Necessity of AVS test if CT shows adenoma?

[Guest guest]

Dr. Grim what is your opinion on the need for the AVS test if the one adrenal

gland is " normal " on CT but the other shows an adenoma (2cm?)

I see Dr. Reid of (Camden NJ) in late August. She lists herself as a

Conn specialist, endocrine doc and surgeon. Just trying to get an idea of your

opinion on the AVS.

Thanks

Jill

2cm left adenoma found via CT scan July 2012

32 aldosterone/

low K for 2+years

155/100 bp avg

[Guest guest]

Jill, a CT or MRI does not tell you if an Adrenal is " normal " or not. All it

tells you is whether they can see a tumor or not and often a real small one is

missed or not visible. (It is amazing what a real experienced doctor can see

but they see 1000's of them a year!)

Based on your age they may recommend skipping the AVS all together if you are

under 40. (This is a cost saving for insurance companies and MOST of the time

they are right, IMHO!) You also avoid the risks associated with the procedure.

Dr. Grim will recommend skipping the procedure because he recommends treating

with medicine and diet and proceeding to AVS only if that doesn't work. You

need to look at the whole picture and decide what is best for you. Isn't this

game fun!

>

> Dr. Grim what is your opinion on the need for the AVS test if the one adrenal

gland is " normal " on CT but the other shows an adenoma (2cm?)

>

> I see Dr. Reid of (Camden NJ) in late August. She lists herself as

a Conn specialist, endocrine doc and surgeon. Just trying to get an idea of your

opinion on the AVS.

>

> Thanks

> Jill

>

> 2cm left adenoma found via CT scan July 2012

> 32 aldosterone/

> low K for 2+years

> 155/100 bp avg

>

[Guest guest]

The issue is how certain do you want to be that the surgery will help.Ask her her 1, 5 and 10 year cure rates based on the local AVS expert data.I would not recommend surgery without it.

Clarence Grim MDlowerbp2@...

On Jul 31, 2012, at 10:01 PM, NJ Roadie wrote:

Dr. Grim what is your opinion on the need for the AVS test if the one adrenal gland is "normal" on CT but the other shows an adenoma (2cm?)

I see Dr. Reid of (Camden NJ) in late August. She lists herself as a Conn specialist, endocrine doc and surgeon. Just trying to get an idea of your opinion on the AVS.

Thanks

Jill

2cm left adenoma found via CT scan July 2012

32 aldosterone/

low K for 2+years

155/100 bp avg

[Guest guest]

And need a better thumbnail-no age no renin eg.

Clarence Grim MD

On Aug 1, 2012, at 12:52 AM, wrote:

Jill, a CT or MRI does not tell you if an Adrenal is "normal" or not. All it tells you is whether they can see a tumor or not and often a real small one is missed or not visible. (It is amazing what a real experienced doctor can see but they see 1000's of them a year!)

Based on your age they may recommend skipping the AVS all together if you are under 40. (This is a cost saving for insurance companies and MOST of the time they are right, IMHO!) You also avoid the risks associated with the procedure.

Dr. Grim will recommend skipping the procedure because he recommends treating with medicine and diet and proceeding to AVS only if that doesn't work. You need to look at the whole picture and decide what is best for you. Isn't this game fun!

>

> Dr. Grim what is your opinion on the need for the AVS test if the one adrenal gland is "normal" on CT but the other shows an adenoma (2cm?)

>

> I see Dr. Reid of (Camden NJ) in late August. She lists herself as a Conn specialist, endocrine doc and surgeon. Just trying to get an idea of your opinion on the AVS.

>

> Thanks

> Jill

>

> 2cm left adenoma found via CT scan July 2012

> 32 aldosterone/

> low K for 2+years

> 155/100 bp avg

>

[Guest guest]

I'm 41, and my renin was <.15 or something like that. It was a weird number with

no reference of " normal range " that I could see.

> > >

> > > Dr. Grim what is your opinion on the need for the AVS test if the one

adrenal gland is " normal " on CT but the other shows an adenoma (2cm?)

> > >

> > > I see Dr. Reid of (Camden NJ) in late August. She lists

herself as a Conn specialist, endocrine doc and surgeon. Just trying to get an

idea of your opinion on the AVS.

> > >

> > > Thanks

> > > Jill

> > >

> > > 2cm left adenoma found via CT scan July 2012

> > > 32 aldosterone/

> > > low K for 2+years

> > > 155/100 bp avg

> > >

> >

> >

>

[Guest guest]

Like said earlier, there is an accepted cutoff of skipping AVS up to age

40. I was 45 at the time of my diagnosis and even in my advanced age, I was

offered the option to skip AVS, since on CT my left adrenal had a clear tumor

and was enlarged and misshapen, while my right appeared " normal, " whatever that

means.

