Re: Potassium level decreased during Saline Suppression Test

May 14, 2012

K candrop that much just by breathing fast. Don't recall last saline numbers. If you want your K to become quickly normal please start the 14 day tI in the DASH book NOW. DO IT like your life depended on it. Tell team and keep us posted. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn May 14, 2012, at 21:22, jessdell72 <jessdell72@...> wrote:

Hi everyone,

I posted a couple weeks ago, that my Saline Suppression test was inconclusive because I was on Amlodipine and Atenenol, also my K taken at the beginning of the test was 3.1 (should be 3.5). So, my Endo switched me to Varapamil for the past 2 weeks and we re-did my test. This time my K was 3.6 prior to test. At the end of the test it was down to 3.1. The results of the test take a week or so. Does anyone know if it is normal for potassium to fall this drastically during the test (last time it didn't drop much at all). Would the low K level ruin the results again?

, age 39.75 2cm adenoma on left adrenal gland, ARR over 200. I am on 180m Verapamil Slow Release, 7 potassium pills daily (20 meqs) and my K never gets higher than about 3.8, BP is creeping back up again, was doing fine on Amlodopine and Atenenol.

May 14, 2012

Sorry to say but that was not done properly.

Low K will further supress Aldo hence you can get false negative results.

They suppose to supplement K during the properly done testing to compensate the

K you pee during the test.

My 3 day saline was also wrong because they did not told me about K depletion

which will supress aldo even further hence my aldo was 9.5 with the PA cutoff

being 10 in their protocol and voila " you don't have PA " (per my endo).

So if your suppressed aldo is very close to their cutoff the test has to be

repeated or you can assume you do have PA (or if aldo is very low you do NOT

have PA).

tiu

>

> Hi everyone,

>

> I posted a couple weeks ago, that my Saline Suppression test was inconclusive

because I was on Amlodipine and Atenenol, also my K taken at the beginning of

the test was 3.1 (should be 3.5). So, my Endo switched me to Varapamil for the

past 2 weeks and we re-did my test. This time my K was 3.6 prior to test. At

the end of the test it was down to 3.1. The results of the test take a week or

so. Does anyone know if it is normal for potassium to fall this drastically

during the test (last time it didn't drop much at all). Would the low K level

ruin the results again?

>

> , age 39.75 2cm adenoma on left adrenal gland, ARR over 200. I am

on 180m Verapamil Slow Release, 7 potassium pills daily (20 meqs) and my K never

gets higher than about 3.8, BP is creeping back up again, was doing fine on

Amlodopine and Atenenol.

>

May 14, 2012

Sorry to say but that was not done properly.

Low K will further supress Aldo hence you can get false negative results.

They suppose to supplement K during the properly done testing to compensate the

K you pee during the test.

My 3 day saline was also wrong because they did not told me about K depletion

which will supress aldo even further hence my aldo was 9.5 with the PA cutoff

being 10 in their protocol and voila " you don't have PA " (per my endo).

So if your suppressed aldo is very close to their cutoff the test has to be

repeated or you can assume you do have PA (or if aldo is very low you do NOT

have PA).

tiu

>

> Hi everyone,

>

> I posted a couple weeks ago, that my Saline Suppression test was inconclusive

because I was on Amlodipine and Atenenol, also my K taken at the beginning of

the test was 3.1 (should be 3.5). So, my Endo switched me to Varapamil for the

past 2 weeks and we re-did my test. This time my K was 3.6 prior to test. At

the end of the test it was down to 3.1. The results of the test take a week or

so. Does anyone know if it is normal for potassium to fall this drastically

during the test (last time it didn't drop much at all). Would the low K level

ruin the results again?

>

> , age 39.75 2cm adenoma on left adrenal gland, ARR over 200. I am

on 180m Verapamil Slow Release, 7 potassium pills daily (20 meqs) and my K never

gets higher than about 3.8, BP is creeping back up again, was doing fine on

Amlodopine and Atenenol.

