Am I a Candidate For AVS or Not ?

[Guest guest]

I have recently been through a programme to evaluate my suitability for AVS

with a view to adrenalectomy. My Ednocrinilogist is a busy man who can be hard

to contact and I am bit confused about where I stand regarding AVS.So I am

hoping if I explain what has happened the experts here can fill in the blanks

for me. My medication regime which I had been on for over a year prior to

starting this exercise was :-

10.0 mg Bisoprolol Fumerate tablets

12.0 mg Doxazosin tablets

200.0 mcg Moxonidine tablet

50.0 mg Spirononlactone tablets

32.0 mg Candesartan tablets

I was instructed to stop the Spironolactone about 6 weeks ago and the

Candesrartan 2 weeks ago . I have been having blood tests at my GP for

potassium levels every two weeks which have all come back ok.

Today I had the special blood test at the Endocrinology clinic to assess my

suitability for AVS. The Doctor told me the blood test came back ok and my

kidney function was fine and that I should resume my old medication regime with

Spironolactone and Candesratan.

But I am confused – should I conclude from this that I am a candidate for AVS

and perhaps adrenalectomy or not?

[Guest guest]

I imagine that most people could have AVS if the desire took them but I don't

really understand from your message what makes them think you have Conn's? The

point of the blood tests is not to assess your suitability for AVS - that's just

a surgical procedure that helps narrow down whether one or both of your adrenal

glands is malfunctioning - but to work out whether you have PA/Conns.

So do you have figures for your aldosterone and renin levels? Potassium levels

are only a secondary indicator i.e. if your diet is superb, your potassium

levels will be fine even if you have PA. But you can't disguise the primary

indicators which are the hormones that your adrenal glands are over or under

producing.

What made you think you might need an adrenalectomy? What are your other

symptoms? Have you had an MRI or other scan that indicates a growth on either of

your adrenal glands? That normally precedes an AVS.

However busy your endocrinologist is, you deserve to understand what is

happening to you so book face to face time with him and ask him a ton of

questions. Be prepared - this site is a good place to start - so that you're

asking him the right things - what are my blood test results vs. the norm? What

do these drugs do? Why is he recommending AVS?

Personally I have no idea what most of those drugs do. I only took Spiro briefly

while waiting for surgery and that was sufficient. But I wouldn't dream of

taking a drug that I didn't understand what it was for - it's your body, you

fight for it!

H

>

> I have recently been through a programme to evaluate my suitability for AVS

with a view to adrenalectomy. My Ednocrinilogist is a busy man who can be hard

to contact and I am bit confused about where I stand regarding AVS.So I am

hoping if I explain what has happened the experts here can fill in the blanks

for me. My medication regime which I had been on for over a year prior to

starting this exercise was :-

>

> 10.0 mg Bisoprolol Fumerate tablets

> 12.0 mg Doxazosin tablets

> 200.0 mcg Moxonidine tablet

> 50.0 mg Spirononlactone tablets

> 32.0 mg Candesartan tablets

>

> I was instructed to stop the Spironolactone about 6 weeks ago and the

Candesrartan 2 weeks ago . I have been having blood tests at my GP for

potassium levels every two weeks which have all come back ok.

>

> Today I had the special blood test at the Endocrinology clinic to assess

my suitability for AVS. The Doctor told me the blood test came back ok and my

kidney function was fine and that I should resume my old medication regime with

Spironolactone and Candesratan.

>

> But I am confused – should I conclude from this that I am a candidate for AVS

and perhaps adrenalectomy or not?

>

[Guest guest]

What are your numbers, with normal values? Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of AlanI have recently been through a programme to evaluate my suitability for AVS with a view to adrenalectomy. My Ednocrinilogist is a busy man who can be hard to contact and I am bit confused about where I stand regarding AVS.So I am hoping if I explain what has happened the experts here can fill in the blanks for me. My medication regime which I had been on for over a year prior to starting this exercise was :-10.0 mg Bisoprolol Fumerate tablets12.0 mg Doxazosin tablets200.0 mcg Moxonidine tablet50.0 mg Spirononlactone tablets 32.0 mg Candesartan tablets I was instructed to stop the Spironolactone about 6 weeks ago and the Candesrartan 2 weeks ago . I have been having blood tests at my GP for potassium levels every two weeks which have all come back ok.Today I had the special blood test at the Endocrinology clinic to assess my suitability for AVS. The Doctor told me the blood test came back ok and my kidney function was fine and that I should resume my old medication regime with Spironolactone and Candesratan.But I am confused – should I conclude from this that I am a candidate for AVS and perhaps adrenalectomy or not?.

[Guest guest]

Thanks for the reply - to answer your questions. I don't have the figures from

my blood test. In my experience NHS, doctors don't give out that sort of

numerical information. They only tell you if the result was too high, too low

or ok – mine were all ok.

