Guest guest Posted June 12, 2012 Report Share Posted June 12, 2012 Nice review but leaves out some classical studies by Symington and Dobbie I think. At one time I had a copy of the Dobbie art that defined the problem that most autopsies do not really sample the adrenal properly to look for hyperplasia. The study in our files by shows how to do this but rarely done. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jun 11, 2012, at 23:34, <jclark24p@...> wrote: Here is a 2003 study that shows the prevalence of incidental adenomas at autopsy is 2.3% in 71,206 cases: "Prevalence and natural history of adrenal incidentalomas" Source: http://eje-online.org/content/149/4/273.full.pdf Note that the likelihood increases with age to 6.9% in persons oF 70 and older. > > > > > > You will want to have some help with the children for a few days. If your > > > other adrenal develops an adenoma, the treatment is a mineralocorticoid > > > blocker (spiro or Inspra), not a steroid. > > > > > > > > > > > > Val > > > > > > > > > > > > From: hyperaldosteronism > > > [mailto:hyperaldosteronism ] On Behalf Of Sara > > > > > > > > > Hi everyone! I just got my test results back from my adrenal vein sampling. > > > The excess aldosterone is coming from the left adrenal (35 x higher), which > > > is the one with the 1 cm tumor. I am going to have an adrenalectomy. Any > > > tips on recovery? I have a toddler and a baby and was just wondering what I > > > should expect. Also I am worried that if I get one adrenal out at such a > > > young age (31) if something could go wrong with the other adrenal down the > > > road. I don't want to have to be stuck on steroids or anything. Any advice > > > is greatly appreciated. So glad to have this group. > > > > > > . > > > > > > > > > <http://geo./serv?s=97359714/grpId=7299303/grpspId=1705132763/msgId > > > =43906/stime=1339162511/nc1=3848643/nc2=5191951/nc3=5191950> > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2012 Report Share Posted June 12, 2012 And NIH says most with subclinical excess cortisol production are difficult to Dx as UFCs are normal. And Grim says most with PA are not diagnosed until the reach the stage of Group Hyperaldosetonism-ie tests are high based on "normal" values and not based on physiology such as: if renin is low and aldo is not then you have pre Group Hyperaldo. CE Grim MDOn Jun 12, 2012, at 5:38 AM, Francis Bill SUSPECTED PA wrote: Current thinking is about 80% of adenomas are non functioning. Maybe this is because 80% of the time they fail to do proper testing. > > > > > > > > > > You will want to have some help with the children for a few days. If your > > > > > other adrenal develops an adenoma, the treatment is a mineralocorticoid > > > > > blocker (spiro or Inspra), not a steroid. > > > > > > > > > > > > > > > > > > > > Val > > > > > > > > > > > > > > > > > > > > From: hyperaldosteronism > > > > > [mailto:hyperaldosteronism ] On Behalf Of Sara > > > > > > > > > > > > > > > Hi everyone! I just got my test results back from my adrenal vein sampling. > > > > > The excess aldosterone is coming from the left adrenal (35 x higher), which > > > > > is the one with the 1 cm tumor. I am going to have an adrenalectomy. Any > > > > > tips on recovery? I have a toddler and a baby and was just wondering what I > > > > > should expect. Also I am worried that if I get one adrenal out at such a > > > > > young age (31) if something could go wrong with the other adrenal down the > > > > > road. I don't want to have to be stuck on steroids or anything. Any advice > > > > > is greatly appreciated. So glad to have this group. > > > > > > > > > > . > > > > > > > > > > > > > > > <http://geo./serv?s=97359714/grpId=7299303/grpspId=1705132763/msgId > > > > > =43906/stime=1339162511/nc1=3848643/nc2=5191951/nc3=5191950> > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2012 Report Share Posted June 12, 2012 This depends on how carefully one looks for "function". CE Grim MDOn Jun 12, 2012, at 5:38 AM, Francis Bill SUSPECTED PA wrote: Current thinking is about 80% of adenomas are non functioning. Maybe this is because 80% of the time they fail to do proper testing. > > > > > > > > > > You will want to have some help with the children for a few days. If your > > > > > other adrenal develops an adenoma, the treatment is a mineralocorticoid > > > > > blocker (spiro or Inspra), not a steroid. > > > > > > > > > > > > > > > > > > > > Val > > > > > > > > > > > > > > > > > > > > From: hyperaldosteronism > > > > > [mailto:hyperaldosteronism ] On Behalf Of Sara > > > > > > > > > > > > > > > Hi everyone! I just got my test results back from my adrenal vein sampling. > > > > > The excess aldosterone is coming from the left adrenal (35 x higher), which > > > > > is the one with the 1 cm tumor. I am going to have an adrenalectomy. Any > > > > > tips on recovery? I have a toddler and a baby and was just wondering what I > > > > > should expect. Also I am worried that if I get one adrenal out at such a > > > > > young age (31) if something could go wrong with the other adrenal down the > > > > > road. I don't want to have to be stuck on steroids or anything. Any advice > > > > > is greatly appreciated. So glad to have this group. > > > > > > > > > > . > > > > > > > > > > > > > > > <http://geo./serv?s=97359714/grpId=7299303/grpspId=1705132763/msgId > > > > > =43906/stime=1339162511/nc1=3848643/nc2=5191951/nc3=5191950> > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2012 Report Share Posted June 12, 2012 Note they only looked a one slide from each adrenal so likely missed many as pointed out by Dobbie.Dr. Genest is one of the giants in aldo and HTN and has always suggeseted that most HTN is due to excess aldo (subtle). Should also see if we can get pdf of: I can't find mine at this time. Thanks. 