low Na and lower BP. Now I'm no longer plagued with waking up at 3AM filled with non-situational random anxiety. For me Atenolol seemed to help the rapid heartbeat and anxious feelings even though according to Dr. Grim it doesn't have much affect on BP when you have PA, it did help the anxiety.Dianne F-69, bilateral adenomas (1 cm and 1.2 cm), 75mg Spiro, 37.5 mg Atenolol. Yes, this is what i've still got to work out. I've just started taking Spironolactone in the last few days, and currently feeling quite anxious. Bit like a rabbit in headlights! But hopefully that will settle down and i'll be able to think more clearly about where to go and what to do next, particularly as i am currently pretty unsatisfied with the testing/treatment i've been getting From: Francis Bill SUSPECTED PA <georgewbill@...> Having one adrenal removed of you have bilateral hyperplasia may reduce the amount of meds you need to take. But is the risk of surgery worth it? > >My nephrologist insists that based on the results of AVS, I have bilateral hyperplasia, although I have a large adenoma on the left adrenal. Dr. Grim shares the same point of view. > > > > > > > >You cannot be sure that the remaining adrenal is completely healthy. How do you feel? It's the only factor, that you have to consider. Who knows, maybe you are lucky! > > > >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: parkinsoniowa <parkinsoniowa@...> > >hyperaldosteronism > >Sent: Wednesday, February 8, 2012 9:19 AM > >Subject: Adrenal tumor vs bilateral hyperplasia > > > > > >Â > >Can someone have an adrenal tumor and bilateral hyperplasia at the same time? > > > >I had an adrenal tumor on the right side that was removed 6 years ago. I did not have AVS. How do I know the remaining adrenal gland is healthy if I did not have the AVS? Thank you. > > > > > > > > >

[Guest guest]

On Feb 12, 2012, at 10:02 AM, wrote: First, I assume you mean "suspected adenoma" as confirmed by AVS. If the AVS was done correctly, a unilateral adenoma found and the correct adrenal was removed I think the odds of you having bilateral hyperplasia would be extremely low.Adenomas can only be confirmed by surgery-you have to look at them under the microscope. After the adrenalectomy the odds of you having bilateral is zero because bi means two and you only have one! ;>) Now that I've made my "smartassed" comment, I'm sure you meant developing an adenoma in the other adrenal, the info I have read indicates it is "very rare". In fact, I believe there would be a warning in every study that recommends removal of unilateral adenomas, the first choice in every study I've seen!It is most likely "very rare" because most surgeons only follow their patients for about a year. Again here is where our data set can contribute real information if we had a proper data base to follow everyone and everyone took part. Maybe we should look at pros and cons. If you elect MCBs and DASH you will probably be on meds the rest of your life. Many still need K supplements. Most here who have DASHed well do not need K replacement. But few get their DASHing documented with a urine Na/K ratio. Must be less than one if you are low Na DASHing. I've heard with low NA it is possible to eliminate MCBs but don't recall anyone reporting that situation. You should continue to monitor with scans (first at 6-12 months and if no change every 3 to 5 years, hopefully w/o contrast!) If you elect surgery you MAY be off all meds for PA. From what I've read K always resolves. BP resolves in 30% to 40% of the cases and improves in ~97% of the cases. You should be on no or less meds and not need any followup scans!Again we need a good database and long term followup. If you have surgery and do develop PA in the other adrenal, I believe your assumption is correct. If for some unlikely reason you loose both adrenals you will be on meds for the rest of your life, just like the MCB/DASH option but it will start later!And if you run out of meds you may die in a few days. I have a couple questions I have yet to find answers to: Odds of an adenoma growing? Odds of a benign adenoma becoming malignant? Odds of a producing adenoma increasing amount of aldosterone? Risk of adverse/unexpected consequences of long term medicine vs risk of surgery! (Feel free to add your own!)We have no malignant ones here in 700 but maybe they die before they get here? In case you haven't "heard" enough, here is some food for thought: Laparoscopic adrenalectomy for bilateral metachronous aldosteronomas http://www.ncbi.nlm.nih.gov/pubmed/21902953 Primary aldosteronism: results of adrenalectomy for nonsingle adenoma. http://www.ncbi.nlm.nih.gov/pubmed/21489832 Bilateral, incidentally found adrenal tumours - results of observation of 1790 patients registered at a single endocrinological centre.This study did not give details on proper phenotyping the bumps: renin, aldo, cortisol etc. http://www.ncbi.nlm.nih.gov/pubmed/20205107 - 65 yo super ob., fastidious male - 12mm X 13mm rt. a.adnoma with previous rt. flank pain. Treating with DASH. Stats w/o meds = BP 175/90 HR 59 BS 125. D/C Spironolactone 12/20/2011 due to adverse SX. Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, Gynecomastia, MDD and PTSD. Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, AmlodipineBesylate 5mg, 81mg aspirin and Metformin 2000MG. Started washing Spironolactone 12/20/11 to prepare for AVS. > > > Â > >My nephrologist insists that based on the results of AVS, I have bilateral hyperplasia, although I have a large adenoma on the left adrenal. Dr. Grim shares the same point of view. > > > > > > > >You cannot be sure that the remaining adrenal is completely healthy. How do you feel? It's the only factor, that you have to consider. Who knows, maybe you are lucky! > > > >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: parkinsoniowa <parkinsoniowa@...> > >hyperaldosteronism > >Sent: Wednesday, February 8, 2012 9:19 AM > >Subject: Adrenal tumor vs bilateral hyperplasia > > > > > >Â > >Can someone have an adrenal tumor and bilateral hyperplasia at the same time? > > > >I had an adrenal tumor on the right side that was removed 6 years ago. I did not have AVS. How do I know the remaining adrenal gland is healthy if I did not have the AVS? Thank you. > > > > > > > > >