The reason for thinking I have Conns is that the only drug that has been

effective for my drug resistant hypertension is Spironolactone. Also, MRI

scans have indicated borderline evidence of Conns. I would doubt if my diet is

" superb " – far from it - domestic arrangements make it difficult for me to go

on a special diet so I am not doing DASH.

The possibility of adrenalectomy was suggested by my endocrinologist who was

concerned about the large number of drugs being used to control my hypertension

– a situation he described as extreme.

> >

> > I have recently been through a programme to evaluate my suitability for

AVS with a view to adrenalectomy. My Ednocrinilogist is a busy man who can be

hard to contact and I am bit confused about where I stand regarding AVS.So I am

hoping if I explain what has happened the experts here can fill in the blanks

for me. My medication regime which I had been on for over a year prior to

starting this exercise was :-

> >

> > 10.0 mg Bisoprolol Fumerate tablets

> > 12.0 mg Doxazosin tablets

> > 200.0 mcg Moxonidine tablet

> > 50.0 mg Spirononlactone tablets

> > 32.0 mg Candesartan tablets

> >

> > I was instructed to stop the Spironolactone about 6 weeks ago and the

Candesrartan 2 weeks ago . I have been having blood tests at my GP for

potassium levels every two weeks which have all come back ok.

> >

> > Today I had the special blood test at the Endocrinology clinic to assess

my suitability for AVS. The Doctor told me the blood test came back ok and my

kidney function was fine and that I should resume my old medication regime with

Spironolactone and Candesratan.

> >

> > But I am confused – should I conclude from this that I am a candidate for

AVS and perhaps adrenalectomy or not?

> >

>

[Guest guest]

Alan, I don't remember where you are or know who NHS is but you need to STOP ! A good DX starts with a good HX and thorough methodical testing. Is your BP being taken correctly? Did they do the proper testing for ARR and what meds, if any, were you on? There is a progression for the testing process and AVS is last on the list!

If they won't give you actual number from your tests along with lab ranges I would consider it a major problem. What are they hiding? ALL my labs are available to me on line and go back to 2005!

Enough "tough love" for this morning so I will save the DASH speach for later.

BTW, I like the reasoning for why they think you have Conn's, They thought I was pregnant because I had a craving for pickles and ice cream!

.....

> > >> > > I have recently been through a programme to evaluate my suitability for AVS with a view to adrenalectomy. My Ednocrinilogist is a busy man who can be hard to contact and I am bit confused about where I stand regarding AVS.So I am hoping if I explain what has happened the experts here can fill in the blanks for me. My medication regime which I had been on for over a year prior to starting this exercise was :-> > > > > > 10.0 mg Bisoprolol Fumerate tablets> > > 12.0 mg Doxazosin tablets> > > 200.0 mcg Moxonidine tablet> > > 50.0 mg Spirononlactone tablets > > > 32.0 mg Candesartan tablets > > > > > > I was instructed to stop the Spironolactone about 6 weeks ago and the Candesrartan 2 weeks ago . I have been having blood tests at my GP for potassium levels every two weeks which have all come back ok.> > > > > > Today I had the special blood test at the Endocrinology clinic to assess my suitability for AVS. The Doctor told me the blood test came back ok and my kidney function was fine and that I should resume my old medication regime with Spironolactone and Candesratan.> > > > > > But I am confused – should I conclude from this that I am a candidate for AVS and perhaps adrenalectomy or not?> > >> >>

[Guest guest]

Right and the current recommendation is that spiro be added to all with resistant HTN to see if others can be stepped down. Has your K ever been low.Where are you in UK as there is a new research project with a new scanner by Dr. M Brown in UK and they are looking for participants that you can find by searching our emails I think and perhaps our files. On Apr 27, 2012, at 5:41 AM, Alan wrote: Thanks for the reply - to answer your questions. I don't have the figures from my blood test. In my experience NHS, doctors don't give out that sort of numerical information. They only tell you if the result was too high, too low or ok – mine were all ok. The reason for thinking I have Conns is that the only drug that has been effective for my drug resistant hypertension is Spironolactone. Also, MRI scans have indicated borderline evidence of Conns. I would doubt if my diet is "superb " – far from it - domestic arrangements make it difficult for me to go on a special diet so I am not doing DASH. The possibility of adrenalectomy was suggested by my endocrinologist who was concerned about the large number of drugs being used to control my hypertension – a situation he described as extreme. > > > > I have recently been through a programme to evaluate my suitability for AVS with a view to adrenalectomy. My Ednocrinilogist is a busy man who can be hard to contact and I am bit confused about where I stand regarding AVS.So I am hoping if I explain what has happened the experts here can fill in the blanks for me. My medication regime which I had been on for over a year prior to starting this exercise was :- > > > > 10.0 mg Bisoprolol Fumerate tablets > > 12.0 mg Doxazosin tablets > > 200.0 mcg Moxonidine tablet > > 50.0 mg Spirononlactone tablets > > 32.0 mg Candesartan tablets > > > > I was instructed to stop the Spironolactone about 6 weeks ago and the Candesrartan 2 weeks ago . I have been having blood tests at my GP for potassium levels every two weeks which have all come back ok. > > > > Today I had the special blood test at the Endocrinology clinic to assess my suitability for AVS. The Doctor told me the blood test came back ok and my kidney function was fine and that I should resume my old medication regime with Spironolactone and Candesratan. > > > > But I am confused – should I conclude from this that I am a candidate for AVS and perhaps adrenalectomy or not? > > >

