AVS without ACTH

[Guest guest]

Hi everyone, I hope you are all enjoying your summer. I had my AVS last week

Wed. I am still awaiting results. However, I just read in a response to

Virginia Wall to make sure they use ACTH. (By the way, good luck Virginia...it

was a piece of cake!) Anyway, I am about to cry. The interventional

radiologist that did my AVS, specifically said he does NOT use ACTH. He said

something to the affect that if they use ACTH they get more inconclusive results

than with ACTH. The percentage of difference needs to be MUCH higher with ACTH

than without. I can't remember the percentages off hand, but it was a major

difference. He also said there could be problems if too much ACTH was used,

etc. In his opinion the risk outweighed the benefit (which he never actually

told me what the " benefit " would be). I finally felt like I found a good doctor

because he was so careful to explain this to me and it seemed perfectly logical.

Aaagghhh!! Can someone explain to me why ACTH SHOULD be used? Any idea what

the chances are of my AVS results being accurate considering it was not used?

39 y/o female (almost 40)

2cm adenoma on left adrenal

Currently on SEVEN 20meg K supplements per day

Verapamil SR 180 mg

BP creeping back up into high 140's/80s or 90s

[Guest guest]

, please review this article, it's probably better than a "chill pill"! :

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2930893/?tool=pubmed

Consequences of Adrenal Venous Sampling in Primary Hyperaldosteronism and Predictors of Unilateral Adrenal Disease

Note: One of the authors, Dr. E. Chang, is the IR at NIH and does most if not all AVSs done there. The day he did mine I was the third case that day - he knows what he is talking about! (I personally think if you have an experienced IR you are better off letting him do what he is comfortable with. He knows how to do and interpret his procedure.)

You will be well served if you skip directly to the discussion and note "Moreover, the most accurate measurement for AVS lateralization was the post-ACTH stimulation AC ratio, although a majority of patients can be localized without ACTH stimulation" and "pre-ACTH stimulation values successfully lateralized in 95% of patients, and the addition of ACTH allowed 98% of patients to lateralize"

>> Hi everyone, I hope you are all enjoying your summer. I had my AVS last week Wed. I am still awaiting results. However, I just read in a response to Virginia Wall to make sure they use ACTH. (By the way, good luck Virginia...it was a piece of cake!) Anyway, I am about to cry. The interventional radiologist that did my AVS, specifically said he does NOT use ACTH. He said something to the affect that if they use ACTH they get more inconclusive results than with ACTH. The percentage of difference needs to be MUCH higher with ACTH than without. I can't remember the percentages off hand, but it was a major difference. He also said there could be problems if too much ACTH was used, etc. In his opinion the risk outweighed the benefit (which he never actually told me what the "benefit" would be). I finally felt like I found a good doctor because he was so careful to explain this to me and it seemed perfectly logical. Aaagghhh!! Can someone explain to me why ACTH SHOULD be used? Any idea what the chances are of my AVS results being accurate considering it was not used?> > > 39 y/o female (almost 40)> 2cm adenoma on left adrenal> Currently on SEVEN 20meg K supplements per day> Verapamil SR 180 mg> BP creeping back up into high 140's/80s or 90s>

[Guest guest]

Thanks . , If I understood this article correctly, it seems as though the radiologist was able to get conclusive results in 's case even without ACTH? Since it appears she successfully "lateralized"? How do we know if the results were innaccurate? Sorry, I am trying to learn but a lot of this is still too technical for me. I appreciate the question because I've been wondering myself. , were you DASHing before your AVS?Virginia Wall31 year old femaleDASHingAVS scheduled June 27, 2012 at BJC Hospital St. Louis, MO3 cm adenoma in right adrenalDiagnosed February 2012Low K & High BP since appx. 2007Possible family history of hyperaldosteronismMeds: K Cl 20 meq 2 tabs bidPrenatal vitaminBreastfeeding; 5 month old with G6PDDOn Jun 12, 2012, at 8:57 PM, " " <jclark24p@...> wrote:

, please review this article, it's probably better than a "chill pill"! :

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2930893/?tool=pubmed

Consequences of Adrenal Venous Sampling in Primary Hyperaldosteronism and Predictors of Unilateral Adrenal Disease

Note: One of the authors, Dr. E. Chang, is the IR at NIH and does most if not all AVSs done there. The day he did mine I was the third case that day - he knows what he is talking about! (I personally think if you have an experienced IR you are better off letting him do what he is comfortable with. He knows how to do and interpret his procedure.)