[Guest guest]

I never stop BB suddenly. You understand/illustrate why.On the otherhand as you became controlled on spiro and DASH I don't recall another attempt at tapering. If doing OK I would not. But BB are like the shadow-they cloud men's minds.As well as women's. But not always. CE Grim MDOn Feb 12, 2012, at 10:16 AM, wrote: Atenolol, a beta blocker, had an effect on me when I stopped it suddenly! (I was on Metoprolol) HR went from ~60 to 118 and I caught "Hell" from Dr. Grim and ! PCP wants me to stay on it even during AVS but I will see what NIH says about it. .... >  > > > >My nephrologist insists that based on the results of AVS, I have bilateral hyperplasia, although I have a large adenoma on the left adrenal. Dr. Grim shares the same point of view. > > > > > > > > > > > > > > > >You cannot be sure that the remaining adrenal is completely healthy. How do you feel? It's the only factor, that you have to consider. Who knows, maybe you are lucky! > > > > > > > > > > > >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: parkinsoniowa <parkinsoniowa@> > > > >hyperaldosteronism > > > >Sent: Wednesday, February 8, 2012 9:19 AM > > > >Subject: Adrenal tumor vs bilateral hyperplasia > > > > > > > > > > > > > > > >Can someone have an adrenal tumor and bilateral hyperplasia at the same time? > > > > > > > >I had an adrenal tumor on the right side that was removed 6 years ago. I did not have AVS. How do I know the remaining adrenal gland is healthy if I did not have the AVS? Thank you. > > > > > > > > > > > > > > > > > > > >

[Guest guest]

If one has had any heart problems, MI etc the recommendation is to stay on it. So talk with the good folks at Kaiser. They should have a great database to learn from this. CE Grim MDOn Feb 12, 2012, at 11:18 AM, Dianne strong wrote: Thanks for sharing your experience with Atenolol . I'd been thinking that perhaps I could start cutting down on Atenolol again, now I'm not so sure. I had been taking 50mg daily, but cut it to 37.5 at least 6 months ago, without adverse effects. Hate to mess with something that's working.I'll be thinking of you during your AVS. I know you'll make sure they do it right!Dianne Atenolol, a beta blocker, had an effect on me when I stopped it suddenly! (I was on Metoprolol) HR went from ~60 to 118 and I caught "Hell" from Dr. Grim and ! PCP wants me to stay on it even during AVS but I will see what NIH says about it. .... >  > > > >My nephrologist insists that based on the results of AVS, I have bilateral hyperplasia, although I have a large adenoma on the left adrenal. Dr. Grim shares the same point of view. > > > > > > > > > > > > > > > >You cannot be sure that the remaining adrenal is completely healthy. How do you feel? It's the only factor, that you have to consider. Who knows, maybe you are lucky! > > > > > > > > > > > >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: parkinsoniowa <parkinsoniowa@> > > > >hyperaldosteronism > > > >Sent: Wednesday, February 8, 2012 9:19 AM > > > >Subject: Adrenal tumor vs bilateral hyperplasia > > > > > > > > > > > > > > > >Can someone have an adrenal tumor and bilateral hyperplasia at the same time? > > > > > > > >I had an adrenal tumor on the right side that was removed 6 years ago. I did not have AVS. How do I know the remaining adrenal gland is healthy if I did not have the AVS? Thank you. > > > > > > > > > > > > > > > > > > > >