>

May 17, 2012

Here are the results of my saline suppression test and notes from Dr's office. This was my 2nd saline suppression, first was inconclusive. Does anyone have any ideas how my aldosterone could be higher after the infusion test? My potassium level was 3.6 prior to test and 3.1 at the end. Their "normal" range is 3.5 to 5.1. Comments from the Doctor's OfficeBoth aldosterone levels came back high; the one post infusion came back higher than the one pre infusion which does not make sense. Please let me know if I may schedule you with Dr. Eclavea for adrenal vein sampling. Component ResultsComponentYour ValueStandard RangeUnitsALDOSTERONE36ng/dL(NOTE) Adult Reference Ranges for Aldosterone, LC/MS/MS: Upright 8:00-10:00 am < or = 28 ng/dL Upright 4:00-6:00 pm < or = 21 ng/dL Supine 8:00-10:00 am 3-16 ng/dL The last time they ran my Sodium was March 26th. Here are those results.ComponentYour ValueStandard RangeUnitsSODIUM142136 - 145mmol/LPOTASSIUM3.73.5 - 5.1mmol/LCHLORIDE10698 - 107mmol/LCO23121 - 32mmol/LANION GAP55 - 15mmol/LBUN137 - 18mg/dLCREATININE0.60.6 - 1.0mg/dLBUN CREATININE RATIO21.710 - 20:1eGFR Non-Afr. Amer.>60>60mls/min.eGFR Afr. Amer.>60>60mls/min.GLUCOSE9570 -

99mg/dLCALCIUM8.68.5 - 10.1mg/dL, age 39.75 2cm adenoma on left adrenal gland, ARR over 200. I am on 180m Verapamil Slow Release, 7 potassium pills daily (20 meqs) and my K never gets higher than about 3.8, BP is creeping back up again, was doing fine on Amlodopine and Atenenol. From: Clarence Grim <lowerbp2@...> To:

"hyperaldosteronism " <hyperaldosteronism > Sent: Monday, May 14, 2012 9:37 PM Subject: Re: Potassium level decreased during Saline Suppression Test

K candrop that much just by breathing fast. Don't recall last saline numbers. If you want your K to become quickly normal please start the 14 day tI in the DASH book NOW. DO IT like your life depended on it. Tell team and keep us posted. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn May 14, 2012, at 21:22, jessdell72 <jessdell72@...> wrote:

Hi everyone,

I posted a couple weeks ago, that my Saline Suppression test was inconclusive because I was on Amlodipine and Atenenol, also my K taken at the beginning of the test was 3.1 (should be 3.5). So, my Endo switched me to Varapamil for the past 2 weeks and we re-did my test. This time my K was 3.6 prior to test. At the end of the test it was down to 3.1. The results of the test take a week or so. Does anyone know if it is normal for potassium to fall this drastically during the test (last time it didn't drop much at all). Would the low K level ruin the results again?

, age 39.75 2cm adenoma on left adrenal gland, ARR over 200. I am on 180m Verapamil Slow Release, 7 potassium pills daily (20 meqs) and my K never gets higher than about 3.8, BP is creeping back up again, was doing fine on Amlodopine and Atenenol.