However, I *insisted* on AVS, because really - before being cut open and having

parts removed, wouldn't *any* reasonable person want to know as much as possible

about the parts in question?? I know I did. And I was scared out of my wits at

first since I had read my share of AVS horror stories, but really - no big deal

at all. I had to have it twice, in fact, since the first time was done wrong,

but in both cases it was done on Friday, I slept most of Saturday, was back to

my normal routine on Sunday, and back to work on Monday.

Nothing to be afraid of - except for an inexperienced medical team! As long as

your team knows what they are doing, it seems all will go well. It's the

unfortunate folks with inexperienced doctors who seem to have the stories to

tell afterward.

-msmith1928

Left laparoscopic adrenalectomy 10/13/11

> > > >

> > > > Dr. Grim what is your opinion on the need for the AVS test if the one

adrenal gland is " normal " on CT but the other shows an adenoma (2cm?)

> > > >

> > > > I see Dr. Reid of (Camden NJ) in late August. She lists

herself as a Conn specialist, endocrine doc and surgeon. Just trying to get an

idea of your opinion on the AVS.

> > > >

> > > > Thanks

> > > > Jill

> > > >

> > > > 2cm left adenoma found via CT scan July 2012

> > > > 32 aldosterone/

> > > > low K for 2+years

> > > > 155/100 bp avg

> > > >

> > >

> > >

> >

>

[Guest guest]

Thanks for the info. Wasn't there a study about the need for the AVS to

determine with certainty that the overactive adrenal was identified correctly? I

can't seem to find it in the files section, do any of you remember what I'm

talking about?

Thanks

Jill

working on my thumbnail :0

age 41, 2 cm left adrenal adenoma

5'5, 150 pounds, brown hair ;0

> > > > >

> > > > > Dr. Grim what is your opinion on the need for the AVS test if the one

adrenal gland is " normal " on CT but the other shows an adenoma (2cm?)

> > > > >

> > > > > I see Dr. Reid of (Camden NJ) in late August. She lists

herself as a Conn specialist, endocrine doc and surgeon. Just trying to get an

idea of your opinion on the AVS.

> > > > >

> > > > > Thanks

> > > > > Jill

> > > > >

> > > > > 2cm left adenoma found via CT scan July 2012

> > > > > 32 aldosterone/

> > > > > low K for 2+years

> > > > > 155/100 bp avg

> > > > >

> > > >

> > > >

> > >

> >

>

[Guest guest]

I'm not sure what is in our files but it is easier for me to find it with Pubmed. Here you go:

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

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2930893/pdf/nihms206381.pdf

Dr. Chang is the doctor at NIH who has done a few thousand and had the privilege of doing mine!

....Jhn.

-- In hyperaldosteronism , "NJ Roadie" <junk@...> wrote:>> Thanks for the info. Wasn't there a study about the need for the AVS to determine with certainty that the overactive adrenal was identified correctly? I can't seem to find it in the files section, do any of you remember what I'm talking about?> > Thanks> Jill> working on my thumbnail :0> age 41, 2 cm left adrenal adenoma> 5'5, 150 pounds, brown hair ;0> > > > > > > > >> > > > > > Dr. Grim what is your opinion on the need for the AVS test if the one adrenal gland is "normal" on CT but the other shows an adenoma (2cm?)> > > > > > > > > > > > I see Dr. Reid of (Camden NJ) in late August. She lists herself as a Conn specialist, endocrine doc and surgeon. Just trying to get an idea of your opinion on the AVS.> > > > > > > > > > > > Thanks> > > > > > Jill> > > > > > > > > > > > 2cm left adenoma found via CT scan July 2012> > > > > > 32 aldosterone/> > > > > > low K for 2+years> > > > > > 155/100 bp avg> > > > > >> > > > > > > > > >> > > >> > >> >>

[Guest guest]

GOOD ADD TO THUMBNAIL.

Clarence Grim MDlowerbp2@...

On Aug 1, 2012, at 7:49 AM, NJ Roadie wrote:

I'm 41, and my renin was <.15 or something like that. It was a weird number with no reference of "normal range" that I could see.

> > >

> > > Dr. Grim what is your opinion on the need for the AVS test if the one adrenal gland is "normal" on CT but the other shows an adenoma (2cm?)

> > >

> > > I see Dr. Reid of (Camden NJ) in late August. She lists herself as a Conn specialist, endocrine doc and surgeon. Just trying to get an idea of your opinion on the AVS.

> > >

> > > Thanks

> > > Jill

> > >

> > > 2cm left adenoma found via CT scan July 2012

> > > 32 aldosterone/

> > > low K for 2+years

> > > 155/100 bp avg

> > >

> >

> >

>

[Guest guest]

If one is contemplating surgery I always recommend AVS unless patient is willing to accept a lower cure rate after surgery.CE Grim MD

Clarence Grim MDlowerbp2@...