[Guest guest]

OK, you need to ask. This is major surgery. You need to know that the answer is

right for you because there are decisions to make - and only you can make them.

The doctors can advise you but it's your job to read up about the condition and

make sure you are 100% happy with the diagnosis.

Yes, NHS doctors are stretched but so are doctors everywhere. It's no excuse for

not giving you the facts. So ask what blood tests they're run, what the results

were. Ask for copies of your records to save yourself from having to write all

the numbers down.

If all the results are 'OK' you shouldn't be having surgery because there is no

indication that surgery will resolve anything. But you need to know what the

absolute numbers are - my aldosterone number was initially just about in the

normal range but because my renin was so low they couldn't measure it, that made

the diagnosis pretty clear because it's the ratio that's the important bit. Then

my aldosterone went up as well.

And when you say MRI scans have indicated borderline evidence of Conns, what do

you mean? All the MRI can do is show whether you have growths on one or both

adrenal glands. They can't tell you whether those growths are producing hormones

or not - that's where AVS comes in. So what did the scans show? How many

growths? Which side? How big were they?

As the others have said, if this is Conn's, it should be possible to control it

by Spiro alone - in whatever dose. The other drugs have no effect on PA related

hypertension. So start to control the salt in your diet - don't make excuses,

anybody can cut down on salt - and see if you can wean off the other drugs (in

discussion with your doctors). Taking a cocktail of drugs is absolutely no

indicator that PA is the diagnosis nor that an adrenalectomy would be

successful. But if you can control your HBP through diet and Spiro, that's a

better indicator - and gives a genuine choice between that as a long term

solution or surgery.

H

> > >

> > > I have recently been through a programme to evaluate my suitability for

AVS with a view to adrenalectomy. My Ednocrinilogist is a busy man who can be

hard to contact and I am bit confused about where I stand regarding AVS.So I am

hoping if I explain what has happened the experts here can fill in the blanks

for me. My medication regime which I had been on for over a year prior to

starting this exercise was :-

> > >

> > > 10.0 mg Bisoprolol Fumerate tablets

> > > 12.0 mg Doxazosin tablets

> > > 200.0 mcg Moxonidine tablet

> > > 50.0 mg Spirononlactone tablets

> > > 32.0 mg Candesartan tablets

> > >

> > > I was instructed to stop the Spironolactone about 6 weeks ago and the

Candesrartan 2 weeks ago . I have been having blood tests at my GP for

potassium levels every two weeks which have all come back ok.

> > >

> > > Today I had the special blood test at the Endocrinology clinic to assess

my suitability for AVS. The Doctor told me the blood test came back ok and my

kidney function was fine and that I should resume my old medication regime with

Spironolactone and Candesratan.

> > >

> > > But I am confused – should I conclude from this that I am a candidate for

AVS and perhaps adrenalectomy or not?

> > >

> >

>

[Guest guest]

I seem to have just lost a whole long reply to this - doh!

You need to start taking ownership of your own health. An adrenalectomy is a

major surgical procedure. Not one to jump into just because your doctor might

thinks it might save a cocktail of drugs. And not one to agree to without

absolutely understanding all the numbers, the diagnosis, the options.

So first off you have to ask the doctor - even in the time pressured NHS a

doctor has to answer your questions when you ask what tests they've done and

what the results were. Ask for copies of the test results so that you don't have

to write them down - and make sure you know what the normal ranges are. YOU have

to understand why they think you have PA and be sure you agree.

Second what did the MRI actually show? An MRI CAN'T show you have borderline

Conn's. It CAN show that you have one or more growths on one or both adrenal

glands. But you don't know whether they're actively producing hormones or not -

that's what the AVS should be able to tell you.

Thirdly start to try and cut down on the drugs and improve your diet. If this is

Conn's, you should be able to control your HBP with Spiro and diet alone. No

excuses for domestic arrangements - nobody needs to add salt to their food and

everybody should be eating lots of fresh fruit and veg. That's the basics of

DASH. So you ALL do it. OK, I do the cooking but that should be no problem for

anybody cooking - stock was my only issue.