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. CE Grim MDOn Jun 12, 2012, at 12:14 AM, wrote: Here's an older one: "Autopsy Study of Adrenals in Unselected Normotensive and Hypertensive Patients" Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1930349/?tool=pubmed Of course there appears to be no consideration of people being treated with MCBs so I believe this and my previous post overstate the number. There is also no mention of individuals with no adrenals which is the solution for Cushing's. > > > > > > > > You will want to have some help with the children for a few days. If your > > > > other adrenal develops an adenoma, the treatment is a mineralocorticoid > > > > blocker (spiro or Inspra), not a steroid. > > > > > > > > > > > > > > > > Val > > > > > > > > > > > > > > > > From: hyperaldosteronism > > > > [mailto:hyperaldosteronism ] On Behalf Of Sara > > > > > > > > > > > > Hi everyone! I just got my test results back from my adrenal vein sampling. > > > > The excess aldosterone is coming from the left adrenal (35 x higher), which > > > > is the one with the 1 cm tumor. I am going to have an adrenalectomy. Any > > > > tips on recovery? I have a toddler and a baby and was just wondering what I > > > > should expect. Also I am worried that if I get one adrenal out at such a > > > > young age (31) if something could go wrong with the other adrenal down the > > > > road. I don't want to have to be stuck on steroids or anything. Any advice > > > > is greatly appreciated. So glad to have this group. > > > > > > > > . > > > > > > > > > > > > <http://geo./serv?s=97359714/grpId=7299303/grpspId=1705132763/msgId > > > > =43906/stime=1339162511/nc1=3848643/nc2=5191951/nc3=5191950> > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2012 Report Share Posted June 12, 2012 There is a very large chance that it is already there. Again it depends on how you define it and look for it.My assessment is that most PA is due to bilateral hyperplasia. But AVS is best way to predict response to surgery. Based on that 36% will be cured over say 5 years-if you define cure as normal renin and aldo and no need for BP meds. Probably would be higher if more DASHed after surgery as PA is the classic form of salt sensitive HTN as well as aldo/salty induced fibrosis of heart, kidneys etc. CE Grim MDOn Jun 11, 2012, at 11:38 PM, Pnb B wrote: Dr Grim, are you saying there is a 90% chance of developing a tumor in the remaining adrenal gland? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2012 Report Share Posted June 12, 2012 I'm sure it wasn't intended to include all but 171K+ sample should provide a good mix! > > > > > > > > > > You will want to have some help with the children for a few days. If your > > > > > other adrenal develops an adenoma, the treatment is a mineralocorticoid > > > > > blocker (spiro or Inspra), not a steroid. > > > > > > > > > > > > > > > > > > > > Val > > > > > > > > > > > > > > > > > > > > From: hyperaldosteronism > > > > > [mailto:hyperaldosteronism ] On Behalf Of Sara > > > > > > > > > > > > > > > Hi everyone! I just got my test results back from my adrenal vein sampling. > > > > > The excess aldosterone is coming from the left adrenal (35 x higher), which > > > > > is the one with the 1 cm tumor. I am going to have an adrenalectomy. Any > > > > > tips on recovery? I have a toddler and a baby and was just wondering what I > > > > > should expect. Also I am worried that if I get one adrenal out at such a > > > > > young age (31) if something could go wrong with the other adrenal down the > > > > > road. I don't want to have to be stuck on steroids or anything. Any advice > > > > > is greatly appreciated. So glad to have this group. > > > > > > > > > > . > > > > > > > > > > > > > > > <http://geo./serv?s=97359714/grpId=7299303/grpspId=1705132763/msgId > > > > > =43906/stime=1339162511/nc1=3848643/nc2=5191951/nc3=5191950> > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2012 Report Share Posted June 12, 2012 Here is the abstract, maybe can retrieve the whole article. http://www.ncbi.nlm.nih.gov/pubmed?term=Longo%20DL%2C%20Esterly%20JA%2C%20Grim%2\ 0CE%2C%20Keitzer%20WF Pathology of the adrenal gland in refractory low-renin hypertension. Longo DL, Esterly JA, Grim CE, Keitzer WF. PMID: 580727 [PubMed - indexed for MEDLINE] > > > > > > > > > > > > You will want to have some help with the children for a few > > days. If your > > > > > > other adrenal develops an adenoma, the