You will be well served if you skip directly to the discussion and note "Moreover, the most accurate measurement for AVS lateralization was the post-ACTH stimulation AC ratio, although a majority of patients can be localized without ACTH stimulation" and "pre-ACTH stimulation values successfully lateralized in 95% of patients, and the addition of ACTH allowed 98% of patients to lateralize"

>> Hi everyone, I hope you are all enjoying your summer. I had my AVS last week Wed. I am still awaiting results. However, I just read in a response to Virginia Wall to make sure they use ACTH. (By the way, good luck Virginia...it was a piece of cake!) Anyway, I am about to cry. The interventional radiologist that did my AVS, specifically said he does NOT use ACTH. He said something to the affect that if they use ACTH they get more inconclusive results than with ACTH. The percentage of difference needs to be MUCH higher with ACTH than without. I can't remember the percentages off hand, but it was a major difference. He also said there could be problems if too much ACTH was used, etc. In his opinion the risk outweighed the benefit (which he never actually told me what the "benefit" would be). I finally felt like I found a good doctor because he was so careful to explain this to me and it seemed perfectly logical. Aaagghhh!! Can someone explain to me why ACTH SHOULD be used? Any idea what the chances are of my AVS results being accurate considering it was not used?> > > 39 y/o female (almost 40)> 2cm adenoma on left adrenal> Currently on SEVEN 20meg K supplements per day> Verapamil SR 180 mg> BP creeping back up into high 140's/80s or 90s>

[Guest guest]

Hi , thank you so much for the article. I feel much better now!! Yes...better than a chill pill. I really appreciate you taking the time to find it and send it. Dr. Grimm, I will post my AVS results as soon as I receive them. Virginia, no I haven't been dashing, my Endo told me not to dash prior to the 4 hour suppression test, and then with the AVS coming up, I figured I probably shouldn't "change" anything in my diet for fear of messing up the test. Did your endo tell you whether or not to dash prior to AVS? You mentioned in another post about your eyes watering...I am not on spiro, but my eyes have been watery, blurry and take a long time to adjust from

sunlight to inside light. I have an appt with an opthamologist next week. I am pretty sure that this has something to do with PA as these symptoms started at the exact same time as everything else (constipation, palpatations, HTN, etc). I had no other health issues. > > 39 y/o female (almost 40)> 2cm adenoma on left adrenal> Currently on SEVEN 20meg K supplements per day> Verapamil SR 180 mg> BP creeping back up into high 140's/80s or 90s From: <jclark24p@...> hyperaldosteronism Sent: Tuesday, June 12, 2012 8:57 PM Subject: Re: AVS without ACTH

, please review this article, it's probably better than a "chill pill"! :

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2930893/?tool=pubmed

Consequences of Adrenal Venous Sampling in Primary Hyperaldosteronism and Predictors of Unilateral Adrenal Disease

Note: One of the authors, Dr. E. Chang, is the IR at NIH and does most if not all AVSs done there. The day he did mine I was the third case that day - he knows what he is talking about! (I personally think if you have an experienced IR you are better off letting him do what he is comfortable with. He knows how to do and interpret his procedure.)

You will be well served if you skip directly to the discussion and note "Moreover, the most accurate measurement for AVS lateralization was the post-ACTH stimulation AC ratio, although a majority of patients can be localized without ACTH stimulation" and "pre-ACTH stimulation values successfully lateralized in 95% of patients, and the addition of ACTH allowed 98% of patients to lateralize"