No doctor should be recommending adrenalectomy just to cut out a cocktail of

drugs but you should try to cut out some of the other BP drugs if Spiro is

working and see how that goes. Then you have a genuine choice about whether to

stay on Spiro or to have surgery (if an AVS proves that only one adrenal gland

is causing the problem).

H

> > >

> > > I have recently been through a programme to evaluate my suitability for

AVS with a view to adrenalectomy. My Ednocrinilogist is a busy man who can be

hard to contact and I am bit confused about where I stand regarding AVS.So I am

hoping if I explain what has happened the experts here can fill in the blanks

for me. My medication regime which I had been on for over a year prior to

starting this exercise was :-

> > >

> > > 10.0 mg Bisoprolol Fumerate tablets

> > > 12.0 mg Doxazosin tablets

> > > 200.0 mcg Moxonidine tablet

> > > 50.0 mg Spirononlactone tablets

> > > 32.0 mg Candesartan tablets

> > >

> > > I was instructed to stop the Spironolactone about 6 weeks ago and the

Candesrartan 2 weeks ago . I have been having blood tests at my GP for

potassium levels every two weeks which have all come back ok.

> > >

> > > Today I had the special blood test at the Endocrinology clinic to assess

my suitability for AVS. The Doctor told me the blood test came back ok and my

kidney function was fine and that I should resume my old medication regime with

Spironolactone and Candesratan.

> > >

> > > But I am confused – should I conclude from this that I am a candidate for

AVS and perhaps adrenalectomy or not?

> > >

> >

>

[Guest guest]

U.S. law prohibits withholding health care information from the patient. , Alan is in a government system. NHS = UK. If I was in his position, I would be hiring a lawyer. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Alan, I don't remember where you are or know who NHS is but you need to STOP ! A good DX starts with a good HX and thorough methodical testing. Is your BP being taken correctly? Did they do the proper testing for ARR and what meds, if any, were you on? There is a progression for the testing process and AVS is last on the list!If they won't give you actual number from your tests along with lab ranges I would consider it a major problem. What are they hiding? ALL my labs are available to me on line and go back to 2005!Enough " tough love " for this morning so I will save the DASH speach for later.BTW, I like the reasoning for why they think you have Conn's, They thought I was pregnant because I had a craving for pickles and ice cream!.

[Guest guest]

If you ask will they should give them to you I would think.If they have an EMR system then you should be able to access that I would hope.CE Grim MDOn Apr 27, 2012, at 5:41 AM, Alan wrote: Thanks for the reply - to answer your questions. I don't have the figures from my blood test. In my experience NHS, doctors don't give out that sort of numerical information. They only tell you if the result was too high, too low or ok – mine were all ok. The reason for thinking I have Conns is that the only drug that has been effective for my drug resistant hypertension is Spironolactone. Also, MRI scans have indicated borderline evidence of Conns. I would doubt if my diet is "superb " – far from it - domestic arrangements make it difficult for me to go on a special diet so I am not doing DASH. The possibility of adrenalectomy was suggested by my endocrinologist who was concerned about the large number of drugs being used to control my hypertension – a situation he described as extreme. > > > > I have recently been through a programme to evaluate my suitability for AVS with a view to adrenalectomy. My Ednocrinilogist is a busy man who can be hard to contact and I am bit confused about where I stand regarding AVS.So I am hoping if I explain what has happened the experts here can fill in the blanks for me. My medication regime which I had been on for over a year prior to starting this exercise was :- > > > > 10.0 mg Bisoprolol Fumerate tablets > > 12.0 mg Doxazosin tablets > > 200.0 mcg Moxonidine tablet > > 50.0 mg Spirononlactone tablets > > 32.0 mg Candesartan tablets > > > > I was instructed to stop the Spironolactone about 6 weeks ago and the Candesrartan 2 weeks ago . I have been having blood tests at my GP for potassium levels every two weeks which have all come back ok. > > > > Today I had the special blood test at the Endocrinology clinic to assess my suitability for AVS. The Doctor told me the blood test came back ok and my kidney function was fine and that I should resume my old medication regime with Spironolactone and Candesratan. > > > > But I am confused – should I conclude from this that I am a candidate for AVS and perhaps adrenalectomy or not? > > >

[Guest guest]

If you and you team reads my evolution of PA article you will note the following: On Apr 26, 2012, at 4:52 PM, hesterfenwick wrote:> 10.0 mg Bisoprolol Fumerate tabletsWill not work in PA it is a BB> 12.0 mg Doxazosin tabletsPiss poor BP med and rarely indicated.> 200.0 mcg Moxonidine tabletNot sure what this is in US.> 50.0 mg Spirononlactone tablets this alone will control BP if you have PA depending on if you are DASHing but you may need more spiro. > 32.0 mg Candesartan tablets Does not work in PA. It is an ARB