treatment is a > > mineralocorticoid > > > > > > blocker (spiro or Inspra), not a steroid. > > > > > > > > > > > > > > > > > > > > > > > > Val > > > > > > > > > > > > > > > > > > > > > > > > From: hyperaldosteronism > > > > > > [mailto:hyperaldosteronism ] On Behalf Of Sara > > > > > > > > > > > > > > > > > > Hi everyone! I just got my test results back from my adrenal > > vein sampling. > > > > > > The excess aldosterone is coming from the left adrenal (35 x > > higher), which > > > > > > is the one with the 1 cm tumor. I am going to have an > > adrenalectomy. Any > > > > > > tips on recovery? I have a toddler and a baby and was just > > wondering what I > > > > > > should expect. Also I am worried that if I get one adrenal > > out at such a > > > > > > young age (31) if something could go wrong with the other > > adrenal down the > > > > > > road. I don't want to have to be stuck on steroids or > > anything. Any advice > > > > > > is greatly appreciated. So glad to have this group. > > > > > > > > > > > > . > > > > > > > > > > > > > > > > > > <http://geo./serv?s=97359714/grpId=7299303/grpspId=1705132763/msgId > > > > > > =43906/stime=1339162511/nc1=3848643/nc2=5191951/nc3=5191950> > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2012 Report Share Posted June 12, 2012 Again of you only take one slice out of each adrenal u have a very large chance of missing even a 0.5 cm adenoma. I have sliced perhaps 100 every 2 mm perhaps 100 in pts with various stages of PA. I may have also missed Lesions smaller than 2 mm. To really do it right I guess one would need to do 1 mm slices or smaller. But no one does that ESP in a real Hosp path lab. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jun 12, 2012, at 12:28, <jclark24p@...> wrote: I'm sure it wasn't intended to include all but 171K+ sample should provide a good mix! > > > > > > > > > > You will want to have some help with the children for a few days. If your > > > > > other adrenal develops an adenoma, the treatment is a mineralocorticoid > > > > > blocker (spiro or Inspra), not a steroid. > > > > > > > > > > > > > > > > > > > > Val > > > > > > > > > > > > > > > > > > > > From: hyperaldosteronism > > > > > [mailto:hyperaldosteronism ] On Behalf Of Sara > > > > > > > > > > > > > > > Hi everyone! I just got my test results back from my adrenal vein sampling. > > > > > The excess aldosterone is coming from the left adrenal (35 x higher), which > > > > > is the one with the 1 cm tumor. I am going to have an adrenalectomy. Any > > > > > tips on recovery? I have a toddler and a baby and was just wondering what I > > > > > should expect. Also I am worried that if I get one adrenal out at such a > > > > > young age (31) if something could go wrong with the other adrenal down the > > > > > road. I don't want to have to be stuck on steroids or anything. Any advice > > > > > is greatly appreciated. So glad to have this group. > > > > > > > > > > . > > > > > > > > > > > > > > > <http://geo./serv?s=97359714/grpId=7299303/grpspId=1705132763/msgId > > > > > =43906/stime=1339162511/nc1=3848643/nc2=5191951/nc3=5191950> > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2012 Report Share Posted June 12, 2012 Hope he can get it. I no longer have access thru a Medical School. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jun 12, 2012, at 12:42, <jclark24p@...> wrote: Here is the abstract, maybe can retrieve the whole article. http://www.ncbi.nlm.nih.gov/pubmed?term=Longo%20DL%2C%20Esterly%20JA%2C%20Grim%20CE%2C%20Keitzer%20WF Pathology of the adrenal gland in refractory low-renin hypertension. Longo DL, Esterly JA, Grim CE, Keitzer WF. PMID: 580727 [PubMed - indexed for MEDLINE] > > > > > > > > > > > > You will want to have some help with the children for a few > > days. If your > > > > > > other adrenal develops an adenoma, the treatment is a > > mineralocorticoid > > > > > > blocker (spiro or Inspra), not a steroid. > > > > > > > > > > > > > > > > > > > > > > > > Val > > > > > > > > > > > > > > > > > > > > > > > > From: hyperaldosteronism > > > > > > [mailto:hyperaldosteronism ] On Behalf Of Sara > > > > > > > > > > > > > > > > > > Hi everyone! I just got my test results back from my adrenal > > vein sampling. > > > > > > The excess aldosterone is coming from the left adrenal (35 x > > higher), which > > > > > > is the one with the 1 cm tumor. I am going to have an > > adrenalectomy. Any > > > > > > tips on recovery? I have a toddler and a baby and was just > > wondering what I > > > > > > should expect. Also I am worried that if I get one adrenal > > out at such a > > > > > > young age (31) if something could go wrong with the other > > adrenal down the > > > > > > road. I don't want to have to be stuck on steroids or > > anything. Any advice > > > > > > is greatly appreciated. So glad to have this group. > > > > > > > > > > > > . > > > > > > > > > > > > > > > > > > <http://geo./serv?s=97359714/grpId=7299303/grpspId=1705132763/msgId > > > > > > =43906/stime=1339162511/nc1=3848643/nc2=5191951/nc3=5191950> > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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