May 17, 2012

I only see one aldo number. Did you take meds am of saline?Please send numbers for both tests.Perhaps the samples got mislabeled. Had the folks doing the saline seem like they had done lots of these?How much did you pee during the infusion.See below item 6.6 below. Did you get this welcome before?CE Grim MD Welcome to the exciting world of Hyperaldosteronism You are in the right place! I am Dr. CE Grim a retired (well semi-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, and 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. Without excess salt in the diet, aldosterone cannot do most of its damage. Go to: http://www.worldactiononsalt.com/evidence/treatment_trials.htm For a state of the art and science discussion of salt and health. 2. Conn's Stories. 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. I trained with him and his team in Ann Arbor, MI in 1969-70. 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. In oder for aldosterone to cause its damage one must also eat excess salt in the diet. Thus much of the damage can be controlled/reversed by lowering salt (sodium) intake and increasing potassium intake. This is the essence of the low sodium DASH eating plan. 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 own BP and insist that your health care team always measures BP correctly with an recently calibrated device: 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. Most devices will read at least 25 mm Hg too high or too low is some people. The only way to know if you are one is to have your and any other automatic devices checked for accuracy in you. Instructions for doing this are in our files. 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 with the testing for Pheochromocytoma and Cushing's thrown in. 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 accurate 24 hr urine for Na, K and creatinine, aldosterone, urinary free cortisol and catecholamines. See which ones your lab can do all in the same sample. Do not lose a drop of this liquid gold. It is impossible to interpret the plasma renin and aldosterone and urine aldosterone and cortisol without this information. 4. The morning you finish the 24 hr urine have fasting blood drawn for renin, aldosterone 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. Be sure the laboratory orders and does aldosterone NOT aldolase. 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. 7. 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 5/1/12 for me would be Grim120521. 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. Learn as much as you can about how High Blood Pressure should be diagnosed and managed: Go to nih.gov and download and read the latest Joint National Commission (JNC) Report to get an overview on current guidelines. I have always asked all my staff (including secretaries) to read this so they can communicate the importance of high blood pressure to my patients. 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 medical care team contract me directly at lowerbp2@.... My consulting fee is $500 for one year access to my expertise e-mail or by iChat or Skype or snail mail. May your pressure be low!Clarence E. Grim BS, MS, MD, FACP, FACC, FASH.Board Certified in Internal Medicine, Geriatrics, and High Blood Pressure Specializing in Primary Aldosteronism and Difficult to Control High Blood Pressure. On May 17, 2012, at 6:56 AM, J. wrote: Here are the results of my saline suppression test and notes from Dr's office. This was my 2nd saline suppression, first was inconclusive. Does anyone have any ideas how my aldosterone could be higher after the infusion test? My potassium level was 3.6 prior to test and 3.1 at the end. Their "normal" range is 3.5 to 5.1. Comments from the Doctor's OfficeBoth aldosterone levels came back high; the one post infusion came back higher than the one pre infusion which does not make sense. Please let me know if I may schedule you with Dr. Eclavea for adrenal vein sampling. Component ResultsComponentYour ValueStandard RangeUnitsALDOSTERONE36ng/dL(NOTE) Adult Reference Ranges for Aldosterone, LC/MS/MS: Upright 8:00-10:00 am < or = 28 ng/dL Upright 4:00-6:00 pm < or = 21 ng/dL Supine 8:00-10:00 am 3-16 ng/dL The last time they ran my Sodium was March 26th. Here are those results.ComponentYour ValueStandard RangeUnitsSODIUM142136 - 145mmol/LPOTASSIUM3.73.5 - 5.1mmol/LCHLORIDE10698 - 107mmol/LCO23121 - 32mmol/LANION GAP55 - 15mmol/LBUN137 - 18mg/dLCREATININE0.60.6 - 1.0mg/dLBUN CREATININE RATIO21.710 - 20:1eGFR Non-Afr. Amer.>60>60mls/min.eGFR Afr. Amer.>60>60mls/min.GLUCOSE9570 - 99mg/dLCALCIUM8.68.5 - 10.1mg/dL, age 39.75 2cm adenoma on left adrenal gland, ARR over 200. I am on 180m Verapamil Slow Release, 7 potassium pills daily (20 meqs) and my K never gets higher than about 3.8, BP is creeping back up again, was doing fine on Amlodopine and Atenenol. From: Clarence Grim <lowerbp2@...> "hyperaldosteronism " <hyperaldosteronism > Sent: Monday, May 14, 2012 9:37 PM Subject: Re: Potassium level decreased during Saline Suppression Test K candrop that much just by breathing fast. Don't recall last saline numbers. If you want your K to become quickly normal please start the 14 day tI in the DASH book NOW. DO IT like your life depended on it. Tell team and keep us posted. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn May 14, 2012, at 21:22, jessdell72 <jessdell72@...> wrote: Hi everyone, I posted a couple weeks ago, that my Saline Suppression test was inconclusive because I was on Amlodipine and Atenenol, also my K taken at the beginning of the test was 3.1 (should be 3.5). So, my Endo switched me to Varapamil for the past 2 weeks and we re-did my test. This time my K was 3.6 prior to test. At the end of the test it was down to 3.1. The results of the test take a week or so. Does anyone know if it is normal for potassium to fall this drastically during the test (last time it didn't drop much at all). Would the low K level ruin the results again? , age 39.75 2cm adenoma on left adrenal gland, ARR over 200. I am on 180m Verapamil Slow Release, 7 potassium pills daily (20 meqs) and my K never gets higher than about 3.8, BP is creeping back up again, was doing fine on Amlodopine and Atenenol.

May 17, 2012

Hi Dr. Grim,

They didn't provide me with the earlier aldo numbers. I did pee A LOT during the test and the rest of the day. No, they did not seem like they had done many of these tests before. In fact, the nurse said they had to come up with a new protocol after my last botched test.

I did not take any medicine the morning of my infusion test, but I did take 1dose (20 meqs) of K because I knew it was important that my K be in the right range.

I will get the info from item 6.6 to my team...too late for me, but hopefully it will help the next person. Do you think it is fine to proceed with AVS without having a proper saline infusion test? Do you know any good endos (or specialists in PA) in the Green Bay, WI area?

Thanks!

From: Clarence Grim <lowerbp2@...>hyperaldosteronism Cc: Clarence Grim <lowerbp2@...> Sent: Thursday, May 17, 2012 10:12 AMSubject: Re: Potassium level decreased during Saline Suppression Test

I only see one aldo number. Did you take meds am of saline?

Please send numbers for both tests.

Perhaps the samples got mislabeled. Had the folks doing the saline seem like they had done lots of these?

How much did you pee during the infusion.

See below item 6.6 below. Did you get this welcome before?