[Guest guest]

If you see Dr. Gill at NIH tell him I said hello. He may be retired. CE Grim MDOn Feb 12, 2012, at 11:51 AM, wrote: I probably should mention I went from 400mg to zero and quickly learned the term "step down"! I'm now on 100mg bid and PCP is uncomfortable with me going any lower at this time. (Probably due to such a long time of HTN and obvious LVH. (I decided to let her have her way with this one since I've made most of the rest of the decisions!) Thanks for your good thoughts re. AVS. Going to NIH should increase the odds! > > >  > > > > > > > >My nephrologist insists that based on the results of AVS, I have bilateral hyperplasia, although I have a large adenoma on the left adrenal. Dr. Grim shares the same point of view. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >You cannot be sure that the remaining adrenal is completely healthy. How do you feel? It's the only factor, that you have to consider. Who knows, maybe you are lucky! > > > > > > > > > > > > > > > > > > > > > > > >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: parkinsoniowa <parkinsoniowa@> > > > > > > > >hyperaldosteronism > > > > > > > >Sent: Wednesday, February 8, 2012 9:19 AM > > > > > > > >Subject: Adrenal tumor vs bilateral hyperplasia > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >Can someone have an adrenal tumor and bilateral hyperplasia at the same time? > > > > > > > > > > > > > > > >I had an adrenal tumor on the right side that was removed 6 years ago. I did not have AVS. How do I know the remaining adrenal gland is healthy if I did not have the AVS? Thank you. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >

[Guest guest]

Yes, before Spiro and a low Na diet, getting up to pee at night was constant, or at least it felt that way. Now I still get up, but not so much, sometimes once but generally twice. Comparatively that is wonderful and since the getting up is usually driven by something besides having to pee, (hip pain), it doesn't bother me.Dianne Yes, this is what i've still

got to work out. I've just started taking Spironolactone in the last few days, and currently feeling quite anxious. Bit like a rabbit in headlights! But hopefully that will settle down and i'll be able to think more clearly about where to go and what to do next, particularly as i am currently pretty unsatisfied with the testing/treatment i've been getting From: Francis Bill SUSPECTED PA <georgewbill@...> Having one adrenal removed of you have

bilateral hyperplasia may reduce the amount of meds you need to take. But is the risk of surgery worth it? > >My nephrologist insists that based on the

results of AVS, I have bilateral hyperplasia, although I have a large adenoma on the left adrenal. Dr. Grim shares the same point of view. > > > > > > > >You cannot be sure that the remaining adrenal is completely healthy. How do you feel? It's the only factor, that you have to consider. Who knows, maybe you are lucky! > > > >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: parkinsoniowa <parkinsoniowa@...> > >hyperaldosteronism > >Sent: Wednesday, February 8, 2012 9:19 AM > >Subject:

Adrenal tumor vs bilateral hyperplasia > > > > > >Â > >Can someone have an adrenal tumor and bilateral hyperplasia at the same time? > > > >I had an adrenal tumor on the right side that was removed 6 years ago. I did not have AVS. How do I know the remaining adrenal gland is healthy if I did not have the AVS? Thank you. > > > > > > > > >

[Guest guest]

How much are you on? Did it slow down before or after the atenolol?On Feb 12, 2012, at 2:15 PM, D. Platt wrote: I take Atenolol it has always seemed in the past to be the only BP med that really works my concern is my resting heartbeat is between 37 and 45 a bit too slow really. I am considering talking with PCP to see how can I come off Atenolol. I had a Bi Lateral AVS last week and am awaiting results.On 2012-02-12, at 2:42 PM, Francis Bill SUSPECTED PA wrote: Beta blockers are also giver to treat PTSD. > > > > >  > > > > > > > > > > > >My nephrologist insists that based on the results of AVS, I have bilateral hyperplasia, although I have a large adenoma on the left adrenal. Dr. Grim shares the same point of view. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >You cannot be sure that the remaining adrenal is completely healthy. How do you feel? It's the only factor, that you have to consider. Who knows, maybe you are lucky! > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >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: parkinsoniowa <parkinsoniowa@> > > > > > > > > > > > >hyperaldosteronism > > > > > > > > > > > >Sent: Wednesday, February 8, 2012 9:19 AM > > > > > > > > > > > >Subject: Adrenal tumor vs bilateral hyperplasia > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >Can someone have an adrenal tumor and bilateral hyperplasia at the same time? > > > > > > > > > > > > > > > > > > > > > > > >I had an adrenal tumor on the right side that was removed 6 years ago. I did not have AVS. How do I know the remaining adrenal gland is healthy if I did not have the AVS? Thank you. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >

[Guest guest]

For the anxiety component. Also work for some migraine headaches.CE Grim MDOn Feb 12, 2012, at 1:42 PM, Francis Bill SUSPECTED PA wrote: Beta blockers are also giver to treat PTSD. > > > > >  > > > > > > > > > > > >My nephrologist insists that based on the results of AVS, I have bilateral hyperplasia, although I have a large adenoma on the left adrenal. Dr. Grim shares the same point of view. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >You cannot be sure that the remaining adrenal is completely healthy. How do you feel? It's the only factor, that you have to consider. Who knows, maybe you are lucky! > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >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: parkinsoniowa <parkinsoniowa@> > > > > > > > > > > > >hyperaldosteronism > > > > > > > > > > > >Sent: Wednesday, February 8, 2012 9:19 AM > > > > > > > > > > > >Subject: Adrenal tumor vs bilateral hyperplasia > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >Can someone have an adrenal tumor and bilateral hyperplasia at the same time? > > > > > > > > > > > > > > > > > > > > > > > >I had an adrenal tumor on the right side that was removed 6 years ago. I did not have AVS. How do I know the remaining adrenal gland is healthy if I did not have the AVS? Thank you. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >

[Guest guest]

Good to add that to your thumbnail I think. CE Grim MDOn Feb 12, 2012, at 4:47 PM, Dianne strong wrote: Yes, before Spiro and a low Na diet, getting up to pee at night was constant, or at least it felt that way. Now I still get up, but not so much, sometimes once but generally twice. Comparatively that is wonderful and since the getting up is usually driven by something besides having to pee, (hip pain), it doesn't bother me.Dianne Yes, this is what i've still got to work out. I've just started taking Spironolactone in the last few days, and currently feeling quite anxious. Bit like a rabbit in headlights! But hopefully that will settle down and i'll be able to think more clearly about where to go and what to do next, particularly as i am currently pretty unsatisfied with the testing/treatment i've been getting From: Francis Bill SUSPECTED PA <georgewbill@...> Having one adrenal removed of you have bilateral hyperplasia may reduce the amount of meds you need to take. But is the risk of surgery worth it? > >My nephrologist insists that based on the results of AVS, I have bilateral hyperplasia, although I have a large adenoma on the left adrenal. Dr. Grim shares the same point of view. > > > > > > > >You cannot be sure that the remaining adrenal is completely healthy. How do you feel? It's the only factor, that you have to consider. Who knows, maybe you are lucky! > > > >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: parkinsoniowa <parkinsoniowa@...> > >hyperaldosteronism > >Sent: Wednesday, February 8, 2012 9:19 AM > >Subject: Adrenal tumor vs bilateral hyperplasia > > > > > >Â > >Can someone have an adrenal tumor and bilateral hyperplasia at the same time? > > > >I had an adrenal tumor on the right side that was removed 6 years ago. I did not have AVS. How do I know the remaining adrenal gland is healthy if I did not have the AVS? Thank you. > > > > > > > > >

[Guest guest]

Kaiser had originally put me on Atenolol mostly because they couldn't think of anything else to try that hadn't been tried before to lower my BP. I believe they figured that since they couldn't lower my BP the least they could do was protect my heart. Atenolol didn't do a thing to lower my BP, but it did lower my heart rate and make me feel less anxious. That's the reason I like it. Last Autumn Kaiser was going to drop my prescription for Atenolol as they thought I probably didn't need it for my BP, but I asked if I could keep it. Don't know if the anxiety would return without it. Probably not, but I'm afraid to cut down on it. Really compared to the soup of meds I was on before finding this group and being diagnosed with PA, keeping the Atenolol on board is small potatoes. Is there a good reason to cut my dose down to

25mg? Dianne Atenolol, a beta blocker, had an effect on me when I stopped it suddenly! (I was on Metoprolol) HR went from ~60 to 118 and I caught "Hell" from Dr. Grim and ! PCP wants me to stay on it even during AVS but I will see what NIH says about it. .... > Â > > > >My nephrologist insists that based on the results of AVS, I have bilateral hyperplasia, although I have a large adenoma on the left adrenal. Dr. Grim shares the same point of view. > >

> > > > > > > > > > > > > >You cannot be sure that the remaining adrenal is completely healthy. How do you feel? It's the only factor, that you have to consider. Who knows, maybe you are lucky! > > > > > > > > > > > >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: parkinsoniowa <parkinsoniowa@> > > > >hyperaldosteronism > > > >Sent: Wednesday, February 8,

2012 9:19 AM > > > >Subject: Adrenal tumor vs bilateral hyperplasia > > > > > > > > > > > > > > > >Can someone have an adrenal tumor and bilateral hyperplasia at the same time? > > > > > > > >I had an adrenal tumor on the right side that was removed 6 years ago. I did not have AVS. How do I know the remaining adrenal gland is healthy if I did not have the AVS? Thank you. > > > > > > > > > > > > > > > > > > > >

[Guest guest]

Not if u are feeling well. I would stay on it. Gla dot hear u are doingSo much better. I am now working and living in S lake Tahoe area. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Feb 12, 2012, at 17:10, Dianne strong <dianstrong@...> wrote:

Kaiser had originally put me on Atenolol mostly because they couldn't think of anything else to try that hadn't been tried before to lower my BP. I believe they figured that since they couldn't lower my BP the least they could do was protect my heart. Atenolol didn't do a thing to lower my BP, but it did lower my heart rate and make me feel less anxious. That's the reason I like it. Last Autumn Kaiser was going to drop my prescription for Atenolol as they thought I probably didn't need it for my BP, but I asked if I could keep it. Don't know if the anxiety would return without it. Probably not, but I'm afraid to cut down on it. Really compared to the soup of meds I was on before finding this group and being diagnosed with PA, keeping the Atenolol on board is small potatoes. Is there a good reason to cut my dose down to

25mg? Dianne Atenolol, a beta blocker, had an effect on me when I stopped it suddenly! (I was on Metoprolol) HR went from ~60 to 118 and I caught "Hell" from Dr. Grim and ! PCP wants me to stay on it even during AVS but I will see what NIH says about it. .... > Â > > > >My nephrologist insists that based on the results of AVS, I have bilateral hyperplasia, although I have a large adenoma on the left adrenal. Dr. Grim shares the same point of view. > >

> > > > > > > > > > > > > >You cannot be sure that the remaining adrenal is completely healthy. How do you feel? It's the only factor, that you have to consider. Who knows, maybe you are lucky! > > > > > > > > > > > >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: parkinsoniowa <parkinsoniowa@> > > > >hyperaldosteronism > > > >Sent: Wednesday, February 8,

2012 9:19 AM > > > >Subject: Adrenal tumor vs bilateral hyperplasia > > > > > > > > > > > > > > > >Can someone have an adrenal tumor and bilateral hyperplasia at the same time? > > > > > > > >I had an adrenal tumor on the right side that was removed 6 years ago. I did not have AVS. How do I know the remaining adrenal gland is healthy if I did not have the AVS? Thank you. > > > > > > > > > > > > > > > > > > > >

[Guest guest]

None of the studies data bases you cite have published and prob not looked at carefully the adrenal histology of their patients. I have looked systematically and can state that at least 75 % of the "single" adrena adenomas have hyperplasia of the rest of the gland as did the 13 patients I have reported with the earliest for of PA. I will send u some references when on my computer. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Feb 12, 2012, at 19:01, <jclark24p@...> wrote:

> > >

> > >

> > > Â

> > > >My nephrologist insists that based on the results of AVS, I have

> > bilateral hyperplasia, although I have a large adenoma on the left

> > adrenal. Dr. Grim shares the same point of view.

> > > >

> > > >

> > > >

> > > >You cannot be sure that the remaining adrenal is completely

> > healthy. How do you feel? It's the only factor, that you have to

> > consider. Who knows, maybe you are lucky!

> > > >

> > > >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: parkinsoniowa <parkinsoniowa@>

> > > >hyperaldosteronism

> > > >Sent: Wednesday, February 8, 2012 9:19 AM

> > > >Subject: Adrenal tumor vs bilateral

> > hyperplasia

> > > >

> > > >

> > > >Â

> > > >Can someone have an adrenal tumor and bilateral hyperplasia at

> > the same time?

> > > >

> > > >I had an adrenal tumor on the right side that was removed 6 years

> > ago. I did not have AVS. How do I know the remaining adrenal gland

> > is healthy if I did not have the AVS? Thank you.

> > > >

> > > >

> > > >

> > > >

> > >

> >

> >

>

[Guest guest]

Unilateral hyperplasia of an endocrine organ is very rare. So the finding of 2 adenomas on the same gland means it is almost certainly a hyperplastic problem ie on both sides.Here is an older article by the Dr. Vetters who I know. BTW they are identical twins. This was before DASH and eplererenone. And the days before AVS. So one went in the back or front and looked at both sides at the time of surgery-this was big surgery. BTW and I have watched at least 40 of these I recall. Cardiology. 1985;72 Suppl 1:107-16.Adrenalectomy in primary aldosteronism: a long-term follow-up study.Groth H, Vetter W, Stimpel M, Greminger P, Tenschert W, Klaiber E, Vetter H.AbstractThe effect of unilateral adrenalectomy in primary aldosteronism was analyzed in 38 patients with unilateral adenoma, 12 cases with idiopathic bilateral hyperplasia and 1 patient suffering from an aldosterone-producing carcinoma. Responses to surgery differed markedly. In all 38 adenoma cases plasma aldosterone dropped to normal levels and remained within normal range during a mean follow-up period of 75 +/- 12 months. 23 (61%) of these patients became normotensive without medication and thus could be classified as definitely cured. 34% (13 patients) improved (normotensive under medical treatment) and only 2 cases (5%) remained hypertensive despite sufficient medical treatment. In the hyperplasia group, however, the effect of adrenalectomy was disappointing. None of these subjects showed a long-lasting normalization of aldosterone secretion. A temporary remission for no more than 3-4 months was achieved in only 3 patients. In a fourth case with macronodular hyperplasia, primary aldosteronism relapsed after a 6-year period of normal blood pressure and aldosterone values. Therefore, 6 years after adrenalectomy no hyperplasia patient was definitely cured in contrast to 61% of the adenoma cases. The problems in the management of hypertension in adrenal hyperplasia are furthermore documented by a poorer blood pressure control despite antihypertensive medication and a high rate of vascular complications. During the follow-up, 3 of 12 hyperplasia patients experienced a cerebrovascular event and 1 a myocardial infarction. Here are some references in re HTN and hyperplasia.

Grim

CE, Keitzer WF, Esterly JA, and Longo DL. The inappropriate secretion of

aldosterone associated with adrenal hyperplasia. Univ Michigan Medical Center

Journal 1976;42:54-59.

Longo

DL, Esterly JA, Grim CE, Keitzer WF. Pathology of the adrenal gland in

refractory low renin hypertension. Arch Path Lab Med 1978; 102: 322-327.

On Feb 12, 2012, at 9:24 PM, wrote: I think we are on two different agendas. and I were talking about removing the first adrenal which is the one you have done a detailed analysis of. Then we were trying to figure out how often the second adrenal (the last remaining) would develop problems. It does sound like what you are saying means she should not be overly concerned with two tumors in a defective adrenal since a second one is more the norm than the exception, her's might just be little more advanced. > > > > > > > > > > > > > > > Â > > > > > >My nephrologist insists that based on the results of AVS, I have > > > > bilateral hyperplasia, although I have a large adenoma on the left > > > > adrenal. Dr. Grim shares the same point of view. > > > > > > > > > > > > > > > > > > > > > > > >You cannot be sure that the remaining adrenal is completely > > > > healthy. How do you feel? It's the only factor, that you have to > > > > consider. Who knows, maybe you are lucky! > > > > > > > > > > > >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: parkinsoniowa <parkinsoniowa@> > > > > > >hyperaldosteronism > > > > > >Sent: Wednesday, February 8, 2012 9:19 AM > > > > > >Subject: Adrenal tumor vs bilateral > > > > hyperplasia > > > > > > > > > > > > > > > > > >Â > > > > > >Can someone have an adrenal tumor and bilateral hyperplasia at > > > > the same time? > > > > > > > > > > > >I had an adrenal tumor on the right side that was removed 6 years > > > > ago. I did not have AVS. How do I know the remaining adrenal gland > > > > is healthy if I did not have the AVS? Thank you. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >

[Guest guest]

When my HTN was at it's worst (bearing in mind it has never come within the normal range in the last four years!) I was taking Ramipril 2.5mg, Amlodopine 10mg, and Atenolol 25mg daily. Often i'd take further Atenolol if i was feeling anxious, so up to 100mg daily. At it's lowest my BP was 158/85 and highest 210/105.I took the 1st Spironolactone (25mg) on Saturday. I was told not to take Atenolol or Ramipril, but i could take the Amlodopine if my BP was still high. I have also stopped taking potassium. I HAVE taken my Amlodopine in addition to the Spiro as on Saturday my BP was 168/98, yesterday 167/101 and 165/90. My GP will review the dosages this week.I've sent an email to Prof. Brown. Anybody else in the South-East you could recommend??Currently i feel terrible. In fact i've hardly stepped out of the house in the last week! I will get to DASHing eventually, but as i've said, i already have a healthy well-balanced, low salt diet because of my Coeliac disease. Not sure if i've stated my age?! but i am 45yrs oldI'm grateful for any advice Dr Grim From: Clarence Grim

<lowerbp2@...> hyperaldosteronism Cc: Clarence Grim <lowerbp2@...> Sent: Sunday, 12 February 2012, 23:49 Subject: Re: Re: Adrenal tumor vs bilateral hyperplasia

Hop out of the lights.How much spiro and what else are you taking?DASHing yet?CE Grim MDOn Feb 12, 2012, at 5:20 AM, Chambers wrote: Yes, this is what i've still got to work out. I've just started taking Spironolactone in the last few days, and currently feeling quite anxious. Bit like a rabbit in headlights! But hopefully that will settle down and i'll be able to think more clearly about where to go and what to do next, particularly as i am currently pretty unsatisfied with the

testing/treatment i've been getting From: Francis Bill SUSPECTED PA <georgewbill@...> hyperaldosteronism Sent: Sunday, 12 February 2012, 12:41 Subject: Re: Adrenal tumor vs bilateral hyperplasia

Having one adrenal removed of you have bilateral hyperplasia may reduce the amount of meds you need to take. But is the risk of surgery worth it? > > > Â > >My nephrologist insists that based on the results of AVS, I have bilateral

hyperplasia, although I have a large adenoma on the left adrenal. Dr. Grim shares the same point of view. > > > > > > > >You cannot be sure that the remaining adrenal is completely healthy. How do you feel? It's the only factor, that you have to consider. Who knows, maybe you are lucky! > > > >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: parkinsoniowa <parkinsoniowa@...> > >hyperaldosteronism > >Sent: Wednesday, February 8, 2012 9:19 AM > >Subject: Adrenal tumor vs bilateral hyperplasia > > > > > >Â > >Can someone have an adrenal tumor and bilateral hyperplasia at the same time? > > > >I had an adrenal tumor on the right side that was removed 6 years ago. I did not have AVS. How do I know the remaining adrenal gland is healthy if I did not have the AVS? Thank you. > > > > > > > > >

[Guest guest]

Thank you for this article. Clearly planned surgery for me needs to be put on hold, as i need much more investigation by the sounds of it From: Clarence Grim <lowerbp2@...> hyperaldosteronism Cc: Clarence Grim <lowerbp2@...> Sent: Monday, 13 February 2012, 5:39 Subject: Re:

Re: Adrenal tumor vs bilateral hyperplasia

Unilateral hyperplasia of an endocrine organ is very rare. So the finding of 2 adenomas on the same gland means it is almost certainly a hyperplastic problem ie on both sides.Here is an older article by the Dr. Vetters who I know. BTW they are identical twins. This was before DASH and eplererenone. And the days before AVS. So one went in the back or front and looked at both sides at the time of surgery-this was big surgery. BTW and I have watched at least 40 of these I recall. Cardiology. 1985;72 Suppl 1:107-16.Adrenalectomy in primary aldosteronism: a long-term follow-up study.Groth H, Vetter W, Stimpel M, Greminger P, Tenschert W, Klaiber E, Vetter H.AbstractThe effect of unilateral adrenalectomy in primary aldosteronism was analyzed in 38 patients with unilateral adenoma, 12 cases with idiopathic bilateral hyperplasia and 1 patient suffering from an aldosterone-producing carcinoma. Responses to surgery differed markedly. In all 38 adenoma cases plasma aldosterone dropped to normal levels and remained within normal range during a mean follow-up period of 75 +/- 12 months. 23 (61%) of these patients became normotensive without medication and thus could be classified as definitely cured. 34% (13 patients) improved (normotensive under medical treatment) and only 2 cases (5%) remained hypertensive despite sufficient medical treatment. In the hyperplasia group, however, the effect of adrenalectomy was disappointing. None of these subjects showed a long-lasting normalization of aldosterone secretion. A temporary remission for no more than

3-4 months was achieved in only 3 patients. In a fourth case with macronodular hyperplasia, primary aldosteronism relapsed after a 6-year period of normal blood pressure and aldosterone values. Therefore, 6 years after adrenalectomy no hyperplasia patient was definitely cured in contrast to 61% of the adenoma cases. The problems in the management of hypertension in adrenal hyperplasia are furthermore documented by a poorer blood pressure control despite antihypertensive medication and a high rate of vascular complications. During the follow-up, 3 of 12 hyperplasia patients experienced a cerebrovascular event and 1 a myocardial infarction. Here are some references in re HTN and hyperplasia.

Grim

CE, Keitzer WF, Esterly JA, and Longo DL. The inappropriate secretion of

aldosterone associated with adrenal hyperplasia. Univ Michigan Medical Center

Journal 1976;42:54-59. Longo

DL, Esterly JA, Grim CE, Keitzer WF. Pathology of the adrenal gland in

refractory low renin hypertension. Arch Path Lab Med 1978; 102: 322-327.

On Feb 12, 2012, at 9:24 PM, wrote: I think we are on two different agendas. and I were talking about removing the first adrenal which is the one you have done a detailed analysis of. Then we were trying to figure out how often the second adrenal (the last remaining) would develop problems. It does sound like what you are saying means she should not be overly concerned with two tumors in a defective adrenal since a second one is more the norm than the exception, her's might just be little more advanced. > > > > > > > > > > > > > > > Â > > > > > >My nephrologist insists that based on the results of AVS, I have > > > > bilateral hyperplasia, although I have a large adenoma on the left > > > > adrenal. Dr. Grim shares the same point of view. > > > > > > > > > > > > > > > > > > > > > > > >You cannot be sure that the remaining adrenal is completely > > > > healthy. How do you feel? It's the only factor, that you

have to > > > > consider. Who knows, maybe you are lucky! > > > > > > > > > > > >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: parkinsoniowa <parkinsoniowa@> > > > > > >hyperaldosteronism > > > > > >Sent: Wednesday, February 8, 2012 9:19 AM > > > > > >Subject: Adrenal tumor vs bilateral > > > > hyperplasia > > > > > > > > > > > > > > > > > >Â > > > > > >Can someone have an adrenal tumor and bilateral hyperplasia at > > > > the same time? > > > > > > > > > > > >I had an adrenal tumor on the right side that was removed 6 years > > > > ago. I did not have AVS. How do I know the remaining adrenal gland > > > > is healthy if I did not have the AVS? Thank you. > > > > > > > > > > > > > > > > > > > > > > >

> > > > > > > > > > > > > > > > > > > > > >

[Guest guest]

, thank you for your email... I will reply to you properly in due course! From: <jclark24p@...> hyperaldosteronism Sent: Monday, 13 February 2012, 5:24 Subject: Re: Adrenal tumor vs bilateral hyperplasia

I think we are on two different agendas. and I were talking about removing the first adrenal which is the one you have done a detailed analysis of. Then we were trying to figure out how often the second adrenal (the last remaining) would develop problems. It does sound like what you are saying means she should not be overly concerned with two tumors in a defective adrenal since a second one is more the norm than the exception, her's might just be little more advanced.

> > > > >

> > > > >

> > > > > Â

> > > > > >My nephrologist insists that based on the results of AVS, I have

> > > > bilateral hyperplasia, although I have a large adenoma on the left

> > > > adrenal. Dr. Grim shares the same point of view.

> > > > > >

> > > > > >

> > > > > >

> > > > > >You cannot be sure that the remaining adrenal is completely

> > > > healthy. How do you feel? It's the only factor, that you have to

> > > > consider. Who knows, maybe you are lucky!

> > > > > >

> > > > > >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: parkinsoniowa <parkinsoniowa@>

> > > > > >hyperaldosteronism

> > > > > >Sent: Wednesday, February 8, 2012 9:19 AM

> > > > > >Subject: Adrenal tumor vs bilateral

> > > > hyperplasia

> > > > > >

> > > > > >

> > > > > >Â

> > > > > >Can someone have an adrenal tumor and bilateral hyperplasia at

> > > > the same time?

> > > > > >

> > > > > >I had an adrenal tumor on the right side that was removed 6 years

> > > > ago. I did not have AVS. How do I know the remaining adrenal gland

> > > > is healthy if I did not have the AVS? Thank you.

> > > > > >

> > > > > >

> > > > > >

> > > > > >

> > > > >

> > > >

> > > >

> > >

> >

> >

>