Introduction

[Guest guest]

Welcome Glen! This is the place to go to source just about everything you need

food wise ( and lots of things you don't need but definitely want- lol). Check

out the files section for everything from farmer listings to local restaurants,

but of course don't hesitate to just ask on the board too. You'll find that

everyone is ready to help or give some advice whenever it's needed.

Susie Zahratka

[Guest guest]

Thanks, Susie I hope to find all kinds of stuff here.

Incidentally, are you the Susie who left a message on my phone this morning

about the suet? I haven't had a moment to get back to you just yet if you

are....

.... and thanks for the invite, Carolyn I doubt I'll be able to make that, but

thank you for the consideration anyway.

--Glen

[Guest guest]

That's me:)

Talk soon-

Susie

>

[Guest guest]

Yup, I made it!

I've already hit the database a couple of times. There's a bit of stuff in there

to wade thru... I doubt I could even think up a question that hasn't been asked.

One day, though.

Glen

[Guest guest]

I found my way here thru the Wayward Bus blog, which I stumbled upon last night

after getting my CT results back and discovering an answer to my ridiculously

high blood pressure Really enjoyed reading her story.

I am female, 41 years old, with a BMI in the high end of the normal range (5'5 "

155 lbs). I am very active, getting my heart rate up to avg 150 for 45 minutes

at least 4 times a week. I don't smoke or drink, nor do I eat lots of fast

food/processed food.

My blood pressure average is 160/100. My potassium (K) level has been low for

over 2 years. Low K was discovered after I had severe heart palpitations and my

doctor ran a blood test. I have been taking K supplements for quite a while,

admittedly not always faithfully. The BP was thought to just be doctor white

coat fear, not real, so was brushed off (and granted, I allowed that brush off).

My general doctor this year at my checkup insisted I needed to get an answer to

the high BP and sent me to a nephrologist. A young and curious fellow, the

nephrologist took my nicely put together chart of my blood work history, BP

history and looked it over. He suggested there was a chance this was no " run of

the mill " hypertension, but something with a cause. He mentioned the words

Conn's Syndrome.

He ordered bloodwork checks of renin, aldosterone and the ratio one. Sure

enough, aldosterone came back high. He also sent me for a renal duplex

ultrasound to check kidney function. While that was great (yay for good kidney

function!) masses on my liver were a concern enough that he sent me for a C/T

scan of abdomen and pelvis. THAT turned up hepatic hemangioma (benign, Mom also

has) and ....a 2 cm right adrenal adenoma.

I started taking spirolactone last week in advance of the C/T results and my

blood pressure is some lower (145/90). I am not having any side effects from the

med, but I'd rather not be on it for life. I am thinking I would like to get rid

of this adrenal adenoma and " fix " the cause of this BP, heart palpitations and

the inability to shake off weight. I also have always had issues with blood

sugar swings. I meet with the nephologist again next Friday. I assume he'll

point me over to an endocrinologist.

My question to the group is - Any recommendation for an endocrinologist in NJ? I

need one that works with my insurance, but I'll take any name you have. If

possible I'd like to keep the adrenal gland and just lose the tumor, but that

may not be possible.

Thanks!

Jill

[Guest guest]

Hi Jill, and welcome! That's my blog, I'm happy to see that it helped you find

your way here.

Even though this group is moderated by an endocrinologist, I have to say that my

experiences with endos and PA were pretty negative. The average endo knows

diabetes and not much else - a broad generalization but I've been to a few who

are professors at med schools here in SoCal, and they were all clueless. In my

case, it was a nephrologist who knew about PA.

You already know you have an adenoma; if you wish to pursue surgery, the next

step will probably be a saline suppression test, followed by AVS. Your neph can

order the saline test; you'll need an interventional radiologist for AVS.

If AVS indicates you are a candidate for surgery, then you will need an

endocrine surgeon (not an endocrinologist).

Having just started spiro kinda throws a monkey wrench into things - for AVS,

you need to be off of it for at least 6 weeks.

As for keeping the adrenal gland - while I know there is at least one person on

this board who had the tumor removed but not the whole gland, this isn't

commonly done in the U.S. Further, there is a strong possibility that if there

is one tumor, there are others in the same gland that are too small to be

detected via imaging.

Hopefully someone on your side of the country can give you some recommendations.

-msmith1928

Left laparoscopic adrenalectomy 10/13/11

>

> I found my way here thru the Wayward Bus blog, which I stumbled upon last

night after getting my CT results back and discovering an answer to my

ridiculously high blood pressure Really enjoyed reading her story.

>

> I am female, 41 years old, with a BMI in the high end of the normal range

(5'5 " 155 lbs). I am very active, getting my heart rate up to avg 150 for 45

minutes at least 4 times a week. I don't smoke or drink, nor do I eat lots of

fast food/processed food.

>

> My blood pressure average is 160/100. My potassium (K) level has been low for

over 2 years. Low K was discovered after I had severe heart palpitations and my

doctor ran a blood test. I have been taking K supplements for quite a while,

admittedly not always faithfully. The BP was thought to just be doctor white

coat fear, not real, so was brushed off (and granted, I allowed that brush off).

>

> My general doctor this year at my checkup insisted I needed to get an answer

to the high BP and sent me to a nephrologist. A young and curious fellow, the

nephrologist took my nicely put together chart of my blood work history, BP

history and looked it over. He suggested there was a chance this was no " run of

the mill " hypertension, but something with a cause. He mentioned the words

Conn's Syndrome.

>

> He ordered bloodwork checks of renin, aldosterone and the ratio one. Sure

enough, aldosterone came back high. He also sent me for a renal duplex

ultrasound to check kidney function. While that was great (yay for good kidney

function!) masses on my liver were a concern enough that he sent me for a C/T

scan of abdomen and pelvis. THAT turned up hepatic hemangioma (benign, Mom also

has) and ....a 2 cm right adrenal adenoma.

>

> I started taking spirolactone last week in advance of the C/T results and my

blood pressure is some lower (145/90). I am not having any side effects from the

med, but I'd rather not be on it for life. I am thinking I would like to get rid

of this adrenal adenoma and " fix " the cause of this BP, heart palpitations and

the inability to shake off weight. I also have always had issues with blood

sugar swings. I meet with the nephologist again next Friday. I assume he'll

point me over to an endocrinologist.

>

> My question to the group is - Any recommendation for an endocrinologist in NJ?

I need one that works with my insurance, but I'll take any name you have. If

possible I'd like to keep the adrenal gland and just lose the tumor, but that

may not be possible.

>

> Thanks!

> Jill

>

[Guest guest]

See attached excel spread sheet you can use.Some of it will be redundent as it is our data base we ask you to fill out when you first join us.CE Grim MD

On Jul 21, 2012, at 8:08 PM, NJ Roadie wrote:

Little frustrated I cannot get this (below blood test results) to format properly. I have it in an Excel spreadsheet if you'd like to see it.

The first test I had (renal duplex doppler/ultrasound) showed normal kidney function and no renal artery stenosis. Blood tests done the same day showed elevated Aldosterone, and I think the Renin Activity was whacked too.

Because the renal artery ultrasound showed masses on my liver, I had an abdominal C/T, which is when the adrenal adenoma was spotted (right side, 2 cm). Hepatic hemangioma was the call on the liver masses.

The low potassium was picked up for the first time in August 2010, although I had serious heart palpitations in March 2010.

As far as what stage I'm at (from reading your Evolution...pdf) I am really unsure. I am definitely not feeling ill or unwell, although I am annoyed by the heart palpitations and the inability to drop weight even with lots of exercise and an excellent diet.

I have not done any urine tests to be able to say where my results line up. My blood pressure has definitely been impacted hugely in the last 2 years since I believe this started.

Here are some test results:

Test Date 7-12 5-12 4-11 2-11 8-10 3-10

Aldosterone LCMS,

Serum Aldo. 0.0 - 30.0 32.7 n/a n/a n/a n/a n/a

Renin Activity, Plasma <0.15 n/a n/a n/a n/a n/a

Vitamin D 30.0-100 18.8 n/a n/a n/a n/a n/a

Glucose, Serum 65-99 96 90 113 85 85 87

Sodium, Serum 135-145 140 141 142 140 139 142

Potassium, Serum 3.5-5.2 3.7 2.9 3 3 3.4 4.1

Chloride, Serum 97-108 102 100 101 99 100 103

Jill

41 y, mother of 1.

2 years low K (2.9 was my low)

BP avg 155/100

On 25 mg Spiro for just 1 week

Drink little else but regular water from our well

(no coffee, soda, juice etc.)

Eat homemade granola for breakfast, fruit

Eat homemade soup for lunch nearly every day, fruit

Cook dinner every night for family, lots of fresh veggies

Active gym rat, exercising 4-5 times a week intensely, last two weeks have doubled up on workouts 2x a week (7 am and noon) but no weight loss.

[Guest guest]

Answer are inline: From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Clarence GrimSent: 2012-Jul-21 Saturday 20:36hyperaldosteronism Cc: Clarence GrimSubject: Re: Re: Introduction Was metformin stopped?[Max] Metformin was just started close to the time of NP59. What other meds were changed just before and after the drop in eGFR.[Max] Spiro increased from 25 to 50 to 75 to 100. Was you BP a lot lower when e GFR dropped?[Max] BP dropped after Spiro reached 100. CE Grim MDOn Jul 21, 2012, at 8:02 PM, medstatinternational wrote:99mTc-MAG3

[Guest guest]

Stil on Metformin?So fall in eGFR could be related to fall in BP finally when correct Rx was found. It is often the case that as the renal damage from HTN heals the eGFR improves. Can you plot BPs and eGFR and med doses.thanksCE Grim MDOn Jul 21, 2012, at 10:04 PM, MedStat wrote:

Answer are inline: From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Clarence GrimSent: 2012-Jul-21 Saturday 20:36hyperaldosteronism Cc: Clarence GrimSubject: Re: Re: Introduction Was metformin stopped?[Max] Metformin was just started close to the time of NP59. What other meds were changed just before and after the drop in eGFR.[Max] Spiro increased from 25 to 50 to 75 to 100. Was you BP a lot lower when e GFR dropped?[Max] BP dropped after Spiro reached 100. CE Grim MDOn Jul 21, 2012, at 8:02 PM, medstatinternational

wrote:99mTc-MAG3

[Guest guest]

Reply is inline: From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Clarence GrimSent: 2012-Jul-21 Saturday 21:10hyperaldosteronism Cc: Clarence GrimSubject: Re: Re: Introduction Stil on Metformin?[Max] Yes, Metf=500 bid steady since 4 months prior to NP59 scintiscan. So fall in eGFR could be related to fall in BP finally when correct Rx was found. It is often the case that as the renal damage from HTN heals the eGFR improves. [Max] Recent fluctuations in eGFR look strange! Can you plot BPs and eGFR and med doses.[Max] yes, but will look a congested plot! thanks CE Grim MDOn Jul 21, 2012, at 10:04 PM, MedStat wrote: Answer are inline: From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Clarence GrimSent: 2012-Jul-21 Saturday 20:36hyperaldosteronism Cc: Clarence GrimSubject: Re: Re: Introduction Was metformin stopped?[Max] Metformin was just started close to the time of NP59. What other meds were changed just before and after the drop in eGFR.[Max] Spiro increased from 25 to 50 to 75 to 100. Was you BP a lot lower when e GFR dropped?[Max] BP dropped after Spiro reached 100. < p class= " MsoNormal " >CE Grim MDOn Jul 21, 2012, at 8:02 PM, medstatinternational wrote:99mTc-MAG3

[Guest guest]

Dr. Grim,Here is my chart of systolic bp & eGFR monthly means. Statins not included and only major dose changes recorded eliminating minor changes.I noticed that my eGFR with high bp prior to starting medications was in better shape than on medications....actually it appears that medications damaged my kidneys !!!sudden eGFR drop after 2010-Jan might be due to Spiro 100 rather than NP59.eGFR tests (CREAT) are done monthly after 2010...this might be the cause that pronounces fluctuations in eGFR???

Max.

62M HTN (since < c1995, dx 1999) L adenoma by NP59 scan.

Aldos=1065…2056 [28-860] pmol/L, Renin=6 [<30] ng/L (dx 2009). med

combo #79={Spiro=100, Amlo=5mg bid, Indap=2.5mg, Ramip=2.5mg bid, Metf=500mg bid, Crestor=20mg, Feno=67mg,

K.Cl=2x20mEq tid, Motilium=10mg, B12=1000µg/m}{K=4.5}{not DASHing but low-salt

diet just slightly above salt craving while keeping K/Na ratio high, heat

intolerance, insulin resistance, tingling right leg & hand reduced by B12,

BMI=30, non-smoker, non-alcoholic, no history of MI}

> > > > > > > 99mTc-MAG3>

[Guest guest]

1. When BP is high it damages the kidney mostly by causing constriction of the afferent art going into the glomeulus. This is controlled in part by the level of renin. 2. The ability of the kidney to clear creatinine from the blood is related to the pressure driving the plasma filtrate thru the glomerular basement membrane and the number/state of the glomeruli. Dead glomeruli do not filter. Damaged ones filter less. DM can damage then as can HTN. Both may be associated with albumin in the urine (high alb/cr ratio in the urine). High salt diet by itself will affect abluminuria as well. some drugs and contrast agents may also damage the glomeruli. 3. Thus when a previously high BP is suddenly lowered the clearance of creatinine decreases as the driving pressure falls.4. A normal kidney can quickly adjust the control of glomerular pressure thru several mechanisms when systemic pressure falls. The details can be found in any good physiology book.5. If the damage from the HTN heals over time with the fall in pressure the GFR may increase back to normal.6. Day to day fluctuations in plasma Cr and thus eGFR can be affected by time of day, by hydration state, by position say supine overnight vs standing ever for a few minutes and by the control mechanisms going on at the efferent and afferent arterioles of the glomerulus.7. ACEs and ARBs particularly can do this. As they affect the RASS (block) and may lead to a fall in kidney eGFR. If there is severe bilat renal art stenosis acute renal failure can occur.On Jul 22, 2012, at 12:15 AM, medstatinternational wrote:

Dr. Grim,Here is my chart of systolic bp & eGFR monthly means. Statins not included and only major dose changes recorded eliminating minor changes.I noticed that my eGFR with high bp prior to starting medications was in better shape than on medications....actually it appears that medications damaged my kidneys !!!sudden eGFR drop after 2010-Jan might be due to Spiro 100 rather than NP59.eGFR tests (CREAT) are done monthly after 2010...this might be the cause that pronounces fluctuations in eGFR???

Max.62M HTN (since < c1995, dx 1999) L adenoma by NP59 scan.

Aldos=1065…2056 [28-860] pmol/L, Renin=6 [<30] ng/L (dx 2009). med

combo #79={Spiro=100, Amlo=5mg bid, Indap=2.5mg, Ramip=2.5mg bid, Metf=500mg bid, Crestor=20mg, Feno=67mg,

K.Cl=2x20mEq tid, Motilium=10mg, B12=1000µg/m}{K=4.5}{not DASHing but low-salt

diet just slightly above salt craving while keeping K/Na ratio high, heat

intolerance, insulin resistance, tingling right leg & hand reduced by B12,

BMI=30, non-smoker, non-alcoholic, no history of MI}

> > > > > > > 99mTc-MAG3>

[Guest guest]

I forgot to mention that hyper filtration due to HTN MAY be one of the mechanism of injury to the kidney. This is seen in DM early. Ie high eGFR EARLYMay your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jul 22, 2012, at 0:15, medstatinternational <medstat@...> wrote:

Dr. Grim,Here is my chart of systolic bp & eGFR monthly means. Statins not included and only major dose changes recorded eliminating minor changes.I noticed that my eGFR with high bp prior to starting medications was in better shape than on medications....actually it appears that medications damaged my kidneys !!!sudden eGFR drop after 2010-Jan might be due to Spiro 100 rather than NP59.eGFR tests (CREAT) are done monthly after 2010...this might be the cause that pronounces fluctuations in eGFR???

Max.

62M HTN (since < c1995, dx 1999) L adenoma by NP59 scan.

Aldos=1065…2056 [28-860] pmol/L, Renin=6 [<30] ng/L (dx 2009). med

combo #79={Spiro=100, Amlo=5mg bid, Indap=2.5mg, Ramip=2.5mg bid, Metf=500mg bid, Crestor=20mg, Feno=67mg,

K.Cl=2x20mEq tid, Motilium=10mg, B12=1000µg/m}{K=4.5}{not DASHing but low-salt

diet just slightly above salt craving while keeping K/Na ratio high, heat

intolerance, insulin resistance, tingling right leg & hand reduced by B12,

BMI=30, non-smoker, non-alcoholic, no history of MI}

> > > > > > > 99mTc-MAG3>

[Guest guest]

Dr. Grim, Did you really mean high eGFR early? Or is it a typo? Max. From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Clarence GrimSent: 2012-Jul-22 Sunday 06:36hyperaldosteronism Subject: Re: Re: Introduction I forgot to mention that hyper filtration due to HTN MAY be one of the mechanism of injury to the kidney. This is seen in DM early. Ie high eGFR EARLY May your pressure be low! CE Grim MS, MDSpecializing in DifficultHypertensionOn Jul 22, 2012, at 0:15, medstatinternational <medstat@...> wrote: Dr. Grim,Here is my chart of systolic bp & eGFR monthly means. Statins not included and only major dose changes recorded eliminating minor changes.I noticed that my eGFR with high bp prior to starting medications was in better shape than on medications....actually it appears that medications damaged my kidneys !!!sudden eGFR drop after 2010-Jan might be due to Spiro 100 rather than NP59.eGFR tests (CREAT) are done monthly after 2010...this might be the cause that pronounces fluctuations in eGFR???Max.62M HTN (since < c1995, dx 1999) L adenoma by NP59 scan. Aldos=1065…2056 [28-860] pmol/L, Renin=6 [<30] ng/L (dx 2009). med combo #79={Spiro=100, Amlo=5mg bid, Indap=2.5mg, Ramip=2.5mg bid, Metf=500mg bid, Crestor=20mg, Feno=67mg, K.Cl=2x20mEq tid, Motilium=10mg, B12=1000µg/m}{K=4.5}{not DASHing but low-salt diet just slightly above salt craving while keeping K/Na ratio high, heat intolerance, insulin resistance, tingling right leg & hand reduced by B12, BMI=30, non-smoker, non-alcoholic, no history of MI}> > > > > > > 99mTc-MAG3>