CE Grim MD

Welcome to the exciting world of Hyperaldosteronism

You are in the right place!

I am Dr. CE Grim a retired (well semi-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 canâ€™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, and 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. Without excess salt in the diet, aldosterone cannot do most of its damage.

Go to: http://www.worldactiononsalt.com/evidence/treatment_trials.htm

For a state of the art and science discussion of salt and health.

2. Conn's Stories. Other patients with hyperaldosteronism (Connâ€™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. I trained with him and his team in Ann Arbor, MI in 1969-70. To see others' stories on the Hyperaldosteronism home page, go to Files/Connâ€™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. In oder for aldosterone to cause its damage one must also eat excess salt in the diet. Thus much of the damage can be controlled/reversed by lowering salt (sodium) intake and increasing potassium intake. This is the essence of the low sodium DASH eating plan.

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 donâ€™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 Program

The 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 own BP and insist that your health care team always measures BP correctly with an recently calibrated device: 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. Most devices will read at least 25 mm Hg too high or too low is some people. The only way to know if you are one is to have your and any other automatic devices checked for accuracy in you. Instructions for doing this are in our files.

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 with the testing for Pheochromocytoma and Cushing's thrown in.

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 accurate 24 hr urine for Na, K and creatinine, aldosterone, urinary free cortisol and catecholamines. See which ones your lab can do all in the same sample. Do not lose a drop of this liquid gold. It is impossible to interpret the plasma renin and aldosterone and urine aldosterone and cortisol without this information.

4. The morning you finish the 24 hr urine have fasting blood drawn for renin, aldosterone 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. Be sure the laboratory orders and does aldosterone NOT aldolase.

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. Grimâ€™s â€œQuick Pee Testâ€ for PA.

7. 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 5/1/12 for me would be Grim120521. 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/29186

9. 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.htm

10. 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. Learn as much as you can about how High Blood Pressure should be diagnosed and managed:

Go to nih.gov and download and read the latest Joint National Commission (JNC) Report to get an overview on current guidelines. I have always asked all my staff (including secretaries) to read this so they can communicate the importance of high blood pressure to my patients.

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 medical care team contract me directly at lowerbp2@.... My consulting fee is $500 for one year access to my expertise e-mail or by iChat or Skype or snail mail.

May your pressure be low!

Clarence E. Grim BS, MS, MD, FACP, FACC, FASH.

Board Certified in Internal Medicine, Geriatrics, and High Blood Pressure

Specializing in Primary Aldosteronism and Difficult to Control High Blood Pressure.

On May 17, 2012, at 6:56 AM, J. wrote:

Here are the results of my saline suppression test and notes from Dr's office. This was my 2nd saline suppression, first was inconclusive. Does anyone have any ideas how my aldosterone could be higher after the infusion test? My potassium level was 3.6 prior to test and 3.1 at the end. Their "normal" range is 3.5 to 5.1.

Comments from the Doctor's Office

Both aldosterone levels came back high; the one post infusion came back higher than the one pre infusion which does not make sense. Please let me know if I may schedule you with Dr. Eclavea for adrenal vein sampling.

Component Results

Component

Your Value

Standard Range

Units

ALDOSTERONE

36

ng/dL

(NOTE)Adult Reference Ranges for Aldosterone,LC/MS/MS:Upright 8:00-10:00 am < or = 28 ng/dLUpright 4:00-6:00 pm < or = 21 ng/dLSupine 8:00-10:00 am 3-16 ng/dL

The last time they ran my Sodium was March 26th. Here are those results.

Component

Your Value

Standard Range

Units

SODIUM

142

136 - 145

mmol/L

POTASSIUM

3.7

3.5 - 5.1

mmol/L

CHLORIDE

106

98 - 107

mmol/L

CO2

31

21 - 32

mmol/L

ANION GAP

5

5 - 15

mmol/L

BUN

13

7 - 18

mg/dL

CREATININE

0.6

0.6 - 1.0

mg/dL

BUN CREATININE RATIO

21.7

10 - 20

:1

eGFR Non-Afr. Amer.

>60

mls/min.

eGFR Afr. Amer.

>60

mls/min.

GLUCOSE

95

70 - 99

mg/dL

CALCIUM

8.6

8.5 - 10.1

mg/dL, age 39.75 2cm adenoma on left adrenal gland, ARR over 200. I am on 180m Verapamil Slow Release, 7 potassium pills daily (20 meqs) and my K never gets higher than about 3.8, BP is creeping back up again, was doing fine on Amlodopine and Atenenol.