On Aug 1, 2012, at 9:33 AM, msmith_1928 wrote:

Like said earlier, there is an accepted cutoff of skipping AVS up to age 40. I was 45 at the time of my diagnosis and even in my advanced age, I was offered the option to skip AVS, since on CT my left adrenal had a clear tumor and was enlarged and misshapen, while my right appeared "normal," whatever that means.

However, I *insisted* on AVS, because really - before being cut open and having parts removed, wouldn't *any* reasonable person want to know as much as possible about the parts in question?? I know I did. And I was scared out of my wits at first since I had read my share of AVS horror stories, but really - no big deal at all. I had to have it twice, in fact, since the first time was done wrong, but in both cases it was done on Friday, I slept most of Saturday, was back to my normal routine on Sunday, and back to work on Monday.

Nothing to be afraid of - except for an inexperienced medical team! As long as your team knows what they are doing, it seems all will go well. It's the unfortunate folks with inexperienced doctors who seem to have the stories to tell afterward.

-msmith1928

Left laparoscopic adrenalectomy 10/13/11

> > > >

> > > > Dr. Grim what is your opinion on the need for the AVS test if the one adrenal gland is "normal" on CT but the other shows an adenoma (2cm?)

> > > >

> > > > I see Dr. Reid of (Camden NJ) in late August. She lists herself as a Conn specialist, endocrine doc and surgeon. Just trying to get an idea of your opinion on the AVS.

> > > >

> > > > Thanks

> > > > Jill

> > > >

> > > > 2cm left adenoma found via CT scan July 2012

> > > > 32 aldosterone/

> > > > low K for 2+years

> > > > 155/100 bp avg

> > > >

> > >

> > >

> >

>

[Guest guest]

Yes that is the reason to do the AVS. CE Grim MD

Clarence Grim MDlowerbp2@...

On Aug 1, 2012, at 9:47 AM, NJ Roadie wrote:

Thanks for the info. Wasn't there a study about the need for the AVS to determine with certainty that the overactive adrenal was identified correctly? I can't seem to find it in the files section, do any of you remember what I'm talking about?

Thanks

Jill

working on my thumbnail :0

age 41, 2 cm left adrenal adenoma

5'5, 150 pounds, brown hair ;0

> > > > >

> > > > > Dr. Grim what is your opinion on the need for the AVS test if the one adrenal gland is "normal" on CT but the other shows an adenoma (2cm?)

> > > > >

> > > > > I see Dr. Reid of (Camden NJ) in late August. She lists herself as a Conn specialist, endocrine doc and surgeon. Just trying to get an idea of your opinion on the AVS.

> > > > >

> > > > > Thanks

> > > > > Jill

> > > > >

> > > > > 2cm left adenoma found via CT scan July 2012

> > > > > 32 aldosterone/

> > > > > low K for 2+years

> > > > > 155/100 bp avg

> > > > >

> > > >

> > > >

> > >

> >

>

[Guest guest]

To summarize from this article:"Because 50% of patients would have been inappropriately managed based on CT scan findings, patients with biochemical evidence of primary hyperaldosteronism and considering adrenalectomy should have AVS. The most accurate measurement for AVS lateralization was the post-ACTH stimulation values."I know it sounds like an echo but it is what it is.

Clarence Grim MDlowerbp2@...

On Aug 1, 2012, at 10:56 AM, wrote:

I'm not sure what is in our files but it is easier for me to find it with Pubmed. Here you go:"Consequences of Adrenal Venous Sampling in Primary Hyperaldosteronism and Predictors of Unilateral Adrenal Disease"

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2930893/pdf/nihms206381.pdf

Dr. Chang is the doctor at NIH who has done a few thousand and had the privilege of doing mine!...Jhn.-- In hyperaldosteronism , "NJ Roadie" <junk@...> wrote:>> Thanks for the info. Wasn't there a study about the need for the AVS to determine with certainty that the overactive adrenal was identified correctly? I can't seem to find it in the files section, do any of you remember what I'm talking about?> > Thanks> Jill> working on my thumbnail :0> age 41, 2 cm left adrenal adenoma> 5'5, 150 pounds, brown hair ;0> > > > > > > > >> > > > > > Dr. Grim what is your opinion on the need for the AVS test if the one adrenal gland is "normal" on CT but the other shows an adenoma (2cm?)> > > > > > > > > > > > I see Dr.

Reid of (Camden NJ) in late August. She lists herself as a Conn specialist, endocrine doc and surgeon. Just trying to get an idea of your opinion on the AVS.> > > > > > > > > > > > Thanks> > > > > > Jill> > > > > > > > > > > > 2cm left adenoma found via CT scan July 2012> > > > > > 32 aldosterone/> > > > > > low K for 2+years> > > > > > 155/100 bp avg> > > > > >> > > > > > > > > >> > > >> > >> >>