>> Hi everyone, I hope you are all enjoying your summer. I had my AVS last week Wed. I am still awaiting results. However, I just read in a response to Virginia Wall to make sure they use ACTH. (By the way, good luck Virginia...it was a piece of cake!) Anyway, I am about to cry. The interventional radiologist that did my AVS, specifically said he does NOT use ACTH. He said something to the affect that if they use ACTH they get more inconclusive results than with ACTH. The percentage of difference needs to be MUCH higher with ACTH than without. I can't remember the percentages off hand, but it was a major difference. He also said there could be problems if too much ACTH was used, etc. In his opinion the risk outweighed the benefit (which he never actually told me what the "benefit" would be). I finally felt like I found a good doctor because he was

so careful to explain this to me and it seemed perfectly logical. Aaagghhh!! Can someone explain to me why ACTH SHOULD be used? Any idea what the chances are of my AVS results being accurate considering it was not used?> > > 39 y/o female (almost 40)> 2cm adenoma on left adrenal> Currently on SEVEN 20meg K supplements per day> Verapamil SR 180 mg> BP creeping back up into high 140's/80s or 90s>

[Guest guest]

1 cup Low Na V8 is one L pill but 7 cups would also use up your Na for the day. And skin might turn yellow. On the other have would have less ClMay your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jun 13, 2012, at 19:00, " J." <jessdell72@...> wrote:

Hi , thank you so much for the article. I feel much better now!! Yes...better than a chill pill. I really appreciate you taking the time to find it and send it. Dr. Grimm, I will post my AVS results as soon as I receive them. Virginia, no I haven't been dashing, my Endo told me not to dash prior to the 4 hour suppression test, and then with the AVS coming up, I figured I probably shouldn't "change" anything in my diet for fear of messing up the test. Did your endo tell you whether or not to dash prior to AVS? You mentioned in another post about your eyes watering...I am not on spiro, but my eyes have been watery, blurry and take a long time to adjust from

sunlight to inside light. I have an appt with an opthamologist next week. I am pretty sure that this has something to do with PA as these symptoms started at the exact same time as everything else (constipation, palpatations, HTN, etc). I had no other health issues. > > 39 y/o female (almost 40)> 2cm adenoma on left adrenal> Currently on SEVEN 20meg K supplements per day> Verapamil SR 180 mg> BP creeping back up into high 140's/80s or 90s

From: <jclark24p@...> hyperaldosteronism Sent: Tuesday, June 12, 2012 8:57 PM Subject: Re: AVS without ACTH

, please review this article, it's probably better than a "chill pill"! :

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2930893/?tool=pubmed

Consequences of Adrenal Venous Sampling in Primary Hyperaldosteronism and Predictors of Unilateral Adrenal Disease

Note: One of the authors, Dr. E. Chang, is the IR at NIH and does most if not all AVSs done there. The day he did mine I was the third case that day - he knows what he is talking about! (I personally think if you have an experienced IR you are better off letting him do what he is comfortable with. He knows how to do and interpret his procedure.)

You will be well served if you skip directly to the discussion and note "Moreover, the most accurate measurement for AVS lateralization was the post-ACTH stimulation AC ratio, although a majority of patients can be localized without ACTH stimulation" and "pre-ACTH stimulation values successfully lateralized in 95% of patients, and the addition of ACTH allowed 98% of patients to lateralize"

>> Hi everyone, I hope you are all enjoying your summer. I had my AVS last week Wed. I am still awaiting results. However, I just read in a response to Virginia Wall to make sure they use ACTH. (By the way, good luck Virginia...it was a piece of cake!) Anyway, I am about to cry. The interventional radiologist that did my AVS, specifically said he does NOT use ACTH. He said something to the affect that if they use ACTH they get more inconclusive results than with ACTH. The percentage of difference needs to be MUCH higher with ACTH than without. I can't remember the percentages off hand, but it was a major difference. He also said there could be problems if too much ACTH was used, etc. In his opinion the risk outweighed the benefit (which he never actually told me what the "benefit" would be). I finally felt like I found a good doctor because he was

so careful to explain this to me and it seemed perfectly logical. Aaagghhh!! Can someone explain to me why ACTH SHOULD be used? Any idea what the chances are of my AVS results being accurate considering it was not used?> > > 39 y/o female (almost 40)> 2cm adenoma on left adrenal> Currently on SEVEN 20meg K supplements per day> Verapamil SR 180 mg> BP creeping back up into high 140's/80s or 90s>