From: Clarence Grim <lowerbp2@...>"hyperaldosteronism " <hyperaldosteronism > Sent: Monday, May 14, 2012 9:37 PMSubject: Re: Potassium level decreased during Saline Suppression Test

K candrop that much just by breathing fast. Don't recall last saline numbers. If you want your K to become quickly normal please start the 14 day t

I in the DASH book NOW. DO IT like your life depended on it. Tell team and keep us posted.

May your pressure be low!

CE Grim MS, MD

Specializing in Difficult

Hypertension

On May 14, 2012, at 21:22, jessdell72 <jessdell72@...> wrote:

Hi everyone,I posted a couple weeks ago, that my Saline Suppression test was inconclusive because I was on Amlodipine and Atenenol, also my K taken at the beginning of the test was 3.1 (should be 3.5). So, my Endo switched me to Varapamil for the past 2 weeks and we re-did my test. This time my K was 3.6 prior to test. At the end of the test it was down to 3.1. The results of the test take a week or so. Does anyone know if it is normal for potassium to fall this drastically during the test (last time it didn't drop much at all). Would the low K level ruin the results again? , age 39.75 2cm adenoma on left adrenal gland, ARR over 200. I am on 180m Verapamil Slow Release, 7 potassium pills daily (20 meqs) and my K never gets higher than about 3.8, BP is creeping back up again, was doing fine on Amlodopine and

Atenenol.

May 17, 2012

I still see only one aldo. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn May 17, 2012, at 6:56, " J." <jessdell72@...> wrote:

Here are the results of my saline suppression test and notes from Dr's office. This was my 2nd saline suppression, first was inconclusive. Does anyone have any ideas how my aldosterone could be higher after the infusion test? My potassium level was 3.6 prior to test and 3.1 at the end. Their "normal" range is 3.5 to 5.1. Comments from the Doctor's OfficeBoth aldosterone levels came back high; the one post infusion came back higher than the one pre infusion which does not make sense. Please let me know if I may schedule you with Dr. Eclavea for adrenal vein sampling. Component ResultsComponentYour ValueStandard RangeUnitsALDOSTERONE36ng/dL(NOTE) Adult Reference Ranges for Aldosterone, LC/MS/MS: Upright 8:00-10:00 am < or = 28 ng/dL Upright 4:00-6:00 pm < or = 21 ng/dL Supine 8:00-10:00 am 3-16 ng/dL The last time they ran my Sodium was March 26th. Here are those results.ComponentYour ValueStandard RangeUnitsSODIUM142136 - 145mmol/LPOTASSIUM3.73.5 - 5.1mmol/LCHLORIDE10698 - 107mmol/LCO23121 - 32mmol/LANION GAP55 - 15mmol/LBUN137 - 18mg/dLCREATININE0.60.6 - 1.0mg/dLBUN CREATININE RATIO21.710 - 20:1eGFR Non-Afr. Amer.>60>60mls/min.eGFR Afr. Amer.>60>60mls/min.GLUCOSE9570 -

99mg/dLCALCIUM8.68.5 - 10.1mg/dL, age 39.75 2cm adenoma on left adrenal gland, ARR over 200. I am on 180m Verapamil Slow Release, 7 potassium pills daily (20 meqs) and my K never gets higher than about 3.8, BP is creeping back up again, was doing fine on Amlodopine and Atenenol. From: Clarence Grim <lowerbp2@...> To:

"hyperaldosteronism " <hyperaldosteronism > Sent: Monday, May 14, 2012 9:37 PM Subject: Re: Potassium level decreased during Saline Suppression Test

K candrop that much just by breathing fast. Don't recall last saline numbers. If you want your K to become quickly normal please start the 14 day tI in the DASH book NOW. DO IT like your life depended on it. Tell team and keep us posted. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn May 14, 2012, at 21:22, jessdell72 <jessdell72@...> wrote:

Hi everyone,

I posted a couple weeks ago, that my Saline Suppression test was inconclusive because I was on Amlodipine and Atenenol, also my K taken at the beginning of the test was 3.1 (should be 3.5). So, my Endo switched me to Varapamil for the past 2 weeks and we re-did my test. This time my K was 3.6 prior to test. At the end of the test it was down to 3.1. The results of the test take a week or so. Does anyone know if it is normal for potassium to fall this drastically during the test (last time it didn't drop much at all). Would the low K level ruin the results again?

, age 39.75 2cm adenoma on left adrenal gland, ARR over 200. I am on 180m Verapamil Slow Release, 7 potassium pills daily (20 meqs) and my K never gets higher than about 3.8, BP is creeping back up again, was doing fine on Amlodopine and Atenenol.

May 17, 2012

I am MKE. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn May 17, 2012, at 13:00, " J." <jessdell72@...> wrote: