Re: Re: 42 yo woman runner who has had aldo 52 and renin 3.3 normal bp

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What significance does our menstrual cycle play in blood pressure?During my luteal phase my blood pressure ranges from 115/65 to 120/75 but then once menses begins i run a lot lower 90/60.I am in the process of doing the 24 hour urine. should have those numbers in a few days.thanks,suzanneSent from my iPad

Yea but you usually are an alcoholic who does not each much or cancer pt who cannot eat and is starving. CE Grim MDI have read that a magnesium deficiency can cause low K.Sent from my iPad Better to DASH I would think.If you can get it in food why take a pill?CE Grim MDare you serious? I am asking if I should take a b vitamin supplement?Sent from my iPad Still no question?CE Grim MD Was there a question here?Hi Dr. Grim,Is it recommended to take a b-complex vitamin?I have been holding off from taking mine (complete b-complex from life extension) because i am afraid it might encourage more aldosterone production! Am I crazy for worrying about this? I know the adrenals love b vitamins and I don't need anything that will cause me to produce more aldosterone. However, I know for a woman of my age and activity level that the b's are very important and could really benefit my body!!Thanks, SuzanneSent from my iPad They are all competitors for the receptors but I do not know the measures of association that permits one to quantitate the relative effect of aldo in occupying each of the receptors. Also they circulate in much greater quantities that aldo as I recall. So the effect would seem likely to be weak.CE Grim MD On Nov

13, 2010, at 12:01 PM, Suzanne Kann wrote:Hi Dr. Grim, I wanted to ask if high aldosterone levels will block progesterone, testosterone, and estrogen receptors? Thanks, SuzanneTo: hyperaldosteronism Cc: Clarence Grim Sent: Sun, November 7, 2010 7:36:01 PMSubject: Re: Re: 42 yo woman runner who has had aldo 52 and renin 3.3 normal

bp That's what this paper says. No one has looked at in anymore detail that I can find.CE Grim MDOk, by doing this it will be ok to test any time of my cycle?Sent from my iPadOn Nov 7, 2010, at 6:02

PM, Clarence Grim wrote: Ask your lab to use plasma renin activity not direct renin assay.CE Grim MDThis is the article I did read. I didn't feel like it gave a definitive answer. I have read it is best to test aldosterone on the third day of the menstrual cycle but not sure how that will go seeing it is a urine test and not a simple blood draw. Any advice would be greatly appreciated. ThanksSent from my iPadOn Nov 7,

2010, at 1:32 PM, Clarence Grim wrote: Guess you did not search aldosterone renin

ratio.Here is one.J Clin Endocrinol Metab. 2010 Oct 20. [Epub ahead of print]Are Women More at Risk of False-Positive Primary Aldosteronism Screening and Unnecessary Suppression Testing than

Men?Ahmed AH, Gordon RD, PJ, Ward G, Pimenta E, Stowasser M.Endocrine Hypertension Research Centre (A.H.A., R.D.G., P.J.T., E.P., M.S.), University of Queensland School of Medicine, Greenslopes and Princess andra Hospitals, Brisbane, Queensland 4102, Australia; and Sullivan and Nicolaides

Pathology (G.W.), Brisbane, 4068 Queensland, Australia.AbstractBackground: Because primary aldosteronism is not uncommon, specifically treatable and in some cases curable, and carries higher risks for cardiovascular morbidity and mortality than essential hypertension, screening hypertensive patients for its presence by measuring aldosterone to renin ratio (ARR) is increasingly common. A significantly higher false-positive ARR rate for women than men, resulting in unnecessary suppression tests has previously been reported. Methods: Using a new, highly accurate aldosterone assay and both of the currently widely used renin assays, ARR was measured in 19 normal, ovulating women at three time points in the menstrual cycle and compared with single measurements in 21 normal males of similar age. Results: ARRs in males were

possibly too well down in the current normal range. Although normotensive and normokalemic, two women had raised ARRs in the luteal phase but only when direct renin concentration (DRC) was used. Their DRC levels were low at all sampling times [despite midrange plasma renin activity levels], whereas their progesterone and aldosterone levels were highest for the group. Saline suppression testing, performed in one of them, showed normal aldosterone suppressibility. Conclusion: False-positive ARRs in normal women during the luteal phase only when DRC is used may explain the higher incidence of false-positive ARRs in hypertensive women than men and suggest the following: 1) plasma renin activity is preferable to DRC in determination of ARR and 2) new reference ranges for ARR that take into account gender and sex hormone levels are required.Thanks, I did do some reading on pubmed like you suggested about testing and menses but never came up with an answer. Hoping you had the answer. I know aldosterone is naturally higher during the luteal phase but I only want to do this once and I want to get it exactly right . Sent from my iPad I think I sent an abstract recently on menses and testing. If you cant find it let me know.Dr. Grim's Perfect Primary Aldosteronism Blood and Urine Testing to diagnose PA in one day. 1. Eat a regular to high salt diet for 2 weeks.2. No BP meds in last 4-12 weeks depending on meds.3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do not lose a drop of this liquid gold. It is impossible to interpret the renin and aldo without this.4. The morning you finish the 24 hr urine have fasting blood drawn for renin, aldo and K using our guidelines to get an accurate K. Try to get this done about 4 hours after you have been out of bed.5. Send us the results with the normal values for your lab.6. If you ever have a salt (saline) infusion test for PA be certain to ask them to measure how much you pee during the 4 hours of the infusion. If it is 1-1.5 liter of urine it strongly suggests that you may have PA. If more tha 1.5 L you almost certainly have PA. Hi, I am calling my Natural Path tomorrow to have her order test to see if we can figure out why I have high alodsterone. Here are the test I am requesting: (PLEASE LET ME KNOW IF I AM MISSING SOMETHING) -24 hour urine NA, K, Creatinine, Aldosterone -blood draw Renin, Aldosterone, and K Anything else????Also where can I get the info on how to collect K correctly?See our files on how to draw blood.One last question, when during my menstrual cycle is the best time to do these test?'see a recent email re this issue.Thanks so much for you time, SuzanneTo: hyperaldosteronism Cc: Clarence Grim Sent: Fri, November 5, 2010 7:04:29 AMSubject: Re: Re: 42 yo woman runner who has had aldo 52 and renin 3.3 normal bp your team is who you have decided you want to manage your health. Can a Natural Path write prescriptions and order blood tests?CE Grim MDWhat if I don't have a team? Or do you consider a Natural Path my team?Sent from my iPad yes I can work with your team for $500 per

year.CE Grim MDHi Dr Grim , I agree I am afraid I am going to make this 400 mile trip and get nowhere! I don't have a dr other than a Natural Path. Can you be my dr and take care of all of this online?Sent from my iPadOn Nov 3, 2010, at 8:28 PM, Clarence Grim

wrote: she does not seem to understand PA as she did not order a renin.CE Grim MDSend her my article on the evolution of PA and the Endo guidelines in our files---BEFORE you see her. You want to know how many PAs she has treated and followed for at least 10 years.CE Grim MDThanks for the info. I am so frustrated with dr's in my area. It seems NO one knows the correct test around here! My natural path is very willing to order the test but she's the first one to admit that she won't know what to do with the results.I live in Whitefish, Montana and Kalispell is about 15 minutes away. Missoula is about 200 miles but I would drive it if someone could make a recommendation ( preferably first hand experience). I am doing Dr. grimes ideal test in December and then at the end of December I am scheduled to see an

endocrinologist in Missoula. I don't have faith that the endo knows much about hyperaldosteronism but at this point she is my only hope. This endo's name is Dr. Eyler. She has ordered the following test ( which I don't believe are ideal): hypothyroid panel, comprehensive metabolic panel, vitamin d, hemogram, LH, FSH, 24 hr urine aldosterone.Any comments or feedback would be so appreciated! Thanks, SuzanneSent from my iPad See Dr Grim's ideal test.You cannot interpret the aldo/renin ratio without having a 24 hr urine Na. But maybe your health care team knows how to do this. If so they need to let us know.CE GrimMDWelcome to the exciting world of Hyperaldosteronism! You are in the right place! I am Dr. CE Grim a retired Professor of Medicine and Endocrinology. I have a long standing interest is Primary Aldosteronism since medical school days when I saw my first patient with Primary Aldosteronism in 1963. I trained with Dr. Conn in Endocrinology and Metabolism 1969-70 and have published over 240 papers and book chapters in most areas of the broad discipline of High Blood Pressure. My CV is in our files for details. The goal of our group is to teach you and your health care team

about the ins and outs of the causes, diagnosis and control of the many forms of hyperaldosteronism. The steps below will introduce you into the fascinating world of high blood pressure, salt and potassium and the role of the adrenal hormone aldosterone in health and disease. Doing these in sequence will save you time and effort in getting up to speed in taking control of you health and educating your own health care team. While we can’t make you a doctor we will make you into a pretty good BP doctor-a skill that you will have for life. 1. A brief history of Primary Aldosteronsim and why it is so common today in drug resistant high blood pressure. Read my article in our files on the evolution of PA (Evolution_of_PA-Grim.pdf ) and take to all members of health care team. Tell us what stage you believe you are in. This is a

brief review of most causes of hyperaldosteronism, high blood pressure, low potassium (K). 2. Read about other patients with hyperaldosteronism (Conn’s syndrome). Read our Conn's stories in our files and then give us your own in as much detail as you can. Dr. Conn was the first to describe this disease process and the syndrome is named after him.To see others' stories, on the Hyperaldosteronism home page, go to Files/Conn’s Stories. You'll find instructions in "A - How to put your story here.doc " First send us your story in an email and they we may have questions and suggestions before you upload it to our files. 3. DASH to lower your BP. Your and my tax dollars funded the most important series of studies on how to improve blood pressure, blood sugar, blood lipids and make your heart

smaller: The DASH Eating Plan to control high blood pressure due to hyperaldosteronism and most others with high blood pressure. This will reduce your need for medications and in many will get your BP and K to goal without meds.. Get the DASH diet book by T. et al, (http://www.amazon.com/DASH-Diet-Hypertension--/dp/0743202953) read it and use it: ~$8 in paperback at your local bookstore or online. If they don’t have it ask them to order it for you. You can also get the hardback larger print version as well at Amazon. Learning to eat the DASH way will play a major role in your road to good BP and K control and, in many of our folks here, will revolutionize your life. See http://en.wikipedia.org/wiki/DASH_diet for an overview and more details. In the book go to chapter 9 and do the 14 day challenge. Tell your Dr you are doing this as your BP may plummet if you are on other meds. Measure your BP every day and post to us. or go to http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf download this 64 page booklet free and do the Week on the DASH Diet for 2 weeks. If you are on BP meds be prepared for a large fall in BP (20/10 mm Hg or more) and let your Dr. know you are doing this. And/Or go to (but costs money monthly) DASH Diet for Health Program (http://www.dashforhealth.com/pages/public/tour.php)The DASH Diet for Health Program is designed to help you improve your eating and exercise habits. Twice each week they will provide you with information on our website about food, food preparation, eating out, losing weight, getting fit and much more. In addition to providing new information each week on the website, they create a web page specially for you where you can track progress in areas such as your weight, blood pressure, and exercise. I strongly recommend you get this book and read it. 4. Measure your BP: Measure your BP daily so you can see if it is getting better. If you are taking meds be sure to tell your health care team you are doing this as your BP may plummet to normal quickly. We recommend you use a device you listen to and will

help you learn how to do this. If this is not something you want to do we can teach a significant other how to do it. See sharedcareinc.com or email to sharedcare@... to order a video on how to do this. If you

already have one we will teach you how to teach your health care team how to validate your device. Your life and health depends on accurate BP measurements. Go to the amricanheart.org and download the Guidelines for Human Blood Pressure Measurement. Insist the your health care team do BP the AHA way. Never trust your life to an automatic BP machine unless you know it is accurate on YOU. 5. Genetics and your BP: Go to familyhistory.hhs.gov and do your detailed family medical

history so we can review with you to help Dx familial causes of high blood pressure and heart disease. If BP runs in your family you may save lives in your family by checking their BP yourself. 6. How to DX and treat PA: Go to our file/Conn's Articles of Note/Medications/Bravo spir 1973.pdf and read this article and take to your health care team. It is old but still one of the best in the medical management of PA. Also see our file from the Endocrine Society Guidelines on PA. Dr. Grim's Perfect Primary Aldosteronism Blood and Urine Testing to diagnose PA in one day. 1. Eat a regular to high salt diet for 2 weeks.2. No BP meds in last 4-12 weeks depending on meds.3. Collect 24 hr urine for Na, K and creatinine and

aldosterone. Do not lose a drop of this liquid gold. It is impossible to interpret the renin and aldo without this.4. The morning you finish the 24 hr urine have fasting blood drawn for renin, aldo and K using our guidelines to get an accurate K. Try to get this done about 4 hours after you have been out of bed.5. Send us the results with the normal values for your lab.6. If you ever have a salt (saline) infusion test for PA be certain to ask them to measure how much you pee during the 4 hours of the infusion. If it is 1-1.5 liter of urine it strongly suggests that you may have PA. If more tha 1.5 L you almost certainly have PA. 8. Become a participant in our PA Registry and contribute to our large database on PA: If you have been Dxed with PA already and are on Rx or have had surgery please

go to http://www.kwiksurveys.com/online-survey.php?surveyID=HIJIO_f2685379 and complete our survey with as much information as you know. If there is some information you don't

know ask us and we will help. If you need to update this as you journey thru the diagnostic/treatment process you can add another entry but label it as Nameyymmdd. For example today 6/12/09 for me would be Grim090612. This ever increasing number will allow us and you to sort your multiple entries into a dated order. 9. Learn the language: If you are new to medical lingo then download the acroyms from http://health.groups.yahoo.com/group/bloodpressureline/message/2918610. Salt and high blood pressure: To learn the state of the science of salt and blood pressure please spend some time looking at http://www.worldactiononsalt.com/evidence/treatment_trials.htm11. Become a HBP expert consumer: Expect that it will take at least several weeks to get all this digested and to learn the new language of high blood pressure health care. As most doctors and nurses in practice have had very little training in high blood pressure you must become an expert yourself. For example most have never had anyone listen with them with a double stethoscope to verify that they can hear BP sounds. We cannot make you a doctor but we will make you a pretty good BP

doctor.12. How High Blood Pressure should be managed: Go to nih.gov and download and read the Joint National Commission (JNC) Report 7 to get an overview on current guidelines. I ask all my secretaries to read this so they can communicate the importance of high blood pressure to my patients. JNC 8 will be out soon.Then: get (and study) the Hypertension Primer from americanheart.org. This is the most up-to-date compendium of what is known about high blood pressure and what every Dr. should know when they graduate from Medical School. Every chapter is only 2-3 pages. Read one chapter every week-night and you will finish it in about a year. I am working on a reading guide for lay people for the Primer.

Stay tuned.13. Ask us questions: Ask any questions about high blood pressure you want answered. That is what we are here for. We have had this site for 10 years and over 30,000 emails are searchable. This is the largest collection of communications about Conn's Syndrome in the World. 14. One-on-one Consulting: I can provide individual consulting if you do not want to go public. If you want individual one-on-one consulting for you and your Doctor contract me directly at lowerbp2@....May your pressure be low!Clarence E. Grim BS, MS, MD, FACP, FACC, FAHABoard Certified in Internal Medicine, Geriatrics, and High Blood Pressure Retired Faculty/Professor of Medicine (U of MO, Indiana, UCLA/DREW, Medical College of Wisconsin and Cardiology, Endocrinology, Nephrology, and Epidemiology. Specializing in Primary Aldosteronism and Difficult to Control High Blood

Pressure. I'm going in on Thursday for the following test: basic panel and serum aldosterone.Shouldn't there be a urine test? Are these test a waste

of my time if I want real answers to why I have high aldosterone.What would be the ideal test? Please help I am feeling pressured for time! Thank youSent from my iPad Not that I know of or can make a connection to in my wildest Endocrine/Heme thoughs.

But then another reason we need a good data base.Do you do data bases?CE Grim,MDIs there any connection between high aldosterone and low ferritin?Sent from my iPad If your BP and K is normal you may not need to DASH.Runners may have aldo if it was collected after a run.Drink when you are thirsty. A low Na suggests you are drinking too much.CE Grim

MDCould I get some input on water intake? I tried searching the web-site about dashing but couldn't find what I was looking for.I know are bodies are constantly trying to keep things in balance so I feel like h2o consumption is just as important as sodium intake. However, I don't think I can assume the average 8

cups a day will be my norm.Here are a few things that I think might influence my sodium/h20 consumption: I have lowish serum sodium 138 (135-145), I have low blood pressure110/65, high aldosterone (24 hr urine 54.3 ( 17-44) and I am active ( runner)I feel it is reasonable that I keep my sodium intake at the higher end of the Dashing Diet , because of low sodium and low blood pressure and activity level, but I also want to try and lower aldosterone naturally ( if possible) and I'm hoping maybe it's a matter of the right amount of daily water and sodium consumption. Are there any right ratios for this? For example, if you consume 1,500 mg of sodium you should have 8 cups of h2o or maybe if you consume 2,300 mg of sodium you should shoot for 10 cups of h2o?Thanks so much! Really trying to get it right!Sent from my

iPad Keep us

posted. so you have high renin and high aldo and low K and low BP?CE Grim MDHi Dr. Grim, The following post grabbed my attention. I started following you and this site when I was thought to have primary hyperaldosteronism. I had all the expected abnormal lab results except for low to normal blood pressure. Eventually, labaratory

results confirmed Bartters Syndrome and now I follow both yahoo groups. > > >>>>>>>>>> > > >>>>>>>>>>> > > >>>>>>>>>>> Hi everyone, just joined today. Thanks to all of you for this support!> > >>>>>>>>>>> > >

>>>>>>>>>>> I tested high for aldosterone two years ago through a urine test. My ND at the time was not concerned, he thought it was due to the fact that I was a runner. I also thought that made since and was also following a low salt diet. So we ignored it.> > >>>>>>>>>>> > > >>>>>>>>>>> I am treAting a thyroid issue, thyroid hormone resistance, and through recent blood work tested high for aldosterone again. This time I decided not to ignore it! > > >>>>>>>>>>> > > >>>>>>>>>>> I do not have a high blood pressure. It runs pretty normal to low. I don't have issues with potassium. This is all Very confusing as

to why I have high aldosterone.> > >>>>>>>>>>> > > >>>>>>>>>>> I am trying to get into a endocrinologist but will take about three months. I need some education and advise on where to start.> > >>>>>>>>>>> > > >>>>>>>>>>> I don't even know if this is primary or secondary.> > >>>>>>>>>>> > > >>>>>>>>>>> My only real "health" issue, that I know about, has been hair loss. This was one reason for exploring the thyroid but I am wondering if it has been the aldosterone all along. Maybe the aldosterone is what's causing my thyroid issues.> >

>>>>>>>>>>> > > >>>>>>>>>>> Any comments or advice would be greatly appreciated.> > >>>>>>>>>>> > > >>>>>>>>>>> My labs:> > >>>>>>>>>>> > > >>>>>>>>>>> 9/26/2008> > >>>>>>>>>>> Aldosterone (urine)> > >>>>>>>>>>> High 54.3. (normal diet 6-25, low salt 17-44, high salt0-6)> > >>>>>>>>>>> > > >>>>>>>>>>> Other adrenal hormones were fine at that time.

Cortisol was pretty middle of the road. *Progesterone however was really high too. I can post if necessary.> > >>>>>>>>>>> > > >>>>>>>>>>> Rbc potassium 7/14/2010> > >>>>>>>>>>> 97. (90-111)> > >>>>>>>>>>> > > >>>>>>>>>>> Blood aldosterone 7/18/2010> > >>>>>>>>>>> 52.0. (1-16)> > >>>>>>>>>>> > > >>>>>>>>>>> Blood aldosterone/renin 6/30/2010> > >>>>>>>>>>> Aldosterone 49. (1-16)> >

>>>>>>>>>>> Renin. 3.3. (random ambulatory 0.8-2.5, non ambulatory 1.5-5.2)> > >>>>>>>>>>> I was sitting, fasting, taking two hours after waking before/around 8am> > >>>>>>>>>>> > > >>>>>>>>>>> Aldosterone renin ratio = 15> > >>>>>>>>>>> > > >>>>>>>>>>> Sodium. 138. (135-145)> > >>>>>>>>>>> Potassium. 4.5. (3.5-5.3)> > >>>>>>>>>>> Chloride. 106. (98-109)> > >>>>>>>>>>> Co2. 23. (22-31)> > >>>>>>>>>>> Anion gap. 9. (5-16)> >

>>>>>>>>>>> > > >>>>>>>>>>> Saliva cortisol 5/23/2010> > >>>>>>>>>>> 7am. 3.7. (3.7-9.5)> > >>>>>>>>>>> 11am. 1.6. (1.2-3.0)> > >>>>>>>>>>> 5pm. 1.3. (0.6-1.9)> > >>>>>>>>>>> 9pm. 0.5. (0.4-1.0)> > >>>>>>>>>>> > > >>>>>>>>>>> Rbc magnesium 5/26/2010> > >>>>>>>>>>> 4.2. (4.0-6.4)> > >>>>>>>>>>> > > >>>>>>>>>>> Lot of test!!!!> >

>>>>>>>>>>> > > >>>>>>>>>>> Thanks again for your kind support! Suzanne> > >>>>>>>>>>> > > >>>>>>>>>>> > > >>>>>>>>>> > > >>>>>>>>> > > >>>>>>>>> > > >>>>>>>> > > >>>>>>>> > > >>>>>>> > > >>>>>>> > > >>>>>> > > >>>>>> > > >>>>> > > >>>>> > > >>>> > > >>>> > > >>> > > >>> > > >> > > > > > >> >> > > Reply to sender |>

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It varies. Do a pubmed.CE Grim MDWhat significance does our menstrual cycle play in blood pressure?During my luteal phase my blood pressure ranges from 115/65 to 120/75 but then once menses begins i run a lot lower 90/60.I am in the process of doing the 24 hour urine. should have those numbers in a few days.thanks,suzanneSent from my iPad Yea but you usually are an alcoholic who does not each much or cancer pt who cannot eat and is starving. CE Grim MDI have read that a magnesium deficiency can cause low K.Sent from my iPad Better to DASH I would think.If you can get it in food why take a pill?CE Grim MDare you serious? I am asking if I should take a b vitamin supplement?Sent from my iPad Still no question?CE Grim MD Was there a question here?Hi Dr. Grim,Is it recommended to take a b-complex vitamin?I have been holding off from taking mine (complete b-complex from life extension) because i am afraid it might encourage more aldosterone production! Am I crazy for worrying about this? I know the adrenals love b vitamins and I don't need anything that will cause me to produce more aldosterone. However, I know for a woman of my age and activity level that the b's are very important and could really benefit my body!!Thanks, SuzanneSent from my iPad They are all competitors for the receptors but I do not know the measures of association that permits one to quantitate the relative effect of aldo in occupying each of the receptors. Also they circulate in much greater quantities that aldo as I recall. So the effect would seem likely to be weak.CE Grim MD Hi Dr. Grim, I wanted to ask if high aldosterone levels will block progesterone, testosterone, and estrogen receptors? Thanks, SuzanneTo: hyperaldosteronism Cc: Clarence Grim Sent: Sun, November 7, 2010 7:36:01 PMSubject: Re: Re: 42 yo woman runner who has had aldo 52 and renin 3.3 normal bp That's what this paper says. No one has looked at in anymore detail that I can find.CE Grim MDOk, by doing this it will be ok to test any time of my cycle?Sent from my iPad Ask your lab to use plasma renin activity not direct renin assay.CE Grim MDThis is the article I did read. I didn't feel like it gave a definitive answer. I have read it is best to test aldosterone on the third day of the menstrual cycle but not sure how that will go seeing it is a urine test and not a simple blood draw. Any advice would be greatly appreciated. ThanksSent from my iPad Guess you did not search aldosterone renin ratio.Here is one.J Clin Endocrinol Metab. 2010 Oct 20. [Epub ahead of print]Are Women More at Risk of False-Positive Primary Aldosteronism Screening and Unnecessary Suppression Testing than Men?Ahmed AH, Gordon RD, PJ, Ward G, Pimenta E, Stowasser M.Endocrine Hypertension Research Centre (A.H.A., R.D.G., P.J.T., E.P., M.S.), University of Queensland School of Medicine, Greenslopes and Princess andra Hospitals, Brisbane, Queensland 4102, Australia; and Sullivan and Nicolaides Pathology (G.W.), Brisbane, 4068 Queensland, Australia.AbstractBackground: Because primary aldosteronism is not uncommon, specifically treatable and in some cases curable, and carries higher risks for cardiovascular morbidity and mortality than essential hypertension, screening hypertensive patients for its presence by measuring aldosterone to renin ratio (ARR) is increasingly common. A significantly higher false-positive ARR rate for women than men, resulting in unnecessary suppression tests has previously been reported. Methods: Using a new, highly accurate aldosterone assay and both of the currently widely used renin assays, ARR was measured in 19 normal, ovulating women at three time points in the menstrual cycle and compared with single measurements in 21 normal males of similar age. Results: ARRs in males were possibly too well down in the current normal range. Although normotensive and normokalemic, two women had raised ARRs in the luteal phase but only when direct renin concentration (DRC) was used. Their DRC levels were low at all sampling times [despite midrange plasma renin activity levels], whereas their progesterone and aldosterone levels were highest for the group. Saline suppression testing, performed in one of them, showed normal aldosterone suppressibility. Conclusion: False-positive ARRs in normal women during the luteal phase only when DRC is used may explain the higher incidence of false-positive ARRs in hypertensive women than men and suggest the following: 1) plasma renin activity is preferable to DRC in determination of ARR and 2) new reference ranges for ARR that take into account gender and sex hormone levels are required.Thanks, I did do some reading on pubmed like you suggested about testing and menses but never came up with an answer. Hoping you had the answer. I know aldosterone is naturally higher during the luteal phase but I only want to do this once and I want to get it exactly right . Sent from my iPad I think I sent an abstract recently on menses and testing. If you cant find it let me know.Dr. Grim's Perfect Primary Aldosteronism Blood and Urine Testing to diagnose PA in one day. 1. Eat a regular to high salt diet for 2 weeks.2. No BP meds in last 4-12 weeks depending on meds.3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do not lose a drop of this liquid gold. It is impossible to interpret the renin and aldo without this.4. The morning you finish the 24 hr urine have fasting blood drawn for renin, aldo and K using our guidelines to get an accurate K. Try to get this done about 4 hours after you have been out of bed.5. Send us the results with the normal values for your lab.6. If you ever have a salt (saline) infusion test for PA be certain to ask them to measure how much you pee during the 4 hours of the infusion. If it is 1-1.5 liter of urine it strongly suggests that you may have PA. If more tha 1.5 L you almost certainly have PA. Hi, I am calling my Natural Path tomorrow to have her order test to see if we can figure out why I have high alodsterone. Here are the test I am requesting: (PLEASE LET ME KNOW IF I AM MISSING SOMETHING) -24 hour urine NA, K, Creatinine, Aldosterone -blood draw Renin, Aldosterone, and K Anything else????Also where can I get the info on how to collect K correctly?See our files on how to draw blood.One last question, when during my menstrual cycle is the best time to do these test?'see a recent email re this issue.Thanks so much for you time, SuzanneTo: hyperaldosteronism Cc: Clarence Grim Sent: Fri, November 5, 2010 7:04:29 AMSubject: Re: Re: 42 yo woman runner who has had aldo 52 and renin 3.3 normal bp your team is who you have decided you want to manage your health. Can a Natural Path write prescriptions and order blood tests?CE Grim MDWhat if I don't have a team? Or do you consider a Natural Path my team?Sent from my iPad yes I can work with your team for $500 per year.CE Grim MDHi Dr Grim , I agree I am afraid I am going to make this 400 mile trip and get nowhere! I don't have a dr other than a Natural Path. Can you be my dr and take care of all of this online?Sent from my iPad she does not seem to understand PA as she did not order a renin.CE Grim MDSend her my article on the evolution of PA and the Endo guidelines in our files---BEFORE you see her. You want to know how many PAs she has treated and followed for at least 10 years.CE Grim MDThanks for the info. I am so frustrated with dr's in my area. It seems NO one knows the correct test around here! My natural path is very willing to order the test but she's the first one to admit that she won't know what to do with the results.I live in Whitefish, Montana and Kalispell is about 15 minutes away. Missoula is about 200 miles but I would drive it if someone could make a recommendation ( preferably first hand experience). I am doing Dr. grimes ideal test in December and then at the end of December I am scheduled to see an endocrinologist in Missoula. I don't have faith that the endo knows much about hyperaldosteronism but at this point she is my only hope. This endo's name is Dr. Eyler. She has ordered the following test ( which I don't believe are ideal): hypothyroid panel, comprehensive metabolic panel, vitamin d, hemogram, LH, FSH, 24 hr urine aldosterone.Any comments or feedback would be so appreciated! Thanks, SuzanneSent from my iPad See Dr Grim's ideal test.You cannot interpret the aldo/renin ratio without having a 24 hr urine Na. But maybe your health care team knows how to do this. If so they need to let us know.CE GrimMDWelcome to the exciting world of Hyperaldosteronism! You are in the right place! I am Dr. CE Grim a retired Professor of Medicine and Endocrinology. I have a long standing interest is Primary Aldosteronism since medical school days when I saw my first patient with Primary Aldosteronism in 1963. I trained with Dr. Conn in Endocrinology and Metabolism 1969-70 and have published over 240 papers and book chapters in most areas of the broad discipline of High Blood Pressure. My CV is in our files for details. The goal of our group is to teach you and your health care team about the ins and outs of the causes, diagnosis and control of the many forms of hyperaldosteronism. The steps below will introduce you into the fascinating world of high blood pressure, salt and potassium and the role of the adrenal hormone aldosterone in health and disease. Doing these in sequence will save you time and effort in getting up to speed in taking control of you health and educating your own health care team. While we can’t make you a doctor we will make you into a pretty good BP doctor-a skill that you will have for life. 1. A brief history of Primary Aldosteronsim and why it is so common today in drug resistant high blood pressure. Read my article in our files on the evolution of PA (Evolution_of_PA-Grim.pdf ) and take to all members of health care team. Tell us what stage you believe you are in. This is a brief review of most causes of hyperaldosteronism, high blood pressure, low potassium (K). 2. Read about other patients with hyperaldosteronism (Conn’s syndrome). Read our Conn's stories in our files and then give us your own in as much detail as you can. Dr. Conn was the first to describe this disease process and the syndrome is named after him.To see others' stories, on the Hyperaldosteronism home page, go to Files/Conn’s Stories. You'll find instructions in "A - How to put your story here.doc " First send us your story in an email and they we may have questions and suggestions before you upload it to our files. 3. DASH to lower your BP. Your and my tax dollars funded the most important series of studies on how to improve blood pressure, blood sugar, blood lipids and make your heart smaller: The DASH Eating Plan to control high blood pressure due to hyperaldosteronism and most others with high blood pressure. This will reduce your need for medications and in many will get your BP and K to goal without meds.. Get the DASH diet book by T. et al, (http://www.amazon.com/DASH-Diet-Hypertension--/dp/0743202953) read it and use it: ~$8 in paperback at your local bookstore or online. If they don’t have it ask them to order it for you. You can also get the hardback larger print version as well at Amazon. Learning to eat the DASH way will play a major role in your road to good BP and K control and, in many of our folks here, will revolutionize your life. See http://en.wikipedia.org/wiki/DASH_diet for an overview and more details. In the book go to chapter 9 and do the 14 day challenge. Tell your Dr you are doing this as your BP may plummet if you are on other meds. Measure your BP every day and post to us. or go to http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf download this 64 page booklet free and do the Week on the DASH Diet for 2 weeks. If you are on BP meds be prepared for a large fall in BP (20/10 mm Hg or more) and let your Dr. know you are doing this. And/Or go to (but costs money monthly) DASH Diet for Health Program (http://www.dashforhealth.com/pages/public/tour.php)The DASH Diet for Health Program is designed to help you improve your eating and exercise habits. Twice each week they will provide you with information on our website about food, food preparation, eating out, losing weight, getting fit and much more. In addition to providing new information each week on the website, they create a web page specially for you where you can track progress in areas such as your weight, blood pressure, and exercise. I strongly recommend you get this book and read it. 4. Measure your BP: Measure your BP daily so you can see if it is getting better. If you are taking meds be sure to tell your health care team you are doing this as your BP may plummet to normal quickly. We recommend you use a device you listen to and will help you learn how to do this. If this is not something you want to do we can teach a significant other how to do it. See sharedcareinc.com or email to sharedcare@... to order a video on how to do this. If you already have one we will teach you how to teach your health care team how to validate your device. Your life and health depends on accurate BP measurements. Go to the amricanheart.org and download the Guidelines for Human Blood Pressure Measurement. Insist the your health care team do BP the AHA way. Never trust your life to an automatic BP machine unless you know it is accurate on YOU. 5. Genetics and your BP: Go to familyhistory.hhs.gov and do your detailed family medical history so we can review with you to help Dx familial causes of high blood pressure and heart disease. If BP runs in your family you may save lives in your family by checking their BP yourself. 6. How to DX and treat PA: Go to our file/Conn's Articles of Note/Medications/Bravo spir 1973.pdf and read this article and take to your health care team. It is old but still one of the best in the medical management of PA. Also see our file from the Endocrine Society Guidelines on PA. Dr. Grim's Perfect Primary Aldosteronism Blood and Urine Testing to diagnose PA in one day. 1. Eat a regular to high salt diet for 2 weeks.2. No BP meds in last 4-12 weeks depending on meds.3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do not lose a drop of this liquid gold. It is impossible to interpret the renin and aldo without this.4. The morning you finish the 24 hr urine have fasting blood drawn for renin, aldo and K using our guidelines to get an accurate K. Try to get this done about 4 hours after you have been out of bed.5. Send us the results with the normal values for your lab.6. If you ever have a salt (saline) infusion test for PA be certain to ask them to measure how much you pee during the 4 hours of the infusion. If it is 1-1.5 liter of urine it strongly suggests that you may have PA. If more tha 1.5 L you almost certainly have PA. 8. Become a participant in our PA Registry and contribute to our large database on PA: If you have been Dxed with PA already and are on Rx or have had surgery please go to http://www.kwiksurveys.com/online-survey.php?surveyID=HIJIO_f2685379 and complete our survey with as much information as you know. If there is some information you don't know ask us and we will help. If you need to update this as you journey thru the diagnostic/treatment process you can add another entry but label it as Nameyymmdd. For example today 6/12/09 for me would be Grim090612. This ever increasing number will allow us and you to sort your multiple entries into a dated order. 9. Learn the language: If you are new to medical lingo then download the acroyms from http://health.groups.yahoo.com/group/bloodpressureline/message/2918610. Salt and high blood pressure: To learn the state of the science of salt and blood pressure please spend some time looking at http://www.worldactiononsalt.com/evidence/treatment_trials.htm11. Become a HBP expert consumer: Expect that it will take at least several weeks to get all this digested and to learn the new language of high blood pressure health care. As most doctors and nurses in practice have had very little training in high blood pressure you must become an expert yourself. For example most have never had anyone listen with them with a double stethoscope to verify that they can hear BP sounds. We cannot make you a doctor but we will make you a pretty good BP doctor.12. How High Blood Pressure should be managed: Go to nih.gov and download and read the Joint National Commission (JNC) Report 7 to get an overview on current guidelines. I ask all my secretaries to read this so they can communicate the importance of high blood pressure to my patients. JNC 8 will be out soon.Then: get (and study) the Hypertension Primer from americanheart.org. This is the most up-to-date compendium of what is known about high blood pressure and what every Dr. should know when they graduate from Medical School. Every chapter is only 2-3 pages. Read one chapter every week-night and you will finish it in about a year. I am working on a reading guide for lay people for the Primer. Stay tuned.13. Ask us questions: Ask any questions about high blood pressure you want answered. That is what we are here for. We have had this site for 10 years and over 30,000 emails are searchable. This is the largest collection of communications about Conn's Syndrome in the World. 14. One-on-one Consulting: I can provide individual consulting if you do not want to go public. If you want individual one-on-one consulting for you and your Doctor contract me directly at lowerbp2@....May your pressure be low!Clarence E. Grim BS, MS, MD, FACP, FACC, FAHABoard Certified in Internal Medicine, Geriatrics, and High Blood Pressure Retired Faculty/Professor of Medicine (U of MO, Indiana, UCLA/DREW, Medical College of Wisconsin and Cardiology, Endocrinology, Nephrology, and Epidemiology. Specializing in Primary Aldosteronism and Difficult to Control High Blood Pressure. I'm going in on Thursday for the following test: basic panel and serum aldosterone.Shouldn't there be a urine test? Are these test a waste of my time if I want real answers to why I have high aldosterone.What would be the ideal test? Please help I am feeling pressured for time! Thank youSent from my iPad Not that I know of or can make a connection to in my wildest Endocrine/Heme thoughs. But then another reason we need a good data base.Do you do data bases?CE Grim,MDIs there any connection between high aldosterone and low ferritin?Sent from my iPad If your BP and K is normal you may not need to DASH.Runners may have aldo if it was collected after a run.Drink when you are thirsty. A low Na suggests you are drinking too much.CE Grim MDCould I get some input on water intake? I tried searching the web-site about dashing but couldn't find what I was looking for.I know are bodies are constantly trying to keep things in balance so I feel like h2o consumption is just as important as sodium intake. However, I don't think I can assume the average 8 cups a day will be my norm.Here are a few things that I think might influence my sodium/h20 consumption: I have lowish serum sodium 138 (135-145), I have low blood pressure110/65, high aldosterone (24 hr urine 54.3 ( 17-44) and I am active ( runner)I feel it is reasonable that I keep my sodium intake at the higher end of the Dashing Diet , because of low sodium and low blood pressure and activity level, but I also want to try and lower aldosterone naturally ( if possible) and I'm hoping maybe it's a matter of the right amount of daily water and sodium consumption. Are there any right ratios for this? For example, if you consume 1,500 mg of sodium you should have 8 cups of h2o or maybe if you consume 2,300 mg of sodium you should shoot for 10 cups of h2o?Thanks so much! Really trying to get it right!Sent from my iPad Keep us posted. so you have high renin and high aldo and low K and low BP?CE Grim MDHi Dr. Grim, The following post grabbed my attention. I started following you and this site when I was thought to have primary hyperaldosteronism. I had all the expected abnormal lab results except for low to normal blood pressure. Eventually, labaratory results confirmed Bartters Syndrome and now I follow both yahoo groups. > > >>>>>>>>>> > > >>>>>>>>>>> > > >>>>>>>>>>> Hi everyone, just joined today. Thanks to all of you for this support!> > >>>>>>>>>>> > > >>>>>>>>>>> I tested high for aldosterone two years ago through a urine test. My ND at the time was not concerned, he thought it was due to the fact that I was a runner. I also thought that made since and was also following a low salt diet. So we ignored it.> > >>>>>>>>>>> > > >>>>>>>>>>> I am treAting a thyroid issue, thyroid hormone resistance, and through recent blood work tested high for aldosterone again. This time I decided not to ignore it! > > >>>>>>>>>>> > > >>>>>>>>>>> I do not have a high blood pressure. It runs pretty normal to low. I don't have issues with potassium. This is all Very confusing as to why I have high aldosterone.> > >>>>>>>>>>> > > >>>>>>>>>>> I am trying to get into a endocrinologist but will take about three months. I need some education and advise on where to start.> > >>>>>>>>>>> > > >>>>>>>>>>> I don't even know if this is primary or secondary.> > >>>>>>>>>>> > > >>>>>>>>>>> My only real "health" issue, that I know about, has been hair loss. This was one reason for exploring the thyroid but I am wondering if it has been the aldosterone all along. Maybe the aldosterone is what's causing my thyroid issues.> > >>>>>>>>>>> > > >>>>>>>>>>> Any comments or advice would be greatly appreciated.> > >>>>>>>>>>> > > >>>>>>>>>>> My labs:> > >>>>>>>>>>> > > >>>>>>>>>>> 9/26/2008> > >>>>>>>>>>> Aldosterone (urine)> > >>>>>>>>>>> High 54.3. (normal diet 6-25, low salt 17-44, high salt0-6)> > >>>>>>>>>>> > > >>>>>>>>>>> Other adrenal hormones were fine at that time. Cortisol was pretty middle of the road. *Progesterone however was really high too. I can post if necessary.> > >>>>>>>>>>> > > >>>>>>>>>>> Rbc potassium 7/14/2010> > >>>>>>>>>>> 97. (90-111)> > >>>>>>>>>>> > > >>>>>>>>>>> Blood aldosterone 7/18/2010> > >>>>>>>>>>> 52.0. (1-16)> > >>>>>>>>>>> > > >>>>>>>>>>> Blood aldosterone/renin 6/30/2010> > >>>>>>>>>>> Aldosterone 49. (1-16)> > >>>>>>>>>>> Renin. 3.3. (random ambulatory 0.8-2.5, non ambulatory 1.5-5.2)> > >>>>>>>>>>> I was sitting, fasting, taking two hours after waking before/around 8am> > >>>>>>>>>>> > > >>>>>>>>>>> Aldosterone renin ratio = 15> > >>>>>>>>>>> > > >>>>>>>>>>> Sodium. 138. (135-145)> > >>>>>>>>>>> Potassium. 4.5. (3.5-5.3)> > >>>>>>>>>>> Chloride. 106. (98-109)> > >>>>>>>>>>> Co2. 23. (22-31)> > >>>>>>>>>>> Anion gap. 9. (5-16)> > >>>>>>>>>>> > > >>>>>>>>>>> Saliva cortisol 5/23/2010> > >>>>>>>>>>> 7am. 3.7. (3.7-9.5)> > >>>>>>>>>>> 11am. 1.6. (1.2-3.0)> > >>>>>>>>>>> 5pm. 1.3. (0.6-1.9)> > >>>>>>>>>>> 9pm. 0.5. (0.4-1.0)> > >>>>>>>>>>> > > >>>>>>>>>>> Rbc magnesium 5/26/2010> > >>>>>>>>>>> 4.2. (4.0-6.4)> > >>>>>>>>>>> > > >>>>>>>>>>> Lot of test!!!!> > >>>>>>>>>>> > > >>>>>>>>>>> Thanks again for your kind support! Suzanne> > >>>>>>>>>>> > > >>>>>>>>>>> > > >>>>>>>>>> > > >>>>>>>>> > > >>>>>>>>> > > >>>>>>>> > > >>>>>>>> > > >>>>>>> > > >>>>>>> > > >>>>>> > > >>>>>> > > >>>>> > > >>>>> > > >>>> > > >>>> > > >>> > > >>> > > >> > > > > > >> >> > > Reply to sender |>

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I have some test results back that are worrying me. I don't have all the results so I will post them as I get them. Right now I am concerned with what my creatinine levels mean. Please help!!!Blood creatinineCREAT 0.77 (0.44-1.00)BUN 14 (6-20)urine creatinine (there were two results for this)CREAT,RAND UR 40.86 L (80.00-170 mg./dl)CREAT, UR QUANT 1.0 (0.6-1.8 gm./dy)Should I be worried about the low CREAT, RAND UR?????THANKS, SUZANNESent from my iPad

It varies. Do a pubmed.CE Grim MDWhat significance does our menstrual cycle play in blood pressure?During my luteal phase my blood pressure ranges from 115/65 to 120/75 but then once menses begins i run a lot lower 90/60.I am in the

process of doing the 24 hour urine. should have those numbers in a few days.thanks,suzanneSent from my iPad Yea but you usually are an alcoholic who does not each much or cancer pt who cannot eat and is starving. CE Grim MDI have read that a magnesium deficiency can cause low K.Sent from my iPad Better to DASH I would think.If you can get it in food why take a pill?CE Grim MDare you serious? I am asking if I should take a b vitamin supplement?Sent from my iPad Still no question?CE Grim MD Was there a question here?Hi Dr. Grim,Is it recommended to take a b-complex vitamin?I

have been holding off from taking mine (complete b-complex from life extension) because i am afraid it might encourage more aldosterone production! Am I crazy for worrying about this? I know the adrenals love b vitamins and I don't need anything that will cause me to produce more aldosterone. However, I know for a woman of my age and activity level that the b's are very important and could really benefit my body!!Thanks, SuzanneSent from my iPad They are all competitors for the receptors but I do not know the measures of association that permits one to quantitate the relative effect of aldo in occupying each of the receptors. Also they circulate in much greater quantities that aldo as I recall. So the effect would seem likely to be weak.CE Grim MD Hi Dr. Grim, I wanted to ask if high aldosterone levels will block progesterone, testosterone, and estrogen receptors? Thanks, SuzanneTo: hyperaldosteronism Cc: Clarence Grim Sent: Sun, November 7, 2010 7:36:01 PMSubject: Re: Re: 42 yo woman runner who has had aldo 52 and renin 3.3 normal bp That's what this paper says. No one has looked at in anymore detail that I can find.CE Grim MDOk, by doing this it will be ok to test any time of my cycle?Sent from my iPad Ask your lab to use plasma renin activity not direct renin assay.CE Grim MDThis is the article I did read. I didn't feel like it gave a definitive answer. I have read it is best to test aldosterone on the third day of the menstrual cycle but not sure how that will go seeing it is a urine test and not a simple blood draw. Any advice would be greatly appreciated. ThanksSent from my iPadOn Nov 7,

2010, at 1:32 PM, Clarence Grim wrote: Guess you did not search aldosterone renin ratio.Here is one.J Clin Endocrinol Metab. 2010 Oct 20. [Epub ahead of print]Are Women More at Risk of False-Positive

Primary Aldosteronism Screening and Unnecessary Suppression Testing than Men?Ahmed AH, Gordon RD, PJ, Ward G, Pimenta E, Stowasser M.Endocrine Hypertension Research Centre (A.H.A., R.D.G., P.J.T., E.P., M.S.), University of Queensland School of

Medicine, Greenslopes and Princess andra Hospitals, Brisbane, Queensland 4102, Australia; and Sullivan and Nicolaides Pathology (G.W.), Brisbane, 4068 Queensland, Australia.AbstractBackground: Because primary aldosteronism is not uncommon, specifically treatable and in some cases curable, and carries higher risks for cardiovascular morbidity and mortality than essential hypertension, screening hypertensive patients for its presence by measuring aldosterone to renin ratio (ARR) is increasingly common. A significantly higher false-positive ARR rate for women than men, resulting in unnecessary suppression tests has previously been reported. Methods: Using a new, highly accurate aldosterone assay and both of the currently widely used renin assays, ARR was measured in 19 normal, ovulating women at three time points in

the menstrual cycle and compared with single measurements in 21 normal males of similar age. Results: ARRs in males were possibly too well down in the current normal range. Although normotensive and normokalemic, two women had raised ARRs in the luteal phase but only when direct renin concentration (DRC) was used. Their DRC levels were low at all sampling times [despite midrange plasma renin activity levels], whereas their progesterone and aldosterone levels were highest for the group. Saline suppression testing, performed in one of them, showed normal aldosterone suppressibility. Conclusion: False-positive ARRs in normal women during the luteal phase only when DRC is used may explain the higher incidence of false-positive ARRs in hypertensive women than men and suggest the following: 1) plasma renin activity is preferable to DRC in determination of ARR and 2) new reference ranges for ARR that take into account gender and sex hormone levels are

required.Thanks, I did do some reading on pubmed like you suggested about testing and menses but never came up with an answer. Hoping you had the answer. I know aldosterone is naturally higher during the luteal phase but I only want to do this once and I want to get it exactly right . Sent from my

iPad I think I sent an abstract recently on menses and testing. If you cant find it let me know.Dr. Grim's Perfect Primary Aldosteronism Blood and Urine Testing to diagnose PA in one day. 1. Eat a regular to high salt diet for 2 weeks.2. No BP meds in last 4-12 weeks depending on meds.3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do not lose a drop of this liquid gold. It is impossible to interpret the renin and aldo without this.4. The morning you finish the 24 hr urine have fasting blood

drawn for renin, aldo and K using our guidelines to get an accurate K. Try to get this done about 4 hours after you have been out of bed.5. Send us the results with the normal values for your lab.6. If you ever have a salt (saline) infusion test for PA be certain to ask them to measure how much you pee during the 4 hours of the infusion. If it is 1-1.5 liter of urine it strongly suggests that you may have PA. If more tha 1.5 L you almost certainly have PA. Hi, I am calling my Natural Path tomorrow to have her order test to see if we can figure out why I have high alodsterone. Here are the test I am requesting: (PLEASE LET ME KNOW IF I AM MISSING SOMETHING) -24 hour urine NA, K, Creatinine, Aldosterone -blood draw Renin, Aldosterone, and K Anything else????Also where can I get the info on how to collect K correctly?See our files on how to draw

blood.One last question, when during my menstrual cycle is the best time to do these test?'see a recent email re this issue.Thanks so much for you time, SuzanneTo: hyperaldosteronism Cc: Clarence Grim Sent: Fri, November 5, 2010 7:04:29 AMSubject: Re:

Re: 42 yo woman runner who has had aldo 52 and renin 3.3 normal bp your team is who you have decided you want to manage your health. Can a Natural Path write prescriptions and order blood tests?CE Grim MDWhat if I don't have a team? Or do you consider a Natural Path my team?Sent from my iPad yes I can work with your team for $500 per year.CE Grim MDHi Dr Grim , I agree I am afraid I am going to make this 400 mile trip and get nowhere! I don't have a dr other than a Natural Path. Can you be my dr and take care of all of this online?Sent from my iPad she does not

seem to understand PA as she did not order a renin.CE Grim MDSend her my article on the evolution of PA and the Endo guidelines in our files---BEFORE you see her. You want to know how many PAs she has treated and followed for at least 10 years.CE Grim MDThanks for the info. I am so frustrated with dr's in my area. It seems NO one knows the correct test around here! My natural path is very willing to order the test but she's the first one to admit that she won't know what to do with the results.I live in Whitefish, Montana and Kalispell is about 15 minutes away. Missoula is about 200 miles but I would drive it if someone could make a recommendation ( preferably first hand experience). I am doing Dr. grimes ideal test in December and then at the end of December I am scheduled to see an endocrinologist in Missoula. I don't have faith that the endo knows much about hyperaldosteronism but at this point she is my only hope. This endo's name is Dr. Eyler. She has ordered the following test ( which I don't believe are ideal): hypothyroid panel, comprehensive metabolic panel, vitamin d, hemogram, LH, FSH, 24 hr urine

aldosterone.Any comments or feedback would be so appreciated! Thanks, SuzanneSent from my iPad See Dr Grim's ideal test.You cannot interpret the aldo/renin ratio without having a 24 hr urine Na. But maybe your health care team knows how to do this. If so they need to let

us know.CE GrimMDWelcome to the exciting world of

Hyperaldosteronism! You are in the right place! I am Dr. CE Grim a retired Professor of Medicine and Endocrinology. I have a long standing interest is Primary Aldosteronism since medical school days when I saw my first patient with Primary Aldosteronism in 1963. I trained with Dr. Conn in Endocrinology and Metabolism 1969-70 and have published over 240 papers and book chapters in most areas of the broad discipline of High Blood Pressure. My CV is in our files for details. The goal of our group is to teach you and your health care team about the ins and outs of the causes, diagnosis and control of the many forms of hyperaldosteronism. The steps below will introduce you into the fascinating world of high blood pressure, salt and potassium and the role

of the adrenal hormone aldosterone in health and disease. Doing these in sequence will save you time and effort in getting up to speed in taking control of you health and educating your own health care team. While we can’t make you a doctor we will make you into a pretty good BP doctor-a skill that you will have for life. 1. A brief history of Primary Aldosteronsim and why it is so common today in drug resistant high blood pressure. Read my article in our files on the evolution of PA (Evolution_of_PA-Grim.pdf ) and take to all members of health care team. Tell us what stage you believe you are in. This is a brief review of most causes of hyperaldosteronism, high blood pressure, low potassium (K). 2. Read about other patients with hyperaldosteronism (Conn’s syndrome). Read our Conn's stories in our files

and then give us your own in as much detail as you can. Dr. Conn was the first to describe this disease process and the syndrome is named after him.To see others' stories, on the Hyperaldosteronism home page, go to Files/Conn’s Stories. You'll find instructions in "A - How to put your story here.doc " First send us your story in an email and they we may have questions and suggestions before you upload it to our files. 3. DASH to lower your BP. Your and my tax dollars funded the most important series of studies on how to improve blood pressure, blood sugar, blood lipids and make your heart smaller: The DASH Eating Plan to control high blood pressure due to hyperaldosteronism and most others with high blood pressure. This will reduce your need for medications and in many will get your BP and K to goal without meds..

Get the DASH diet book by T. et al, (http://www.amazon.com/DASH-Diet-Hypertension--/dp/0743202953) read it and use it: ~$8 in paperback at your local bookstore or online. If they don’t have it ask them to order it for you. You can also get the hardback larger print version as well at Amazon. Learning to eat the DASH way will play a major role in your road to good BP and K control and, in many of our folks here, will revolutionize your life. See http://en.wikipedia.org/wiki/DASH_diet for an overview and more details. In the book go to chapter 9 and do the 14 day challenge. Tell your Dr you are doing this as your BP may plummet if you are on other meds. Measure your BP every day and post to us. or go to http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf download this 64 page booklet free and do the Week on the DASH Diet for 2 weeks. If you are on BP meds be prepared for a large fall in BP (20/10 mm Hg or more) and let your Dr. know you are doing this. And/Or go to (but costs money monthly) DASH Diet for Health Program (http://www.dashforhealth.com/pages/public/tour.php)The DASH Diet for Health Program is designed to help you improve your eating and exercise habits. Twice each week they will provide you with information on our website about food, food preparation, eating out, losing weight, getting fit and much more. In addition to providing new information each week on the website, they create a web page specially for you where you can track progress in areas such as your weight, blood pressure, and exercise. I strongly recommend you get this book and read

it. 4. Measure your BP: Measure your BP daily so you can see if it is getting better. If you are taking meds be sure to tell your health care team you are doing this as your BP may plummet to normal quickly. We recommend you use a device you listen to and will help you learn how to do this. If this is not something you want to do we can teach a significant other how to do it. See sharedcareinc.com or email to sharedcare@... to order a video on how to do this. If you already have one we will teach you how to teach your health care team how to validate your device. Your life and health depends on accurate BP measurements. Go to the amricanheart.org and download the Guidelines

for Human Blood Pressure Measurement. Insist the your health care team do BP the AHA way. Never trust your life to an automatic BP machine unless you know it is accurate on YOU. 5. Genetics and your BP: Go to familyhistory.hhs.gov and do your detailed family medical history so we can review with you to help Dx familial causes of high blood pressure and heart disease. If BP runs in your family you may save lives in your family by checking their BP yourself. 6. How to DX and treat PA: Go to our file/Conn's Articles of Note/Medications/Bravo spir 1973.pdf and read this article and take to your health care team. It is old but still one of the best in the medical management of PA. Also see our file from the Endocrine Society Guidelines on PA. Dr. Grim's Perfect Primary Aldosteronism Blood and Urine Testing to diagnose PA in one day. 1. Eat a regular to high salt diet for 2 weeks.2. No BP meds in last 4-12 weeks depending on meds.3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do not lose a drop of this liquid gold. It is impossible to interpret the renin and aldo without this.4. The morning you finish the 24 hr urine have fasting blood drawn for renin, aldo and K using our guidelines to get an accurate K. Try

to get this done about 4 hours after you have been out of bed.5. Send us the results with the normal values for your lab.6. If you ever have a salt (saline) infusion test for PA be certain to ask them to measure how much you pee during the 4 hours of the infusion. If it is 1-1.5 liter of urine it strongly suggests that you may have PA. If more tha 1.5 L you almost certainly have PA. 8. Become a participant in our PA Registry and contribute to our large database on PA: If you have been Dxed with PA already and are on Rx or have had surgery please go to http://www.kwiksurveys.com/online-survey.php?surveyID=HIJIO_f2685379 and complete our survey with as much information as you know. If there is some information you don't know ask us and we will help. If you need to update this as you journey thru the diagnostic/treatment process you can add another entry but label it as Nameyymmdd. For

example today 6/12/09 for me would be Grim090612. This ever increasing number will allow us and you to sort your multiple entries into a dated order. 9. Learn the language: If you are new to medical lingo then download the acroyms from http://health.groups.yahoo.com/group/bloodpressureline/message/2918610. Salt and high blood pressure: To learn the state of the science of salt and blood pressure please spend some time looking at http://www.worldactiononsalt.com/evidence/treatment_trials.htm11. Become a HBP expert consumer: Expect that it will take at least several weeks to get all this digested and to learn the new language of high blood pressure health care. As most doctors and nurses in practice have had very little training in high blood pressure you must become an expert yourself. For example most have never had anyone listen with them with a double stethoscope to verify that they can hear BP sounds. We cannot make you a doctor but we will make you a pretty good BP

doctor.12. How High Blood Pressure should be managed: Go to nih.gov and download and read the Joint National Commission (JNC) Report 7 to get an overview on current guidelines. I ask all my secretaries to read this so they can communicate the importance of high blood pressure to my patients. JNC 8 will be out soon.Then: get (and study) the Hypertension Primer from americanheart.org. This is the most up-to-date compendium of what is known about high blood pressure and what every Dr. should know when they graduate from Medical School. Every chapter is only 2-3 pages.

Read one chapter every week-night and you will finish it in about a year. I am working on a reading guide for lay people for the Primer. Stay tuned.13. Ask us questions: Ask any questions about high blood pressure you want answered. That is what we are here for. We have had this site for 10 years and over 30,000 emails are searchable. This is the largest collection of communications about Conn's Syndrome in the World. 14. One-on-one Consulting: I can provide individual consulting if you do not want to go public. If you want individual one-on-one consulting for you and your Doctor contract me directly at lowerbp2@....May your pressure be low!Clarence E. Grim BS, MS, MD, FACP, FACC, FAHABoard Certified in Internal Medicine, Geriatrics, and High Blood Pressure Retired Faculty/Professor of Medicine (U of MO, Indiana, UCLA/DREW, Medical College of Wisconsin and Cardiology, Endocrinology, Nephrology, and Epidemiology. Specializing in Primary Aldosteronism

and Difficult to Control High Blood Pressure. I'm going in on Thursday for the following test: basic panel and serum aldosterone.Shouldn't there be a

urine test? Are these test a waste of my time if I want real answers to why I have high aldosterone.What would be the ideal test? Please help I am feeling pressured for time! Thank youSent from my iPad Not that I know of or can make a connection to in my wildest Endocrine/Heme thoughs. But then another reason we need a good data base.Do you do data bases?CE Grim,MDIs there any connection between high aldosterone and low ferritin?Sent from my iPadOn Oct

30, 2010, at 2:34 PM, Clarence Grim wrote: If your BP and K is normal you may not need to DASH.Runners may have aldo if it was

collected after a run.Drink when you are thirsty. A low Na suggests you are drinking too much.CE Grim MDCould I get some input on water intake? I tried searching the web-site about dashing but couldn't find what I was looking for.I know are bodies are

constantly trying to keep things in balance so I feel like h2o consumption is just as important as sodium intake. However, I don't think I can assume the average 8 cups a day will be my norm.Here are a few things that I think might influence my sodium/h20 consumption: I have lowish serum sodium 138 (135-145), I have low blood pressure110/65, high aldosterone (24 hr urine 54.3 ( 17-44) and I am active ( runner)I feel it is reasonable that I keep my sodium intake at the higher end of the Dashing Diet , because of low sodium and low blood pressure and activity level, but I also want to try and lower aldosterone naturally ( if possible) and I'm hoping maybe it's a matter of the right amount of daily water and sodium consumption. Are there any right ratios for this? For example, if you consume 1,500 mg of sodium you should have 8 cups of h2o or maybe if you

consume 2,300 mg of sodium you should shoot for 10 cups of h2o?Thanks so much! Really trying to get it right!Sent from my iPad Keep us posted. so you have high renin and high aldo and low K and low BP?CE Grim MDHi Dr. Grim, The following post

grabbed my attention. I started following you and this site when I was thought to have primary hyperaldosteronism. I had all the expected abnormal lab results except for low to normal blood pressure. Eventually, labaratory results confirmed Bartters Syndrome and now I follow both yahoo groups. > > >>>>>>>>>> > > >>>>>>>>>>> > > >>>>>>>>>>> Hi everyone, just joined today. Thanks to all of you for this support!> > >>>>>>>>>>> > > >>>>>>>>>>> I tested high for aldosterone two years ago through a urine test. My ND at the time was not concerned, he thought it was due to the fact that I was a runner. I also thought that made since and was also following a low salt diet. So we ignored it.> > >>>>>>>>>>> > > >>>>>>>>>>> I am treAting a thyroid issue, thyroid hormone resistance, and through recent blood work tested high for

aldosterone again. This time I decided not to ignore it! > > >>>>>>>>>>> > > >>>>>>>>>>> I do not have a high blood pressure. It runs pretty normal to low. I don't have issues with potassium. This is all Very confusing as to why I have high aldosterone.> > >>>>>>>>>>> > > >>>>>>>>>>> I am trying to get into a endocrinologist but will take about three months. I need some education and advise on where to start.> > >>>>>>>>>>> > > >>>>>>>>>>> I don't even know if this is primary or secondary.> >

>>>>>>>>>>> > > >>>>>>>>>>> My only real "health" issue, that I know about, has been hair loss. This was one reason for exploring the thyroid but I am wondering if it has been the aldosterone all along. Maybe the aldosterone is what's causing my thyroid issues.> > >>>>>>>>>>> > > >>>>>>>>>>> Any comments or advice would be greatly appreciated.> > >>>>>>>>>>> > > >>>>>>>>>>> My labs:> > >>>>>>>>>>> > > >>>>>>>>>>> 9/26/2008> >

>>>>>>>>>>> Aldosterone (urine)> > >>>>>>>>>>> High 54.3. (normal diet 6-25, low salt 17-44, high salt0-6)> > >>>>>>>>>>> > > >>>>>>>>>>> Other adrenal hormones were fine at that time. Cortisol was pretty middle of the road. *Progesterone however was really high too. I can post if necessary.> > >>>>>>>>>>> > > >>>>>>>>>>> Rbc potassium 7/14/2010> > >>>>>>>>>>> 97. (90-111)> > >>>>>>>>>>> > > >>>>>>>>>>> Blood aldosterone 7/18/2010>

> >>>>>>>>>>> 52.0. (1-16)> > >>>>>>>>>>> > > >>>>>>>>>>> Blood aldosterone/renin 6/30/2010> > >>>>>>>>>>> Aldosterone 49. (1-16)> > >>>>>>>>>>> Renin. 3.3. (random ambulatory 0.8-2.5, non ambulatory 1.5-5.2)> > >>>>>>>>>>> I was sitting, fasting, taking two hours after waking before/around 8am> > >>>>>>>>>>> > > >>>>>>>>>>> Aldosterone renin ratio = 15> > >>>>>>>>>>> > > >>>>>>>>>>> Sodium. 138.

(135-145)> > >>>>>>>>>>> Potassium. 4.5. (3.5-5.3)> > >>>>>>>>>>> Chloride. 106. (98-109)> > >>>>>>>>>>> Co2. 23. (22-31)> > >>>>>>>>>>> Anion gap. 9. (5-16)> > >>>>>>>>>>> > > >>>>>>>>>>> Saliva cortisol 5/23/2010> > >>>>>>>>>>> 7am. 3.7. (3.7-9.5)> > >>>>>>>>>>> 11am. 1.6. (1.2-3.0)> > >>>>>>>>>>> 5pm. 1.3. (0.6-1.9)> > >>>>>>>>>>> 9pm. 0.5. (0.4-1.0)> > >>>>>>>>>>> > >

>>>>>>>>>>> Rbc magnesium 5/26/2010> > >>>>>>>>>>> 4.2. (4.0-6.4)> > >>>>>>>>>>> > > >>>>>>>>>>> Lot of test!!!!> > >>>>>>>>>>> > > >>>>>>>>>>> Thanks again for your kind support! Suzanne> > >>>>>>>>>>> > > >>>>>>>>>>> > > >>>>>>>>>> > > >>>>>>>>> > >

>>>>>>>>> > > >>>>>>>> > > >>>>>>>> > > >>>>>>> > > >>>>>>> > > >>>>>> > > >>>>>> > > >>>>> > > >>>>> > > >>>> > > >>>> >

> >>> > > >>> > > >> > > > > > >> >> > > Reply to sender |>

[Guest guest]

I assume your Dr. gets paid for doing this sort of interpretation.I can do it one on one for a fee. They all look good to me.CE Grim MDI have some test results back that are worrying me. I don't have all the results so I will post them as I get them. Right now I am concerned with what my creatinine levels mean. Please help!!!Blood creatinineCREAT 0.77 (0.44-1.00)BUN 14 (6-20)urine creatinine (there were two results for this)CREAT,RAND UR 40.86 L (80.00-170 mg./dl)CREAT, UR QUANT 1.0 (0.6-1.8 gm./dy)Should I be worried about the low CREAT, RAND UR?????THANKS, SUZANNESent from my iPad It varies. Do a pubmed.CE Grim MDWhat significance does our menstrual cycle play in blood pressure?During my luteal phase my blood pressure ranges from 115/65 to 120/75 but then once menses begins i run a lot lower 90/60.I am in the process of doing the 24 hour urine. should have those numbers in a few days.thanks,suzanneSent from my iPad Yea but you usually are an alcoholic who does not each much or cancer pt who cannot eat and is starving. CE Grim MDI have read that a magnesium deficiency can cause low K.Sent from my iPad Better to DASH I would think.If you can get it in food why take a pill?CE Grim MDare you serious? I am asking if I should take a b vitamin supplement?Sent from my iPad Still no question?CE Grim MD Was there a question here?Hi Dr. Grim,Is it recommended to take a b-complex vitamin?I have been holding off from taking mine (complete b-complex from life extension) because i am afraid it might encourage more aldosterone production! Am I crazy for worrying about this? I know the adrenals love b vitamins and I don't need anything that will cause me to produce more aldosterone. However, I know for a woman of my age and activity level that the b's are very important and could really benefit my body!!Thanks, SuzanneSent from my iPad They are all competitors for the receptors but I do not know the measures of association that permits one to quantitate the relative effect of aldo in occupying each of the receptors. Also they circulate in much greater quantities that aldo as I recall. So the effect would seem likely to be weak.CE Grim MD Hi Dr. Grim, I wanted to ask if high aldosterone levels will block progesterone, testosterone, and estrogen receptors? Thanks, SuzanneTo: hyperaldosteronism Cc: Clarence Grim Sent: Sun, November 7, 2010 7:36:01 PMSubject: Re: Re: 42 yo woman runner who has had aldo 52 and renin 3.3 normal bp That's what this paper says. No one has looked at in anymore detail that I can find.CE Grim MDOk, by doing this it will be ok to test any time of my cycle?Sent from my iPad Ask your lab to use plasma renin activity not direct renin assay.CE Grim MDThis is the article I did read. I didn't feel like it gave a definitive answer. I have read it is best to test aldosterone on the third day of the menstrual cycle but not sure how that will go seeing it is a urine test and not a simple blood draw. Any advice would be greatly appreciated. ThanksSent from my iPad Guess you did not search aldosterone renin ratio.Here is one.J Clin Endocrinol Metab. 2010 Oct 20. [Epub ahead of print]Are Women More at Risk of False-Positive Primary Aldosteronism Screening and Unnecessary Suppression Testing than Men?Ahmed AH, Gordon RD, PJ, Ward G, Pimenta E, Stowasser M.Endocrine Hypertension Research Centre (A.H.A., R.D.G., P.J.T., E.P., M.S.), University of Queensland School of Medicine, Greenslopes and Princess andra Hospitals, Brisbane, Queensland 4102, Australia; and Sullivan and Nicolaides Pathology (G.W.), Brisbane, 4068 Queensland, Australia.AbstractBackground: Because primary aldosteronism is not uncommon, specifically treatable and in some cases curable, and carries higher risks for cardiovascular morbidity and mortality than essential hypertension, screening hypertensive patients for its presence by measuring aldosterone to renin ratio (ARR) is increasingly common. A significantly higher false-positive ARR rate for women than men, resulting in unnecessary suppression tests has previously been reported. Methods: Using a new, highly accurate aldosterone assay and both of the currently widely used renin assays, ARR was measured in 19 normal, ovulating women at three time points in the menstrual cycle and compared with single measurements in 21 normal males of similar age. Results: ARRs in males were possibly too well down in the current normal range. Although normotensive and normokalemic, two women had raised ARRs in the luteal phase but only when direct renin concentration (DRC) was used. Their DRC levels were low at all sampling times [despite midrange plasma renin activity levels], whereas their progesterone and aldosterone levels were highest for the group. Saline suppression testing, performed in one of them, showed normal aldosterone suppressibility. Conclusion: False-positive ARRs in normal women during the luteal phase only when DRC is used may explain the higher incidence of false-positive ARRs in hypertensive women than men and suggest the following: 1) plasma renin activity is preferable to DRC in determination of ARR and 2) new reference ranges for ARR that take into account gender and sex hormone levels are required.Thanks, I did do some reading on pubmed like you suggested about testing and menses but never came up with an answer. Hoping you had the answer. I know aldosterone is naturally higher during the luteal phase but I only want to do this once and I want to get it exactly right . Sent from my iPad I think I sent an abstract recently on menses and testing. If you cant find it let me know.Dr. Grim's Perfect Primary Aldosteronism Blood and Urine Testing to diagnose PA in one day. 1. Eat a regular to high salt diet for 2 weeks.2. No BP meds in last 4-12 weeks depending on meds.3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do not lose a drop of this liquid gold. It is impossible to interpret the renin and aldo without this.4. The morning you finish the 24 hr urine have fasting blood drawn for renin, aldo and K using our guidelines to get an accurate K. Try to get this done about 4 hours after you have been out of bed.5. Send us the results with the normal values for your lab.6. If you ever have a salt (saline) infusion test for PA be certain to ask them to measure how much you pee during the 4 hours of the infusion. If it is 1-1.5 liter of urine it strongly suggests that you may have PA. If more tha 1.5 L you almost certainly have PA. Hi, I am calling my Natural Path tomorrow to have her order test to see if we can figure out why I have high alodsterone. Here are the test I am requesting: (PLEASE LET ME KNOW IF I AM MISSING SOMETHING) -24 hour urine NA, K, Creatinine, Aldosterone -blood draw Renin, Aldosterone, and K Anything else????Also where can I get the info on how to collect K correctly?See our files on how to draw blood.One last question, when during my menstrual cycle is the best time to do these test?'see a recent email re this issue.Thanks so much for you time, SuzanneTo: hyperaldosteronism Cc: Clarence Grim Sent: Fri, November 5, 2010 7:04:29 AMSubject: Re: Re: 42 yo woman runner who has had aldo 52 and renin 3.3 normal bp your team is who you have decided you want to manage your health. Can a Natural Path write prescriptions and order blood tests?CE Grim MDWhat if I don't have a team? Or do you consider a Natural Path my team?Sent from my iPad yes I can work with your team for $500 per year.CE Grim MDHi Dr Grim , I agree I am afraid I am going to make this 400 mile trip and get nowhere! I don't have a dr other than a Natural Path. Can you be my dr and take care of all of this online?Sent from my iPad she does not seem to understand PA as she did not order a renin.CE Grim MDSend her my article on the evolution of PA and the Endo guidelines in our files---BEFORE you see her. You want to know how many PAs she has treated and followed for at least 10 years.CE Grim MDThanks for the info. I am so frustrated with dr's in my area. It seems NO one knows the correct test around here! My natural path is very willing to order the test but she's the first one to admit that she won't know what to do with the results.I live in Whitefish, Montana and Kalispell is about 15 minutes away. Missoula is about 200 miles but I would drive it if someone could make a recommendation ( preferably first hand experience). I am doing Dr. grimes ideal test in December and then at the end of December I am scheduled to see an endocrinologist in Missoula. I don't have faith that the endo knows much about hyperaldosteronism but at this point she is my only hope. This endo's name is Dr. Eyler. She has ordered the following test ( which I don't believe are ideal): hypothyroid panel, comprehensive metabolic panel, vitamin d, hemogram, LH, FSH, 24 hr urine aldosterone.Any comments or feedback would be so appreciated! Thanks, SuzanneSent from my iPad See Dr Grim's ideal test.You cannot interpret the aldo/renin ratio without having a 24 hr urine Na. But maybe your health care team knows how to do this. If so they need to let us know.CE GrimMDWelcome to the exciting world of Hyperaldosteronism! You are in the right place! I am Dr. CE Grim a retired Professor of Medicine and Endocrinology. I have a long standing interest is Primary Aldosteronism since medical school days when I saw my first patient with Primary Aldosteronism in 1963. I trained with Dr. Conn in Endocrinology and Metabolism 1969-70 and have published over 240 papers and book chapters in most areas of the broad discipline of High Blood Pressure. My CV is in our files for details. The goal of our group is to teach you and your health care team about the ins and outs of the causes, diagnosis and control of the many forms of hyperaldosteronism. The steps below will introduce you into the fascinating world of high blood pressure, salt and potassium and the role of the adrenal hormone aldosterone in health and disease. Doing these in sequence will save you time and effort in getting up to speed in taking control of you health and educating your own health care team. While we can’t make you a doctor we will make you into a pretty good BP doctor-a skill that you will have for life. 1. A brief history of Primary Aldosteronsim and why it is so common today in drug resistant high blood pressure. Read my article in our files on the evolution of PA (Evolution_of_PA-Grim.pdf ) and take to all members of health care team. Tell us what stage you believe you are in. This is a brief review of most causes of hyperaldosteronism, high blood pressure, low potassium (K). 2. Read about other patients with hyperaldosteronism (Conn’s syndrome). Read our Conn's stories in our files and then give us your own in as much detail as you can. Dr. Conn was the first to describe this disease process and the syndrome is named after him.To see others' stories, on the Hyperaldosteronism home page, go to Files/Conn’s Stories. You'll find instructions in "A - How to put your story here.doc " First send us your story in an email and they we may have questions and suggestions before you upload it to our files. 3. DASH to lower your BP. Your and my tax dollars funded the most important series of studies on how to improve blood pressure, blood sugar, blood lipids and make your heart smaller: The DASH Eating Plan to control high blood pressure due to hyperaldosteronism and most others with high blood pressure. This will reduce your need for medications and in many will get your BP and K to goal without meds.. Get the DASH diet book by T. et al, (http://www.amazon.com/DASH-Diet-Hypertension--/dp/0743202953) read it and use it: ~$8 in paperback at your local bookstore or online. If they don’t have it ask them to order it for you. You can also get the hardback larger print version as well at Amazon. Learning to eat the DASH way will play a major role in your road to good BP and K control and, in many of our folks here, will revolutionize your life. See http://en.wikipedia.org/wiki/DASH_diet for an overview and more details. In the book go to chapter 9 and do the 14 day challenge. Tell your Dr you are doing this as your BP may plummet if you are on other meds. Measure your BP every day and post to us. or go to http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf download this 64 page booklet free and do the Week on the DASH Diet for 2 weeks. If you are on BP meds be prepared for a large fall in BP (20/10 mm Hg or more) and let your Dr. know you are doing this. And/Or go to (but costs money monthly) DASH Diet for Health Program (http://www.dashforhealth.com/pages/public/tour.php)The DASH Diet for Health Program is designed to help you improve your eating and exercise habits. Twice each week they will provide you with information on our website about food, food preparation, eating out, losing weight, getting fit and much more. In addition to providing new information each week on the website, they create a web page specially for you where you can track progress in areas such as your weight, blood pressure, and exercise. I strongly recommend you get this book and read it. 4. Measure your BP: Measure your BP daily so you can see if it is getting better. If you are taking meds be sure to tell your health care team you are doing this as your BP may plummet to normal quickly. We recommend you use a device you listen to and will help you learn how to do this. If this is not something you want to do we can teach a significant other how to do it. See sharedcareinc.com or email to sharedcare@... to order a video on how to do this. If you already have one we will teach you how to teach your health care team how to validate your device. Your life and health depends on accurate BP measurements. Go to the amricanheart.org and download the Guidelines for Human Blood Pressure Measurement. Insist the your health care team do BP the AHA way. Never trust your life to an automatic BP machine unless you know it is accurate on YOU. 5. Genetics and your BP: Go to familyhistory.hhs.gov and do your detailed family medical history so we can review with you to help Dx familial causes of high blood pressure and heart disease. If BP runs in your family you may save lives in your family by checking their BP yourself. 6. How to DX and treat PA: Go to our file/Conn's Articles of Note/Medications/Bravo spir 1973.pdf and read this article and take to your health care team. It is old but still one of the best in the medical management of PA. Also see our file from the Endocrine Society Guidelines on PA. Dr. Grim's Perfect Primary Aldosteronism Blood and Urine Testing to diagnose PA in one day. 1. Eat a regular to high salt diet for 2 weeks.2. No BP meds in last 4-12 weeks depending on meds.3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do not lose a drop of this liquid gold. It is impossible to interpret the renin and aldo without this.4. The morning you finish the 24 hr urine have fasting blood drawn for renin, aldo and K using our guidelines to get an accurate K. Try to get this done about 4 hours after you have been out of bed.5. Send us the results with the normal values for your lab.6. If you ever have a salt (saline) infusion test for PA be certain to ask them to measure how much you pee during the 4 hours of the infusion. If it is 1-1.5 liter of urine it strongly suggests that you may have PA. If more tha 1.5 L you almost certainly have PA. 8. Become a participant in our PA Registry and contribute to our large database on PA: If you have been Dxed with PA already and are on Rx or have had surgery please go to http://www.kwiksurveys.com/online-survey.php?surveyID=HIJIO_f2685379 and complete our survey with as much information as you know. If there is some information you don't know ask us and we will help. If you need to update this as you journey thru the diagnostic/treatment process you can add another entry but label it as Nameyymmdd. For example today 6/12/09 for me would be Grim090612. This ever increasing number will allow us and you to sort your multiple entries into a dated order. 9. Learn the language: If you are new to medical lingo then download the acroyms from http://health.groups.yahoo.com/group/bloodpressureline/message/2918610. Salt and high blood pressure: To learn the state of the science of salt and blood pressure please spend some time looking at http://www.worldactiononsalt.com/evidence/treatment_trials.htm11. Become a HBP expert consumer: Expect that it will take at least several weeks to get all this digested and to learn the new language of high blood pressure health care. As most doctors and nurses in practice have had very little training in high blood pressure you must become an expert yourself. For example most have never had anyone listen with them with a double stethoscope to verify that they can hear BP sounds. We cannot make you a doctor but we will make you a pretty good BP doctor.12. How High Blood Pressure should be managed: Go to nih.gov and download and read the Joint National Commission (JNC) Report 7 to get an overview on current guidelines. I ask all my secretaries to read this so they can communicate the importance of high blood pressure to my patients. JNC 8 will be out soon.Then: get (and study) the Hypertension Primer from americanheart.org. This is the most up-to-date compendium of what is known about high blood pressure and what every Dr. should know when they graduate from Medical School. Every chapter is only 2-3 pages. Read one chapter every week-night and you will finish it in about a year. I am working on a reading guide for lay people for the Primer. Stay tuned.13. Ask us questions: Ask any questions about high blood pressure you want answered. That is what we are here for. We have had this site for 10 years and over 30,000 emails are searchable. This is the largest collection of communications about Conn's Syndrome in the World. 14. One-on-one Consulting: I can provide individual consulting if you do not want to go public. If you want individual one-on-one consulting for you and your Doctor contract me directly at lowerbp2@....May your pressure be low!Clarence E. Grim BS, MS, MD, FACP, FACC, FAHABoard Certified in Internal Medicine, Geriatrics, and High Blood Pressure Retired Faculty/Professor of Medicine (U of MO, Indiana, UCLA/DREW, Medical College of Wisconsin and Cardiology, Endocrinology, Nephrology, and Epidemiology. Specializing in Primary Aldosteronism and Difficult to Control High Blood Pressure. I'm going in on Thursday for the following test: basic panel and serum aldosterone.Shouldn't there be a urine test? Are these test a waste of my time if I want real answers to why I have high aldosterone.What would be the ideal test? Please help I am feeling pressured for time! Thank youSent from my iPad Not that I know of or can make a connection to in my wildest Endocrine/Heme thoughs. But then another reason we need a good data base.Do you do data bases?CE Grim,MDIs there any connection between high aldosterone and low ferritin?Sent from my iPad If your BP and K is normal you may not need to DASH.Runners may have aldo if it was collected after a run.Drink when you are thirsty. A low Na suggests you are drinking too much.CE Grim MDCould I get some input on water intake? I tried searching the web-site about dashing but couldn't find what I was looking for.I know are bodies are constantly trying to keep things in balance so I feel like h2o consumption is just as important as sodium intake. However, I don't think I can assume the average 8 cups a day will be my norm.Here are a few things that I think might influence my sodium/h20 consumption: I have lowish serum sodium 138 (135-145), I have low blood pressure110/65, high aldosterone (24 hr urine 54.3 ( 17-44) and I am active ( runner)I feel it is reasonable that I keep my sodium intake at the higher end of the Dashing Diet , because of low sodium and low blood pressure and activity level, but I also want to try and lower aldosterone naturally ( if possible) and I'm hoping maybe it's a matter of the right amount of daily water and sodium consumption. Are there any right ratios for this? For example, if you consume 1,500 mg of sodium you should have 8 cups of h2o or maybe if you consume 2,300 mg of sodium you should shoot for 10 cups of h2o?Thanks so much! Really trying to get it right!Sent from my iPad Keep us posted. so you have high renin and high aldo and low K and low BP?CE Grim MDHi Dr. Grim, The following post grabbed my attention. I started following you and this site when I was thought to have primary hyperaldosteronism. I had all the expected abnormal lab results except for low to normal blood pressure. Eventually, labaratory results confirmed Bartters Syndrome and now I follow both yahoo groups. > > >>>>>>>>>> > > >>>>>>>>>>> > > >>>>>>>>>>> Hi everyone, just joined today. Thanks to all of you for this support!> > >>>>>>>>>>> > > >>>>>>>>>>> I tested high for aldosterone two years ago through a urine test. My ND at the time was not concerned, he thought it was due to the fact that I was a runner. I also thought that made since and was also following a low salt diet. So we ignored it.> > >>>>>>>>>>> > > >>>>>>>>>>> I am treAting a thyroid issue, thyroid hormone resistance, and through recent blood work tested high for aldosterone again. This time I decided not to ignore it! > > >>>>>>>>>>> > > >>>>>>>>>>> I do not have a high blood pressure. It runs pretty normal to low. I don't have issues with potassium. This is all Very confusing as to why I have high aldosterone.> > >>>>>>>>>>> > > >>>>>>>>>>> I am trying to get into a endocrinologist but will take about three months. I need some education and advise on where to start.> > >>>>>>>>>>> > > >>>>>>>>>>> I don't even know if this is primary or secondary.> > >>>>>>>>>>> > > >>>>>>>>>>> My only real "health" issue, that I know about, has been hair loss. This was one reason for exploring the thyroid but I am wondering if it has been the aldosterone all along. Maybe the aldosterone is what's causing my thyroid issues.> > >>>>>>>>>>> > > >>>>>>>>>>> Any comments or advice would be greatly appreciated.> > >>>>>>>>>>> > > >>>>>>>>>>> My labs:> > >>>>>>>>>>> > > >>>>>>>>>>> 9/26/2008> > >>>>>>>>>>> Aldosterone (urine)> > >>>>>>>>>>> High 54.3. (normal diet 6-25, low salt 17-44, high salt0-6)> > >>>>>>>>>>> > > >>>>>>>>>>> Other adrenal hormones were fine at that time. Cortisol was pretty middle of the road. *Progesterone however was really high too. I can post if necessary.> > >>>>>>>>>>> > > >>>>>>>>>>> Rbc potassium 7/14/2010> > >>>>>>>>>>> 97. (90-111)> > >>>>>>>>>>> > > >>>>>>>>>>> Blood aldosterone 7/18/2010> > >>>>>>>>>>> 52.0. (1-16)> > >>>>>>>>>>> > > >>>>>>>>>>> Blood aldosterone/renin 6/30/2010> > >>>>>>>>>>> Aldosterone 49. (1-16)> > >>>>>>>>>>> Renin. 3.3. (random ambulatory 0.8-2.5, non ambulatory 1.5-5.2)> > >>>>>>>>>>> I was sitting, fasting, taking two hours after waking before/around 8am> > >>>>>>>>>>> > > >>>>>>>>>>> Aldosterone renin ratio = 15> > >>>>>>>>>>> > > >>>>>>>>>>> Sodium. 138. (135-145)> > >>>>>>>>>>> Potassium. 4.5. (3.5-5.3)> > >>>>>>>>>>> Chloride. 106. (98-109)> > >>>>>>>>>>> Co2. 23. (22-31)> > >>>>>>>>>>> Anion gap. 9. (5-16)> > >>>>>>>>>>> > > >>>>>>>>>>> Saliva cortisol 5/23/2010> > >>>>>>>>>>> 7am. 3.7. (3.7-9.5)> > >>>>>>>>>>> 11am. 1.6. (1.2-3.0)> > >>>>>>>>>>> 5pm. 1.3. (0.6-1.9)> > >>>>>>>>>>> 9pm. 0.5. (0.4-1.0)> > >>>>>>>>>>> > > >>>>>>>>>>> Rbc magnesium 5/26/2010> > >>>>>>>>>>> 4.2. (4.0-6.4)> > >>>>>>>>>>> > > >>>>>>>>>>> Lot of test!!!!> > >>>>>>>>>>> > > >>>>>>>>>>> Thanks again for your kind support! Suzanne> > >>>>>>>>>>> > > >>>>>>>>>>> > > >>>>>>>>>> > > >>>>>>>>> > > >>>>>>>>> > > >>>>>>>> > > >>>>>>>> > > >>>>>>> > > >>>>>>> > > >>>>>> > > >>>>>> > > >>>>> > > >>>>> > > >>>> > > >>>> > > >>> > > >>> > > >> > > > > > >> >> > > Reply to sender |>

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Thanks!!Would you mind explaining the difference between the creatinine random urine and the creatinine quantitative urine? I am concerned that my creat. rand is low meaning kidney trouble.I have been sitting here "researching" this for an hour or so and can't find an explanation.I won't been able to see my doctor until the end of this month and even then I don't think she is well educated in this area.I really wanted to rule out any kidney issues before December 28th.Thanks for your time and input! SuzanneSent from my iPad

I assume your Dr. gets paid for doing this sort of interpretation.I can do it one on one for a fee. They all look good to me.CE Grim MDI have some test results back that are worrying me. I don't have all the results so I will post

them as I get them. Right now I am concerned with what my creatinine levels mean. Please help!!!Blood creatinineCREAT 0.77 (0.44-1.00)BUN 14 (6-20)urine creatinine (there were two results for this)CREAT,RAND UR 40.86 L (80.00-170 mg./dl)CREAT, UR QUANT 1.0 (0.6-1.8 gm./dy)Should I be worried about the low CREAT, RAND UR?????THANKS, SUZANNESent from my iPad It varies. Do a pubmed.CE Grim MDWhat significance does our menstrual cycle play in blood pressure?During my luteal phase my blood pressure ranges from 115/65 to 120/75 but then once menses

begins i run a lot lower 90/60.I am in the process of doing the 24 hour urine. should have those numbers in a few days.thanks,suzanneSent from my iPad Yea but you usually are an alcoholic who does not each much or cancer pt who cannot eat and is starving. CE Grim MDI have read that a magnesium deficiency can cause low K.Sent from my iPad Better to DASH I

would think.If you can get it in food why take a pill?CE Grim MDare you serious? I am asking if I should take a b vitamin supplement?Sent from my iPad Still no question?CE Grim MD Was there a question here?Hi Dr. Grim,Is it recommended to take a b-complex vitamin?I have been holding off from taking mine (complete b-complex from life extension) because i am afraid it might encourage more aldosterone production! Am I crazy for worrying about this? I know the adrenals love b vitamins and I don't need anything that will cause me to produce more aldosterone. However, I know for a woman of my age and activity level that the b's are very important and could really benefit my body!!Thanks, SuzanneSent from my iPad They are all competitors for the receptors but I do not know the measures of association that permits one to quantitate the relative effect of aldo in occupying each of the receptors. Also they circulate in much greater quantities that aldo as I recall. So the effect would seem likely to be weak.CE Grim MD On Nov 13, 2010,

at 12:01 PM, Suzanne Kann wrote:Hi Dr. Grim, I wanted to ask if high aldosterone levels will block progesterone, testosterone, and estrogen receptors? Thanks, SuzanneTo: hyperaldosteronism Cc: Clarence Grim Sent: Sun, November 7, 2010 7:36:01 PMSubject: Re: Re: 42 yo woman runner who has had aldo 52 and renin 3.3 normal bp That's what this paper says. No one has looked at in anymore detail that I can find.CE Grim MDOk, by doing this it will be ok to test any time of my cycle?Sent from my iPad Ask your lab to use plasma renin activity not direct renin assay.CE Grim MDThis is the article I did read. I didn't feel like it gave a definitive answer. I have read it is best to test aldosterone on the third day of the menstrual cycle but not sure how that will go seeing it is a urine test and not a simple blood draw. Any advice would be greatly appreciated. ThanksSent from my iPad Guess you did not search aldosterone renin ratio.Here is one.J Clin Endocrinol Metab. 2010 Oct 20. [Epub ahead of print]Are Women More at Risk of False-Positive Primary Aldosteronism Screening and Unnecessary Suppression Testing than Men?Ahmed AH, Gordon RD, PJ, Ward G, Pimenta E, Stowasser M.Endocrine Hypertension Research Centre (A.H.A., R.D.G., P.J.T., E.P., M.S.), University of Queensland School of Medicine, Greenslopes and Princess andra Hospitals, Brisbane, Queensland 4102, Australia; and Sullivan and Nicolaides Pathology (G.W.), Brisbane, 4068 Queensland, Australia.AbstractBackground: Because primary aldosteronism is not

uncommon, specifically treatable and in some cases curable, and carries higher risks for cardiovascular morbidity and mortality than essential hypertension, screening hypertensive patients for its presence by measuring aldosterone to renin ratio (ARR) is increasingly common. A significantly higher false-positive ARR rate for women than men, resulting in unnecessary suppression tests has previously been reported. Methods: Using a new, highly accurate aldosterone assay and both of the currently widely used renin assays, ARR was measured in 19 normal, ovulating women at three time points in the menstrual cycle and compared with single measurements in 21 normal males of similar age. Results: ARRs in males were possibly too well down in the current normal range. Although normotensive and normokalemic, two women had raised ARRs in the luteal phase but only when direct renin concentration (DRC) was used. Their DRC levels were low at all sampling times [despite

midrange plasma renin activity levels], whereas their progesterone and aldosterone levels were highest for the group. Saline suppression testing, performed in one of them, showed normal aldosterone suppressibility. Conclusion: False-positive ARRs in normal women during the luteal phase only when DRC is used may explain the higher incidence of false-positive ARRs in hypertensive women than men and suggest the following: 1) plasma renin activity is preferable to DRC in determination of ARR and 2) new reference ranges for ARR that take into account gender and sex hormone levels are required.Thanks, I did do some reading on pubmed like you suggested about testing and menses but never came up with an answer. Hoping you had the answer. I know aldosterone is naturally higher during the luteal phase but I only want to do this once and I want to get it exactly right . Sent from my iPad I think I sent an abstract recently on menses and testing. If you cant find it let me

know.Dr. Grim's Perfect Primary Aldosteronism Blood and Urine Testing to diagnose PA in one day. 1. Eat a regular to high salt diet for 2 weeks.2. No BP meds in last 4-12 weeks depending on meds.3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do not lose a drop of this liquid gold. It is impossible to interpret the renin and aldo without this.4. The morning you finish the 24 hr urine have fasting blood drawn for renin, aldo and K using our guidelines to get an accurate K. Try to get this done about 4 hours after you have been out of bed.5. Send us the results with the normal values for your lab.6. If you

ever have a salt (saline) infusion test for PA be certain to ask them to measure how much you pee during the 4 hours of the infusion. If it is 1-1.5 liter of urine it strongly suggests that you may have PA. If more tha 1.5 L you almost certainly have PA. Hi, I am calling my Natural Path tomorrow to have her order test to see if we can figure out why I have high alodsterone. Here are the test I am requesting: (PLEASE LET ME KNOW IF I AM MISSING SOMETHING) -24 hour urine NA, K, Creatinine, Aldosterone -blood draw Renin, Aldosterone, and K Anything else????Also where can I get the info on how to collect K correctly?See our files on how to draw blood.One last question, when during my menstrual cycle is the best time to do these test?'see a recent email re this issue.Thanks so much for you time, SuzanneTo: hyperaldosteronism Cc: Clarence Grim Sent: Fri, November 5, 2010 7:04:29 AMSubject: Re: Re: 42 yo woman runner who has had aldo 52 and renin 3.3 normal

bp your team is who you have decided you want to manage your health. Can a Natural Path write prescriptions and order blood tests?CE Grim MDWhat if I don't have a team? Or do you consider a Natural

Path my team?Sent from my iPad yes I can work with your team for $500 per year.CE Grim MDHi Dr Grim , I agree I am afraid I am going to make this 400 mile trip and get nowhere! I don't have a dr other than a Natural Path. Can you be my dr and take care of all of this online?Sent from my iPad she does not seem to understand PA as she did not order a renin.CE Grim MDSend her my article on the evolution of PA and the Endo guidelines in our files---BEFORE you see her. You want to know how many PAs she has treated and followed for at least 10 years.CE Grim MDThanks for the info. I am so frustrated with dr's in my area. It seems NO one knows the correct test around here! My natural path is very willing to order the test but she's the first one to admit that she won't know what to do with the results.I live in Whitefish, Montana and Kalispell is about 15 minutes away. Missoula is about 200 miles but I would drive it if someone could make a recommendation ( preferably first hand experience). I am doing Dr. grimes ideal test in December and then at the end of December I am scheduled to see an endocrinologist in Missoula. I don't have faith that the endo knows much about hyperaldosteronism but at this point she is my only hope. This endo's name is Dr. Eyler. She has ordered the following test ( which I don't believe are ideal): hypothyroid panel, comprehensive metabolic panel, vitamin d, hemogram, LH, FSH, 24 hr urine

aldosterone.Any comments or feedback would be so appreciated! Thanks, SuzanneSent from my iPad See Dr Grim's ideal test.You cannot interpret the aldo/renin ratio without having a 24 hr urine Na. But

maybe your health care team knows how to do this. If so they need to let us know.CE GrimMDWelcome to the

exciting world of Hyperaldosteronism! You are in the right place! I am Dr. CE Grim a retired Professor of Medicine and Endocrinology. I have a long standing interest is Primary Aldosteronism since medical school days when I saw my first patient with Primary Aldosteronism in 1963. I trained with Dr. Conn in Endocrinology and Metabolism 1969-70 and have published over 240 papers and book chapters in most areas of the broad discipline of High Blood Pressure. My CV is in our files for details. The goal of our group is to teach you and your health care team about the ins and outs of the causes, diagnosis and control of the many forms of hyperaldosteronism. The steps below will introduce you into the fascinating world of high blood pressure, salt and

potassium and the role of the adrenal hormone aldosterone in health and disease. Doing these in sequence will save you time and effort in getting up to speed in taking control of you health and educating your own health care team. While we can’t make you a doctor we will make you into a pretty good BP doctor-a skill that you will have for life. 1. A brief history of Primary Aldosteronsim and why it is so common today in drug resistant high blood pressure. Read my article in our files on the evolution of PA (Evolution_of_PA-Grim.pdf ) and take to all members of health care team. Tell us what stage you believe you are in. This is a brief review of most causes of hyperaldosteronism, high blood pressure, low potassium (K). 2. Read about other patients with hyperaldosteronism (Conn’s syndrome). Read our Conn's

stories in our files and then give us your own in as much detail as you can. Dr. Conn was the first to describe this disease process and the syndrome is named after him.To see others' stories, on the Hyperaldosteronism home page, go to Files/Conn’s Stories. You'll find instructions in "A - How to put your story here.doc " First send us your story in an email and they we may have questions and suggestions before you upload it to our files. 3. DASH to lower your BP. Your and my tax dollars funded the most important series of studies on how to improve blood pressure, blood sugar, blood lipids and make your heart smaller: The DASH Eating Plan to control high blood pressure due to hyperaldosteronism and most others with high blood pressure. This will reduce your need for medications and in many will get your BP and K

to goal without meds.. Get the DASH diet book by T. et al, (http://www.amazon.com/DASH-Diet-Hypertension--/dp/0743202953) read it and use it: ~$8 in paperback at your local bookstore or online. If they don’t have it ask them to order it for you. You can also get the hardback larger print version as well at Amazon. Learning to eat the DASH way will play a major role in your road to good BP and K control and, in many of our folks here, will revolutionize your life. See http://en.wikipedia.org/wiki/DASH_diet for an overview and more details. In the book go to chapter 9 and do the 14 day challenge. Tell your Dr you are doing this as your BP may plummet if you are on other meds. Measure your BP every day and post to us. or go to http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf download this 64 page booklet free and do the Week on the DASH Diet for 2 weeks. If you are on BP meds be prepared for a large fall in BP (20/10 mm Hg or more) and let your Dr. know you are doing this. And/Or go to (but costs money monthly) DASH Diet for Health Program (http://www.dashforhealth.com/pages/public/tour.php)The DASH Diet for Health Program is designed to help you improve your eating and exercise habits. Twice each week they will provide you with information on our website about food, food preparation, eating out, losing weight, getting fit and much more. In addition to providing new information each week on the

website, they create a web page specially for you where you can track progress in areas such as your weight, blood pressure, and exercise. I strongly recommend you get this book and read it. 4. Measure your BP: Measure your BP daily so you can see if it is getting better. If you are taking meds be sure to tell your health care team you are doing this as your BP may plummet to normal quickly. We recommend you use a device you listen to and will help you learn how to do this. If this is not something you want to do we can teach a significant other how to do it. See sharedcareinc.com or email to sharedcare@... to order a video on how to do this. If you already have one we will teach you how to teach your health care team how to validate your

device. Your life and health depends on accurate BP measurements. Go to the amricanheart.org and download the Guidelines for Human Blood Pressure Measurement. Insist the your health care team do BP the AHA way. Never trust your life to an automatic BP machine unless you know it is accurate on YOU. 5. Genetics and your BP: Go to familyhistory.hhs.gov and do your detailed family medical history so we can review with you to help Dx familial causes of high blood pressure and heart disease. If BP runs in your family you may save lives in your family by checking their BP yourself. 6. How to DX and treat PA: Go to our file/Conn's Articles of Note/Medications/Bravo spir 1973.pdf and read this article and take to your health care team. It is old but still one of the best in the medical management of PA. Also see our file from the Endocrine Society Guidelines on PA. Dr. Grim's Perfect Primary Aldosteronism Blood and

Urine Testing to diagnose PA in one day. 1. Eat a regular to high salt diet for 2 weeks.2. No BP meds in last 4-12 weeks depending on meds.3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do not lose a drop of this liquid gold. It is impossible to interpret the renin and aldo without this.4. The morning you finish the 24 hr urine have fasting blood drawn for renin, aldo and K using our guidelines to get an accurate K. Try to get this done about 4 hours after you have been out of bed.5. Send us the results with the normal values for your lab.6. If you ever have a salt (saline) infusion test for PA be certain to ask them to measure how much you pee during the 4 hours of the infusion. If it is 1-1.5 liter of urine it strongly suggests that you may have PA. If more tha 1.5 L you almost certainly have

PA. 8. Become a participant in our PA Registry and contribute to our large database on PA: If you have been Dxed with PA already and are on Rx or have had surgery please go to http://www.kwiksurveys.com/online-survey.php?surveyID=HIJIO_f2685379 and complete our survey with as much information as you know. If there is some information you don't know ask us and we will help. If you need to update this as you journey thru the diagnostic/treatment process you can add another entry but label it as Nameyymmdd. For example today 6/12/09 for me would be Grim090612. This ever increasing number will allow us and you to sort your multiple entries into a dated order. 9. Learn the language: If

you are new to medical lingo then download the acroyms from http://health.groups.yahoo.com/group/bloodpressureline/message/2918610. Salt and high blood pressure: To learn the state of the science of salt and blood pressure please spend some time looking at http://www.worldactiononsalt.com/evidence/treatment_trials.htm11. Become a HBP expert consumer: Expect that it will take at least several weeks to get all this digested and to learn the new language of high blood pressure health care. As most doctors and nurses in practice have had very little training in high blood pressure you must become an expert yourself. For example most have never had anyone listen with them with a double stethoscope to verify that they can hear BP sounds. We cannot make you a doctor but we will make you a pretty good BP

doctor.12. How High Blood Pressure should be managed: Go to nih.gov and download and read the Joint National Commission (JNC) Report 7 to get an overview on current guidelines. I ask all my secretaries to read this so they can communicate the importance of high blood pressure to my patients. JNC 8 will be out soon.Then: get (and study) the Hypertension Primer from americanheart.org. This is the most up-to-date compendium of what is known about high blood

pressure and what every Dr. should know when they graduate from Medical School. Every chapter is only 2-3 pages. Read one chapter every week-night and you will finish it in about a year. I am working on a reading guide for lay people for the Primer. Stay tuned.13. Ask us questions: Ask any questions about high blood pressure you want answered. That is what we are here for. We have had this site for 10 years and over 30,000 emails are searchable. This is the largest collection of communications about Conn's Syndrome in the World. 14. One-on-one Consulting: I can provide individual consulting if you do not want to go public. If you want individual one-on-one consulting for you and your Doctor contract me directly at lowerbp2@....May your pressure be low!Clarence E. Grim BS, MS, MD, FACP, FACC, FAHABoard Certified in Internal Medicine, Geriatrics, and High Blood Pressure Retired Faculty/Professor of Medicine (U of MO,

Indiana, UCLA/DREW, Medical College of Wisconsin and Cardiology, Endocrinology, Nephrology, and Epidemiology. Specializing in Primary Aldosteronism and Difficult to Control High Blood Pressure. I'm going in on Thursday for the following test: basic panel and serum aldosterone.Shouldn't there be a urine test? Are these test a waste of my time if I want real answers to why I have high aldosterone.What would be the ideal test? Please help I am feeling pressured for time! Thank youSent from my iPad Not that I know of or can make a connection to in my wildest Endocrine/Heme thoughs. But then another reason we need a good data base.Do you do data bases?CE Grim,MDIs there any connection between high aldosterone and low ferritin?Sent from my iPad If your BP and K is normal you may not need to DASH.Runners may have aldo if it was collected after a run.Drink when you are thirsty. A low Na suggests you are drinking too much.CE Grim MDCould I get some input on water intake? I tried searching the web-site about dashing but couldn't find what I was looking for.I know are bodies are constantly trying to keep things in balance so I feel like h2o consumption is just as important as sodium intake. However, I don't think I can assume the average 8 cups a day will be my norm.Here are a few things that I think might influence my sodium/h20 consumption: I have lowish serum sodium 138 (135-145), I have low blood pressure110/65, high aldosterone (24 hr urine 54.3 ( 17-44) and I am active ( runner)I feel it is reasonable that I keep my sodium intake at the higher end of the Dashing Diet , because of low sodium and low blood pressure and activity level,

but I also want to try and lower aldosterone naturally ( if possible) and I'm hoping maybe it's a matter of the right amount of daily water and sodium consumption. Are there any right ratios for this? For example, if you consume 1,500 mg of sodium you should have 8 cups of h2o or maybe if you consume 2,300 mg of sodium you should shoot for 10 cups of h2o?Thanks so much! Really trying to get it right!Sent from my iPad Keep us posted. so you have high renin and high aldo and low K and low BP?CE Grim MDHi Dr. Grim, The following post grabbed my attention. I started following you and this site when I was thought to have primary hyperaldosteronism. I had all the expected abnormal lab results except for low to normal blood pressure. Eventually, labaratory results confirmed Bartters Syndrome and now I follow both yahoo groups. > > >>>>>>>>>> > > >>>>>>>>>>> > > >>>>>>>>>>> Hi everyone, just joined today. Thanks to all of you for this support!> > >>>>>>>>>>> > >

>>>>>>>>>>> I tested high for aldosterone two years ago through a urine test. My ND at the time was not concerned, he thought it was due to the fact that I was a runner. I also thought that made since and was also following a low salt diet. So we ignored it.> > >>>>>>>>>>> > > >>>>>>>>>>> I am treAting a thyroid issue, thyroid hormone resistance, and through recent blood work tested high for aldosterone again. This time I decided not to ignore it! > > >>>>>>>>>>> > > >>>>>>>>>>> I do not have a high blood pressure. It runs pretty normal to low. I don't have issues with potassium. This is all Very confusing as

to why I have high aldosterone.> > >>>>>>>>>>> > > >>>>>>>>>>> I am trying to get into a endocrinologist but will take about three months. I need some education and advise on where to start.> > >>>>>>>>>>> > > >>>>>>>>>>> I don't even know if this is primary or secondary.> > >>>>>>>>>>> > > >>>>>>>>>>> My only real "health" issue, that I know about, has been hair loss. This was one reason for exploring the thyroid but I am wondering if it has been the aldosterone all along. Maybe the aldosterone is what's causing my thyroid issues.> >

>>>>>>>>>>> > > >>>>>>>>>>> Any comments or advice would be greatly appreciated.> > >>>>>>>>>>> > > >>>>>>>>>>> My labs:> > >>>>>>>>>>> > > >>>>>>>>>>> 9/26/2008> > >>>>>>>>>>> Aldosterone (urine)> > >>>>>>>>>>> High 54.3. (normal diet 6-25, low salt 17-44, high salt0-6)> > >>>>>>>>>>> > > >>>>>>>>>>> Other adrenal hormones were fine at that time.

Cortisol was pretty middle of the road. *Progesterone however was really high too. I can post if necessary.> > >>>>>>>>>>> > > >>>>>>>>>>> Rbc potassium 7/14/2010> > >>>>>>>>>>> 97. (90-111)> > >>>>>>>>>>> > > >>>>>>>>>>> Blood aldosterone 7/18/2010> > >>>>>>>>>>> 52.0. (1-16)> > >>>>>>>>>>> > > >>>>>>>>>>> Blood aldosterone/renin 6/30/2010> > >>>>>>>>>>> Aldosterone 49. (1-16)> >

>>>>>>>>>>> Renin. 3.3. (random ambulatory 0.8-2.5, non ambulatory 1.5-5.2)> > >>>>>>>>>>> I was sitting, fasting, taking two hours after waking before/around 8am> > >>>>>>>>>>> > > >>>>>>>>>>> Aldosterone renin ratio = 15> > >>>>>>>>>>> > > >>>>>>>>>>> Sodium. 138. (135-145)> > >>>>>>>>>>> Potassium. 4.5. (3.5-5.3)> > >>>>>>>>>>> Chloride. 106. (98-109)> > >>>>>>>>>>> Co2. 23. (22-31)> > >>>>>>>>>>> Anion gap. 9. (5-16)> >

>>>>>>>>>>> > > >>>>>>>>>>> Saliva cortisol 5/23/2010> > >>>>>>>>>>> 7am. 3.7. (3.7-9.5)> > >>>>>>>>>>> 11am. 1.6. (1.2-3.0)> > >>>>>>>>>>> 5pm. 1.3. (0.6-1.9)> > >>>>>>>>>>> 9pm. 0.5. (0.4-1.0)> > >>>>>>>>>>> > > >>>>>>>>>>> Rbc magnesium 5/26/2010> > >>>>>>>>>>> 4.2. (4.0-6.4)> > >>>>>>>>>>> > > >>>>>>>>>>> Lot of test!!!!> >

>>>>>>>>>>> > > >>>>>>>>>>> Thanks again for your kind support! Suzanne> > >>>>>>>>>>> > > >>>>>>>>>>> > > >>>>>>>>>> > > >>>>>>>>> > > >>>>>>>>> > > >>>>>>>> > > >>>>>>>> > > >>>>>>> > > >>>>>>> > > >>>>>> > > >>>>>> > > >>>>> > > >>>>> > > >>>> > > >>>> > > >>> > > >>> > > >> > > > > > >> >> > > Reply to sender |>

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Once again this is what I get paid for. Contact me at lowerbp2@... for details of accessing my expertise for a year for only $500.CE Grim MDThanks!!Would you mind explaining the difference between the creatinine random urine and the creatinine quantitative urine? I am concerned that my creat. rand is low meaning kidney trouble.I have been sitting here "researching" this for an hour or so and can't find an explanation.I won't been able to see my doctor until the end of this month and even then I don't think she is well educated in this area.I really wanted to rule out any kidney issues before December 28th.Thanks for your time and input! SuzanneSent from my iPad I assume your Dr. gets paid for doing this sort of interpretation.I can do it one on one for a fee. They all look good to me.CE Grim MDI have some test results back that are worrying me. I don't have all the results so I will post them as I get them. Right now I am concerned with what my creatinine levels mean. Please help!!!Blood creatinineCREAT 0.77 (0.44-1.00)BUN 14 (6-20)urine creatinine (there were two results for this)CREAT,RAND UR 40.86 L (80.00-170 mg./dl)CREAT, UR QUANT 1.0 (0.6-1.8 gm./dy)Should I be worried about the low CREAT, RAND UR?????THANKS, SUZANNESent from my iPad It varies. Do a pubmed.CE Grim MDWhat significance does our menstrual cycle play in blood pressure?During my luteal phase my blood pressure ranges from 115/65 to 120/75 but then once menses begins i run a lot lower 90/60.I am in the process of doing the 24 hour urine. should have those numbers in a few days.thanks,suzanneSent from my iPad Yea but you usually are an alcoholic who does not each much or cancer pt who cannot eat and is starving. CE Grim MDI have read that a magnesium deficiency can cause low K.Sent from my iPad Better to DASH I would think.If you can get it in food why take a pill?CE Grim MDare you serious? I am asking if I should take a b vitamin supplement?Sent from my iPad Still no question?CE Grim MD Was there a question here?Hi Dr. Grim,Is it recommended to take a b-complex vitamin?I have been holding off from taking mine (complete b-complex from life extension) because i am afraid it might encourage more aldosterone production! Am I crazy for worrying about this? I know the adrenals love b vitamins and I don't need anything that will cause me to produce more aldosterone. However, I know for a woman of my age and activity level that the b's are very important and could really benefit my body!!Thanks, SuzanneSent from my iPad They are all competitors for the receptors but I do not know the measures of association that permits one to quantitate the relative effect of aldo in occupying each of the receptors. Also they circulate in much greater quantities that aldo as I recall. So the effect would seem likely to be weak.CE Grim MD Hi Dr. Grim, I wanted to ask if high aldosterone levels will block progesterone, testosterone, and estrogen receptors? Thanks, SuzanneTo: hyperaldosteronism Cc: Clarence Grim Sent: Sun, November 7, 2010 7:36:01 PMSubject: Re: Re: 42 yo woman runner who has had aldo 52 and renin 3.3 normal bp That's what this paper says. No one has looked at in anymore detail that I can find.CE Grim MDOk, by doing this it will be ok to test any time of my cycle?Sent from my iPad Ask your lab to use plasma renin activity not direct renin assay.CE Grim MDThis is the article I did read. I didn't feel like it gave a definitive answer. I have read it is best to test aldosterone on the third day of the menstrual cycle but not sure how that will go seeing it is a urine test and not a simple blood draw. Any advice would be greatly appreciated. ThanksSent from my iPad Guess you did not search aldosterone renin ratio.Here is one.J Clin Endocrinol Metab. 2010 Oct 20. [Epub ahead of print]Are Women More at Risk of False-Positive Primary Aldosteronism Screening and Unnecessary Suppression Testing than Men?Ahmed AH, Gordon RD, PJ, Ward G, Pimenta E, Stowasser M.Endocrine Hypertension Research Centre (A.H.A., R.D.G., P.J.T., E.P., M.S.), University of Queensland School of Medicine, Greenslopes and Princess andra Hospitals, Brisbane, Queensland 4102, Australia; and Sullivan and Nicolaides Pathology (G.W.), Brisbane, 4068 Queensland, Australia.AbstractBackground: Because primary aldosteronism is not uncommon, specifically treatable and in some cases curable, and carries higher risks for cardiovascular morbidity and mortality than essential hypertension, screening hypertensive patients for its presence by measuring aldosterone to renin ratio (ARR) is increasingly common. A significantly higher false-positive ARR rate for women than men, resulting in unnecessary suppression tests has previously been reported. Methods: Using a new, highly accurate aldosterone assay and both of the currently widely used renin assays, ARR was measured in 19 normal, ovulating women at three time points in the menstrual cycle and compared with single measurements in 21 normal males of similar age. Results: ARRs in males were possibly too well down in the current normal range. Although normotensive and normokalemic, two women had raised ARRs in the luteal phase but only when direct renin concentration (DRC) was used. Their DRC levels were low at all sampling times [despite midrange plasma renin activity levels], whereas their progesterone and aldosterone levels were highest for the group. Saline suppression testing, performed in one of them, showed normal aldosterone suppressibility. Conclusion: False-positive ARRs in normal women during the luteal phase only when DRC is used may explain the higher incidence of false-positive ARRs in hypertensive women than men and suggest the following: 1) plasma renin activity is preferable to DRC in determination of ARR and 2) new reference ranges for ARR that take into account gender and sex hormone levels are required.Thanks, I did do some reading on pubmed like you suggested about testing and menses but never came up with an answer. Hoping you had the answer. I know aldosterone is naturally higher during the luteal phase but I only want to do this once and I want to get it exactly right . Sent from my iPad I think I sent an abstract recently on menses and testing. If you cant find it let me know.Dr. Grim's Perfect Primary Aldosteronism Blood and Urine Testing to diagnose PA in one day. 1. Eat a regular to high salt diet for 2 weeks.2. No BP meds in last 4-12 weeks depending on meds.3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do not lose a drop of this liquid gold. It is impossible to interpret the renin and aldo without this.4. The morning you finish the 24 hr urine have fasting blood drawn for renin, aldo and K using our guidelines to get an accurate K. Try to get this done about 4 hours after you have been out of bed.5. Send us the results with the normal values for your lab.6. If you ever have a salt (saline) infusion test for PA be certain to ask them to measure how much you pee during the 4 hours of the infusion. If it is 1-1.5 liter of urine it strongly suggests that you may have PA. If more tha 1.5 L you almost certainly have PA. Hi, I am calling my Natural Path tomorrow to have her order test to see if we can figure out why I have high alodsterone. Here are the test I am requesting: (PLEASE LET ME KNOW IF I AM MISSING SOMETHING) -24 hour urine NA, K, Creatinine, Aldosterone -blood draw Renin, Aldosterone, and K Anything else????Also where can I get the info on how to collect K correctly?See our files on how to draw blood.One last question, when during my menstrual cycle is the best time to do these test?'see a recent email re this issue.Thanks so much for you time, SuzanneTo: hyperaldosteronism Cc: Clarence Grim Sent: Fri, November 5, 2010 7:04:29 AMSubject: Re: Re: 42 yo woman runner who has had aldo 52 and renin 3.3 normal bp your team is who you have decided you want to manage your health. Can a Natural Path write prescriptions and order blood tests?CE Grim MDWhat if I don't have a team? Or do you consider a Natural Path my team?Sent from my iPad yes I can work with your team for $500 per year.CE Grim MDHi Dr Grim , I agree I am afraid I am going to make this 400 mile trip and get nowhere! I don't have a dr other than a Natural Path. Can you be my dr and take care of all of this online?Sent from my iPad she does not seem to understand PA as she did not order a renin.CE Grim MDSend her my article on the evolution of PA and the Endo guidelines in our files---BEFORE you see her. You want to know how many PAs she has treated and followed for at least 10 years.CE Grim MDThanks for the info. I am so frustrated with dr's in my area. It seems NO one knows the correct test around here! My natural path is very willing to order the test but she's the first one to admit that she won't know what to do with the results.I live in Whitefish, Montana and Kalispell is about 15 minutes away. Missoula is about 200 miles but I would drive it if someone could make a recommendation ( preferably first hand experience). I am doing Dr. grimes ideal test in December and then at the end of December I am scheduled to see an endocrinologist in Missoula. I don't have faith that the endo knows much about hyperaldosteronism but at this point she is my only hope. This endo's name is Dr. Eyler. She has ordered the following test ( which I don't believe are ideal): hypothyroid panel, comprehensive metabolic panel, vitamin d, hemogram, LH, FSH, 24 hr urine aldosterone.Any comments or feedback would be so appreciated! Thanks, SuzanneSent from my iPad See Dr Grim's ideal test.You cannot interpret the aldo/renin ratio without having a 24 hr urine Na. But maybe your health care team knows how to do this. If so they need to let us know.CE GrimMDWelcome to the exciting world of Hyperaldosteronism! You are in the right place! I am Dr. CE Grim a retired Professor of Medicine and Endocrinology. I have a long standing interest is Primary Aldosteronism since medical school days when I saw my first patient with Primary Aldosteronism in 1963. I trained with Dr. Conn in Endocrinology and Metabolism 1969-70 and have published over 240 papers and book chapters in most areas of the broad discipline of High Blood Pressure. My CV is in our files for details. The goal of our group is to teach you and your health care team about the ins and outs of the causes, diagnosis and control of the many forms of hyperaldosteronism. The steps below will introduce you into the fascinating world of high blood pressure, salt and potassium and the role of the adrenal hormone aldosterone in health and disease. Doing these in sequence will save you time and effort in getting up to speed in taking control of you health and educating your own health care team. While we can’t make you a doctor we will make you into a pretty good BP doctor-a skill that you will have for life. 1. A brief history of Primary Aldosteronsim and why it is so common today in drug resistant high blood pressure. Read my article in our files on the evolution of PA (Evolution_of_PA-Grim.pdf ) and take to all members of health care team. Tell us what stage you believe you are in. This is a brief review of most causes of hyperaldosteronism, high blood pressure, low potassium (K). 2. Read about other patients with hyperaldosteronism (Conn’s syndrome). Read our Conn's stories in our files and then give us your own in as much detail as you can. Dr. Conn was the first to describe this disease process and the syndrome is named after him.To see others' stories, on the Hyperaldosteronism home page, go to Files/Conn’s Stories. You'll find instructions in "A - How to put your story here.doc " First send us your story in an email and they we may have questions and suggestions before you upload it to our files. 3. DASH to lower your BP. Your and my tax dollars funded the most important series of studies on how to improve blood pressure, blood sugar, blood lipids and make your heart smaller: The DASH Eating Plan to control high blood pressure due to hyperaldosteronism and most others with high blood pressure. This will reduce your need for medications and in many will get your BP and K to goal without meds.. Get the DASH diet book by T. et al, (http://www.amazon.com/DASH-Diet-Hypertension--/dp/0743202953) read it and use it: ~$8 in paperback at your local bookstore or online. If they don’t have it ask them to order it for you. You can also get the hardback larger print version as well at Amazon. Learning to eat the DASH way will play a major role in your road to good BP and K control and, in many of our folks here, will revolutionize your life. See http://en.wikipedia.org/wiki/DASH_diet for an overview and more details. In the book go to chapter 9 and do the 14 day challenge. Tell your Dr you are doing this as your BP may plummet if you are on other meds. Measure your BP every day and post to us. or go to http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf download this 64 page booklet free and do the Week on the DASH Diet for 2 weeks. If you are on BP meds be prepared for a large fall in BP (20/10 mm Hg or more) and let your Dr. know you are doing this. And/Or go to (but costs money monthly) DASH Diet for Health Program (http://www.dashforhealth.com/pages/public/tour.php)The DASH Diet for Health Program is designed to help you improve your eating and exercise habits. Twice each week they will provide you with information on our website about food, food preparation, eating out, losing weight, getting fit and much more. In addition to providing new information each week on the website, they create a web page specially for you where you can track progress in areas such as your weight, blood pressure, and exercise. I strongly recommend you get this book and read it. 4. Measure your BP: Measure your BP daily so you can see if it is getting better. If you are taking meds be sure to tell your health care team you are doing this as your BP may plummet to normal quickly. We recommend you use a device you listen to and will help you learn how to do this. If this is not something you want to do we can teach a significant other how to do it. See sharedcareinc.com or email to sharedcare@... to order a video on how to do this. If you already have one we will teach you how to teach your health care team how to validate your device. Your life and health depends on accurate BP measurements. Go to the amricanheart.org and download the Guidelines for Human Blood Pressure Measurement. Insist the your health care team do BP the AHA way. Never trust your life to an automatic BP machine unless you know it is accurate on YOU. 5. Genetics and your BP: Go to familyhistory.hhs.gov and do your detailed family medical history so we can review with you to help Dx familial causes of high blood pressure and heart disease. If BP runs in your family you may save lives in your family by checking their BP yourself. 6. How to DX and treat PA: Go to our file/Conn's Articles of Note/Medications/Bravo spir 1973.pdf and read this article and take to your health care team. It is old but still one of the best in the medical management of PA. Also see our file from the Endocrine Society Guidelines on PA. Dr. Grim's Perfect Primary Aldosteronism Blood and Urine Testing to diagnose PA in one day. 1. Eat a regular to high salt diet for 2 weeks.2. No BP meds in last 4-12 weeks depending on meds.3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do not lose a drop of this liquid gold. It is impossible to interpret the renin and aldo without this.4. The morning you finish the 24 hr urine have fasting blood drawn for renin, aldo and K using our guidelines to get an accurate K. Try to get this done about 4 hours after you have been out of bed.5. Send us the results with the normal values for your lab.6. If you ever have a salt (saline) infusion test for PA be certain to ask them to measure how much you pee during the 4 hours of the infusion. If it is 1-1.5 liter of urine it strongly suggests that you may have PA. If more tha 1.5 L you almost certainly have PA. 8. Become a participant in our PA Registry and contribute to our large database on PA: If you have been Dxed with PA already and are on Rx or have had surgery please go to http://www.kwiksurveys.com/online-survey.php?surveyID=HIJIO_f2685379 and complete our survey with as much information as you know. If there is some information you don't know ask us and we will help. If you need to update this as you journey thru the diagnostic/treatment process you can add another entry but label it as Nameyymmdd. For example today 6/12/09 for me would be Grim090612. This ever increasing number will allow us and you to sort your multiple entries into a dated order. 9. Learn the language: If you are new to medical lingo then download the acroyms from http://health.groups.yahoo.com/group/bloodpressureline/message/2918610. Salt and high blood pressure: To learn the state of the science of salt and blood pressure please spend some time looking at http://www.worldactiononsalt.com/evidence/treatment_trials.htm11. Become a HBP expert consumer: Expect that it will take at least several weeks to get all this digested and to learn the new language of high blood pressure health care. As most doctors and nurses in practice have had very little training in high blood pressure you must become an expert yourself. For example most have never had anyone listen with them with a double stethoscope to verify that they can hear BP sounds. We cannot make you a doctor but we will make you a pretty good BP doctor.12. How High Blood Pressure should be managed: Go to nih.gov and download and read the Joint National Commission (JNC) Report 7 to get an overview on current guidelines. I ask all my secretaries to read this so they can communicate the importance of high blood pressure to my patients. JNC 8 will be out soon.Then: get (and study) the Hypertension Primer from americanheart.org. This is the most up-to-date compendium of what is known about high blood pressure and what every Dr. should know when they graduate from Medical School. Every chapter is only 2-3 pages. Read one chapter every week-night and you will finish it in about a year. I am working on a reading guide for lay people for the Primer. Stay tuned.13. Ask us questions: Ask any questions about high blood pressure you want answered. That is what we are here for. We have had this site for 10 years and over 30,000 emails are searchable. This is the largest collection of communications about Conn's Syndrome in the World. 14. One-on-one Consulting: I can provide individual consulting if you do not want to go public. If you want individual one-on-one consulting for you and your Doctor contract me directly at lowerbp2@....May your pressure be low!Clarence E. Grim BS, MS, MD, FACP, FACC, FAHABoard Certified in Internal Medicine, Geriatrics, and High Blood Pressure Retired Faculty/Professor of Medicine (U of MO, Indiana, UCLA/DREW, Medical College of Wisconsin and Cardiology, Endocrinology, Nephrology, and Epidemiology. Specializing in Primary Aldosteronism and Difficult to Control High Blood Pressure. I'm going in on Thursday for the following test: basic panel and serum aldosterone.Shouldn't there be a urine test? Are these test a waste of my time if I want real answers to why I have high aldosterone.What would be the ideal test? Please help I am feeling pressured for time! Thank youSent from my iPad Not that I know of or can make a connection to in my wildest Endocrine/Heme thoughs. But then another reason we need a good data base.Do you do data bases?CE Grim,MDIs there any connection between high aldosterone and low ferritin?Sent from my iPad If your BP and K is normal you may not need to DASH.Runners may have aldo if it was collected after a run.Drink when you are thirsty. A low Na suggests you are drinking too much.CE Grim MDCould I get some input on water intake? I tried searching the web-site about dashing but couldn't find what I was looking for.I know are bodies are constantly trying to keep things in balance so I feel like h2o consumption is just as important as sodium intake. However, I don't think I can assume the average 8 cups a day will be my norm.Here are a few things that I think might influence my sodium/h20 consumption: I have lowish serum sodium 138 (135-145), I have low blood pressure110/65, high aldosterone (24 hr urine 54.3 ( 17-44) and I am active ( runner)I feel it is reasonable that I keep my sodium intake at the higher end of the Dashing Diet , because of low sodium and low blood pressure and activity level, but I also want to try and lower aldosterone naturally ( if possible) and I'm hoping maybe it's a matter of the right amount of daily water and sodium consumption. Are there any right ratios for this? For example, if you consume 1,500 mg of sodium you should have 8 cups of h2o or maybe if you consume 2,300 mg of sodium you should shoot for 10 cups of h2o?Thanks so much! Really trying to get it right!Sent from my iPad Keep us posted. so you have high renin and high aldo and low K and low BP?CE Grim MDHi Dr. Grim, The following post grabbed my attention. I started following you and this site when I was thought to have primary hyperaldosteronism. I had all the expected abnormal lab results except for low to normal blood pressure. Eventually, labaratory results confirmed Bartters Syndrome and now I follow both yahoo groups. > > >>>>>>>>>> > > >>>>>>>>>>> > > >>>>>>>>>>> Hi everyone, just joined today. Thanks to all of you for this support!> > >>>>>>>>>>> > > >>>>>>>>>>> I tested high for aldosterone two years ago through a urine test. My ND at the time was not concerned, he thought it was due to the fact that I was a runner. I also thought that made since and was also following a low salt diet. So we ignored it.> > >>>>>>>>>>> > > >>>>>>>>>>> I am treAting a thyroid issue, thyroid hormone resistance, and through recent blood work tested high for aldosterone again. This time I decided not to ignore it! > > >>>>>>>>>>> > > >>>>>>>>>>> I do not have a high blood pressure. It runs pretty normal to low. I don't have issues with potassium. This is all Very confusing as to why I have high aldosterone.> > >>>>>>>>>>> > > >>>>>>>>>>> I am trying to get into a endocrinologist but will take about three months. I need some education and advise on where to start.> > >>>>>>>>>>> > > >>>>>>>>>>> I don't even know if this is primary or secondary.> > >>>>>>>>>>> > > >>>>>>>>>>> My only real "health" issue, that I know about, has been hair loss. This was one reason for exploring the thyroid but I am wondering if it has been the aldosterone all along. Maybe the aldosterone is what's causing my thyroid issues.> > >>>>>>>>>>> > > >>>>>>>>>>> Any comments or advice would be greatly appreciated.> > >>>>>>>>>>> > > >>>>>>>>>>> My labs:> > >>>>>>>>>>> > > >>>>>>>>>>> 9/26/2008> > >>>>>>>>>>> Aldosterone (urine)> > >>>>>>>>>>> High 54.3. (normal diet 6-25, low salt 17-44, high salt0-6)> > >>>>>>>>>>> > > >>>>>>>>>>> Other adrenal hormones were fine at that time. Cortisol was pretty middle of the road. *Progesterone however was really high too. I can post if necessary.> > >>>>>>>>>>> > > >>>>>>>>>>> Rbc potassium 7/14/2010> > >>>>>>>>>>> 97. (90-111)> > >>>>>>>>>>> > > >>>>>>>>>>> Blood aldosterone 7/18/2010> > >>>>>>>>>>> 52.0. (1-16)> > >>>>>>>>>>> > > >>>>>>>>>>> Blood aldosterone/renin 6/30/2010> > >>>>>>>>>>> Aldosterone 49. (1-16)> > >>>>>>>>>>> Renin. 3.3. (random ambulatory 0.8-2.5, non ambulatory 1.5-5.2)> > >>>>>>>>>>> I was sitting, fasting, taking two hours after waking before/around 8am> > >>>>>>>>>>> > > >>>>>>>>>>> Aldosterone renin ratio = 15> > >>>>>>>>>>> > > >>>>>>>>>>> Sodium. 138. (135-145)> > >>>>>>>>>>> Potassium. 4.5. (3.5-5.3)> > >>>>>>>>>>> Chloride. 106. (98-109)> > >>>>>>>>>>> Co2. 23. (22-31)> > >>>>>>>>>>> Anion gap. 9. (5-16)> > >>>>>>>>>>> > > >>>>>>>>>>> Saliva cortisol 5/23/2010> > >>>>>>>>>>> 7am. 3.7. (3.7-9.5)> > >>>>>>>>>>> 11am. 1.6. (1.2-3.0)> > >>>>>>>>>>> 5pm. 1.3. (0.6-1.9)> > >>>>>>>>>>> 9pm. 0.5. (0.4-1.0)> > >>>>>>>>>>> > > >>>>>>>>>>> Rbc magnesium 5/26/2010> > >>>>>>>>>>> 4.2. (4.0-6.4)> > >>>>>>>>>>> > > >>>>>>>>>>> Lot of test!!!!> > >>>>>>>>>>> > > >>>>>>>>>>> Thanks again for your kind support! Suzanne> > >>>>>>>>>>> > > >>>>>>>>>>> > > >>>>>>>>>> > > >>>>>>>>> > > >>>>>>>>> > > >>>>>>>> > > >>>>>>>> > > >>>>>>> > > >>>>>>> > > >>>>>> > > >>>>>> > > >>>>> > > >>>>> > > >>>> > > >>>> > > >>> > > >>> > > >> > > > > > >> >> > > Reply to sender |>

[Guest guest]

so what's the support group for?Sent from my iPad

Once again this is what I get paid for. Contact me at lowerbp2@... for details of accessing my expertise for a year for only $500.CE Grim MDThanks!!Would

you mind explaining the difference between the creatinine random urine and the creatinine quantitative urine? I am concerned that my creat. rand is low meaning kidney trouble.I have been sitting here "researching" this for an hour or so and can't find an explanation.I won't been able to see my doctor until the end of this month and even then I don't think she is well educated in this area.I really wanted to rule out any kidney issues before December 28th.Thanks for your time and input! SuzanneSent from my iPad I assume

your Dr. gets paid for doing this sort of interpretation.I can do it one on one for a fee. They all look good to me.CE Grim MDI have some test results back that are worrying me. I don't have all the results so I will post them as I get them. Right now I am

concerned with what my creatinine levels mean. Please help!!!Blood creatinineCREAT 0.77 (0.44-1.00)BUN 14 (6-20)urine creatinine (there were two results for this)CREAT,RAND UR 40.86 L (80.00-170 mg./dl)CREAT, UR QUANT 1.0 (0.6-1.8 gm./dy)Should I be worried about the low CREAT, RAND UR?????THANKS, SUZANNESent from my iPadOn Dec 3, 2010, at 7:21 AM, Clarence Grim

wrote: It varies. Do a pubmed.CE Grim MDWhat significance does our menstrual cycle play in blood pressure?During my luteal phase my blood pressure ranges from

115/65 to 120/75 but then once menses begins i run a lot lower 90/60.I am in the process of doing the 24 hour urine. should have those numbers in a few days.thanks,suzanneSent from my iPad Yea but you usually are an alcoholic who does not each much or cancer pt who cannot eat and is starving. CE Grim MDI have read that a magnesium deficiency can cause low K.Sent from my iPad Better to DASH I would think.If you can get it in food why take a pill?CE Grim MDare you

serious? I am asking if I should take a b vitamin supplement?Sent from my iPad Still no question?CE Grim MD Was there a question here?Hi Dr. Grim,Is it recommended to take a b-complex vitamin?I have been holding off from taking mine (complete b-complex from life extension) because i am afraid it might encourage more aldosterone production! Am I crazy for worrying about this? I know the adrenals love b vitamins and I don't need anything that will cause me to produce more aldosterone. However, I know for a woman of my age and activity level that the b's are very important and could really benefit my body!!Thanks,

SuzanneSent from my iPad They are all competitors for the receptors but I

do not know the measures of association that permits one to quantitate the relative effect of aldo in occupying each of the receptors. Also they circulate in much greater quantities that aldo as I recall. So the effect would seem likely to be weak.CE Grim MD Hi Dr. Grim, I wanted to ask if high aldosterone levels will block progesterone, testosterone, and estrogen receptors? Thanks, SuzanneTo: hyperaldosteronism Cc: Clarence Grim Sent: Sun, November 7, 2010 7:36:01 PMSubject: Re:

Re: 42 yo woman runner who has had aldo 52 and renin 3.3 normal bp That's what this paper says. No one has looked at in anymore detail that I can find.CE Grim MDOk, by doing this it will be ok to test

any time of my cycle?Sent from my iPadOn Nov 7, 2010, at 6:02 PM, Clarence Grim

wrote: Ask your lab to use plasma renin activity not direct renin assay.CE Grim MDThis is the article I did read. I didn't feel like it gave a definitive

answer. I have read it is best to test aldosterone on the third day of the menstrual cycle but not sure how that will go seeing it is a urine test and not a simple blood draw. Any advice would be greatly appreciated. ThanksSent from my iPad Guess you did not search aldosterone renin ratio.Here is one.J Clin Endocrinol Metab. 2010 Oct 20. [Epub ahead of print]Are Women More at Risk of False-Positive Primary Aldosteronism Screening and Unnecessary Suppression Testing than Men?Ahmed AH, Gordon RD, PJ, Ward G, Pimenta E, Stowasser M.Endocrine Hypertension Research Centre (A.H.A., R.D.G., P.J.T., E.P., M.S.), University of Queensland School of Medicine, Greenslopes and Princess andra Hospitals, Brisbane, Queensland 4102, Australia; and Sullivan and Nicolaides Pathology (G.W.), Brisbane, 4068 Queensland, Australia.AbstractBackground: Because primary aldosteronism is not uncommon, specifically treatable and in some cases curable, and carries higher risks for cardiovascular morbidity and mortality than essential

hypertension, screening hypertensive patients for its presence by measuring aldosterone to renin ratio (ARR) is increasingly common. A significantly higher false-positive ARR rate for women than men, resulting in unnecessary suppression tests has previously been reported. Methods: Using a new, highly accurate aldosterone assay and both of the currently widely used renin assays, ARR was measured in 19 normal, ovulating women at three time points in the menstrual cycle and compared with single measurements in 21 normal males of similar age. Results: ARRs in males were possibly too well down in the current normal range. Although normotensive and normokalemic, two women had raised ARRs in the luteal phase but only when direct renin concentration (DRC) was used. Their DRC levels were low at all sampling times [despite midrange plasma renin activity levels], whereas their progesterone and aldosterone levels were highest for the group. Saline suppression

testing, performed in one of them, showed normal aldosterone suppressibility. Conclusion: False-positive ARRs in normal women during the luteal phase only when DRC is used may explain the higher incidence of false-positive ARRs in hypertensive women than men and suggest the following: 1) plasma renin activity is preferable to DRC in determination of ARR and 2) new reference ranges for ARR that take into account gender and sex hormone levels are required.Thanks, I did do some reading on pubmed like you suggested about testing and menses but never came up with an answer. Hoping you had the answer. I know aldosterone is naturally higher during the luteal phase but I only want to do this once and I want to get it exactly right . Sent from my iPad I think I sent an abstract recently on menses and testing. If you cant find it let me know.Dr. Grim's Perfect Primary

Aldosteronism Blood and Urine Testing to diagnose PA in one day. 1. Eat a regular to high salt diet for 2 weeks.2. No BP meds in last 4-12 weeks depending on meds.3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do not lose a drop of this liquid gold. It is impossible to interpret the renin and aldo without this.4. The morning you finish the 24 hr urine have fasting blood drawn for renin, aldo and K using our guidelines to get an accurate K. Try to get this done about 4 hours after you have been out of bed.5. Send us the results with the normal values for your lab.6. If you ever have a salt (saline) infusion test for PA be certain to ask them to measure how much

you pee during the 4 hours of the infusion. If it is 1-1.5 liter of urine it strongly suggests that you may have PA. If more tha 1.5 L you almost certainly have PA. Hi, I am calling my Natural Path tomorrow to have her order test to

see if we can figure out why I have high alodsterone. Here are the test I am requesting: (PLEASE LET ME KNOW IF I AM MISSING SOMETHING) -24 hour urine NA, K, Creatinine, Aldosterone -blood draw Renin, Aldosterone, and K Anything else????Also where can I get the info on how to collect K correctly?See our files on how to draw blood.One last question, when during my menstrual cycle is the best time to do these test?'see a recent email re this issue.Thanks so much for you time, SuzanneTo: hyperaldosteronism Cc: Clarence Grim Sent: Fri, November 5, 2010 7:04:29 AMSubject: Re: Re: 42 yo woman runner who has had aldo 52 and renin 3.3 normal bp your team is who you have decided you want to manage your health. Can a Natural Path write prescriptions and order blood tests?CE Grim MDWhat if I don't have a team? Or do you consider a Natural Path my team?Sent from my iPad yes I can work with your team for $500 per year.CE Grim MDHi Dr Grim , I agree I am afraid I am going to make this 400 mile trip and get nowhere! I don't have a dr other than a Natural Path. Can you be my dr and take care of all of this online?Sent from my iPad she does not seem to understand PA as she did not order a renin.CE Grim MDSend her my article on the evolution of PA and the Endo guidelines in our files---BEFORE you see her. You want to know how many PAs she has treated and followed for at least 10 years.CE Grim MDThanks for the info. I am so frustrated with dr's in my area. It seems NO one knows the correct test around here! My natural path is very willing to order the test but she's the first one to admit that she won't know what to do with the results.I live in Whitefish, Montana and Kalispell is about 15 minutes away. Missoula is about 200 miles but I would drive it if someone could make a recommendation ( preferably first hand experience). I am doing Dr. grimes ideal test in December and then at the end of December I am scheduled to see an endocrinologist in Missoula. I don't have faith that the

endo knows much about hyperaldosteronism but at this point she is my only hope. This endo's name is Dr. Eyler. She has ordered the following test ( which I don't believe are ideal): hypothyroid panel, comprehensive metabolic panel, vitamin d, hemogram, LH, FSH, 24 hr urine aldosterone.Any comments or feedback would be so appreciated! Thanks, SuzanneSent from my iPad See Dr Grim's ideal test.You cannot interpret the aldo/renin ratio without having a 24 hr urine Na. But maybe your health care team knows how to do this. If so they need to let us know.CE GrimMDWelcome to the exciting world of Hyperaldosteronism! You are in the right place! I am Dr. CE Grim a retired Professor of Medicine and Endocrinology. I have a long standing interest is Primary Aldosteronism since medical school days when I saw my first patient with Primary Aldosteronism in 1963. I trained with Dr. Conn in Endocrinology and Metabolism 1969-70 and have published over 240 papers and book chapters in most areas of the broad discipline of High Blood Pressure. My CV is in our files for

details. The goal of our group is to teach you and your health care team about the ins and outs of the causes, diagnosis and control of the many forms of hyperaldosteronism. The steps below will introduce you into the fascinating world of high blood pressure, salt and potassium and the role of the adrenal hormone aldosterone in health and disease. Doing these in sequence will save you time and effort in getting up to speed in taking control of you health and educating your own health care team. While we can’t make you a doctor we will make you into a pretty good BP doctor-a skill that you will have for life. 1. A brief history of Primary Aldosteronsim and why it is so common today in drug resistant high blood pressure. Read my article in our files on the

evolution of PA (Evolution_of_PA-Grim.pdf ) and take to all members of health care team. Tell us what stage you believe you are in. This is a brief review of most causes of hyperaldosteronism, high blood pressure, low potassium (K). 2. Read about other patients with hyperaldosteronism (Conn’s syndrome). Read our Conn's stories in our files and then give us your own in as much detail as you can. Dr. Conn was the first to describe this disease process and the syndrome is named after him.To see others' stories, on the Hyperaldosteronism home page, go to Files/Conn’s Stories. You'll find instructions in "A - How to put your story here.doc " First send us your story in an email and they we may have questions and suggestions before you upload it to our files. 3. DASH to lower your BP.

Your and my tax dollars funded the most important series of studies on how to improve blood pressure, blood sugar, blood lipids and make your heart smaller: The DASH Eating Plan to control high blood pressure due to hyperaldosteronism and most others with high blood pressure. This will reduce your need for medications and in many will get your BP and K to goal without meds.. Get the DASH diet book by T. et al, (http://www.amazon.com/DASH-Diet-Hypertension--/dp/0743202953) read it and use it: ~$8 in paperback at your local bookstore or online. If they don’t have it ask them to order it for you. You can also get the hardback larger print version as well at Amazon.

Learning to eat the DASH way will play a major role in your road to good BP and K control and, in many of our folks here, will revolutionize your life. See http://en.wikipedia.org/wiki/DASH_diet for an overview and more details. In the book go to chapter 9 and do the 14 day challenge.

Tell your Dr you are doing this as your BP may plummet if you are on other meds. Measure your BP every day and post to us. or go to http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf download this 64 page booklet free and do the Week on the DASH Diet for 2 weeks. If you are on BP meds be prepared for a large fall in BP (20/10 mm Hg or more) and let your Dr. know you are doing this. And/Or go to (but costs money monthly) DASH Diet for Health Program (http://www.dashforhealth.com/pages/public/tour.php)The DASH Diet for Health Program is designed to help you improve your eating and exercise habits. Twice each week they will provide you with information on our website about food, food preparation, eating out, losing weight, getting fit and much more. In addition to providing new information each week on the website, they create a web page

specially for you where you can track progress in areas such as your weight, blood pressure, and exercise. I strongly recommend you get this book and read it. 4. Measure your BP: Measure your BP daily so you can see if it is getting better. If you are taking meds be sure to tell your health care team you are doing this as your BP may plummet to normal quickly. We recommend you use a device you listen to and will help you learn how to do this. If this is not something you want to do we can teach a significant other how to do it. See sharedcareinc.com or email to sharedcare@... to order a video on how to do this. If you already have one we will teach you how to teach your health care team how to validate your device. Your life and health depends on accurate BP measurements. Go to the amricanheart.org and download the Guidelines for Human Blood Pressure Measurement. Insist the your health care team do BP the AHA way. Never trust your life to an automatic BP machine unless you know it is accurate on YOU. 5. Genetics and your BP: Go to familyhistory.hhs.gov and do your detailed family medical history so we can review with you to help Dx familial causes of high blood pressure and heart disease. If BP runs in your family you may save lives in your family by checking their BP yourself. 6. How to DX and treat PA: Go to our file/Conn's Articles of Note/Medications/Bravo spir 1973.pdf and read this

article and take to your health care team. It is old but still one of the best in the medical management of PA. Also see our file from the Endocrine Society Guidelines on PA. Dr. Grim's Perfect Primary Aldosteronism Blood and Urine Testing to diagnose PA in one day. 1. Eat a regular to high salt diet for 2 weeks.2. No BP meds in last 4-12 weeks depending on meds.3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do not lose a drop of this liquid gold. It is impossible to interpret the renin and aldo without this.4. The morning you finish the 24 hr urine have fasting blood drawn for renin, aldo and K using our guidelines to get an accurate K. Try to get this done about 4 hours after you have been out of bed.5. Send us the results with the normal values for your lab.6. If

you ever have a salt (saline) infusion test for PA be certain to ask them to measure how much you pee during the 4 hours of the infusion. If it is 1-1.5 liter of urine it strongly suggests that you may have PA. If more tha 1.5 L you almost certainly have PA. 8. Become a participant in our PA Registry and contribute to our large database on PA: If you have been Dxed with PA already and are on Rx or have had surgery please go to http://www.kwiksurveys.com/online-survey.php?surveyID=HIJIO_f2685379 and complete our survey with as much information as you know. If there is some information you don't know ask us and we will help. If you need to update this as you journey thru the

diagnostic/treatment process you can add another entry but label it as Nameyymmdd. For example today 6/12/09 for me would be Grim090612. This ever increasing number will allow us and you to sort your multiple entries into a dated order. 9. Learn the language: If you are new to medical lingo then download the acroyms from http://health.groups.yahoo.com/group/bloodpressureline/message/2918610. Salt and high blood pressure: To learn the state of the science of salt and blood pressure please spend some time looking at http://www.worldactiononsalt.com/evidence/treatment_trials.htm11. Become a HBP expert

consumer: Expect that it will take at least several weeks to get all this digested and to learn the new language of high blood pressure health care. As most doctors and nurses in practice have had very little training in high blood pressure you must become an expert yourself. For example most have never had anyone listen with them with a double stethoscope to verify that they can hear BP sounds. We cannot make you a doctor but we will make you a pretty good BP doctor.12. How High Blood Pressure should be managed: Go to nih.gov and download and read the Joint National Commission (JNC) Report 7 to get an

overview on current guidelines. I ask all my secretaries to read this so they can communicate the importance of high blood pressure to my patients. JNC 8 will be out soon.Then: get (and study) the Hypertension Primer from americanheart.org. This is the most up-to-date compendium of what is known about high blood pressure and what every Dr. should know when they graduate from Medical School. Every chapter is only 2-3 pages. Read one chapter every week-night and you will finish it in about a year. I am working on a reading guide for lay people for the Primer. Stay

tuned.13. Ask us questions: Ask any questions about high blood pressure you want answered. That is what we are here for. We have had this site for 10 years and over 30,000 emails are searchable. This is the largest collection of communications about Conn's Syndrome in the World. 14. One-on-one Consulting: I can provide individual consulting if you do not want to go public. If you want individual one-on-one consulting for you and your Doctor contract me directly at lowerbp2@....May your pressure be low!Clarence E. Grim BS, MS, MD, FACP, FACC, FAHABoard Certified in Internal Medicine, Geriatrics, and High Blood Pressure Retired Faculty/Professor of Medicine (U of MO, Indiana, UCLA/DREW, Medical College of Wisconsin and Cardiology, Endocrinology, Nephrology, and Epidemiology. Specializing in Primary Aldosteronism and Difficult to Control

High Blood Pressure. I'm going in on Thursday for the following test: basic panel and serum aldosterone.Shouldn't there be a urine test? Are these

test a waste of my time if I want real answers to why I have high aldosterone.What would be the ideal test? Please help I am feeling pressured for time! Thank youSent from my iPadOn Nov 1, 2010, at 8:02 PM, Clarence Grim

wrote: Not that I know of or can make a connection to in my wildest Endocrine/Heme thoughs. But then another reason we need a good data base.Do you do data bases?CE Grim,MDIs there any connection between high aldosterone and low ferritin?Sent from my iPad If your BP and K is normal you may not need to DASH.Runners may have aldo if it was collected after a run.Drink when you are thirsty. A low Na suggests you are drinking too much.CE Grim MDCould I get some input on water intake? I tried searching the web-site about dashing but couldn't find what I was looking for.I know are bodies are constantly trying to keep things in balance so I feel like h2o consumption is just as important as sodium intake. However, I don't think I can assume the average 8 cups a day will be my norm.Here are a few things that I think might influence my sodium/h20 consumption: I have lowish serum sodium 138 (135-145), I have low blood pressure110/65, high aldosterone (24 hr urine 54.3 ( 17-44) and I am active ( runner)I feel it is reasonable that I keep my sodium intake at the higher end of the Dashing Diet , because of low sodium and low blood pressure and activity level, but I also want

to try and lower aldosterone naturally ( if possible) and I'm hoping maybe it's a matter of the right amount of daily water and sodium consumption. Are there any right ratios for this? For example, if you consume 1,500 mg of sodium you should have 8 cups of h2o or maybe if you consume 2,300 mg of sodium you should shoot for 10 cups of h2o?Thanks so much! Really trying to get it right!Sent from my iPad Keep us posted. so you have high renin and high aldo and low K and low BP?CE Grim MDHi Dr. Grim, The following post grabbed my attention. I started following you and this site when I was thought to have primary hyperaldosteronism. I had all the expected abnormal lab results except for low to normal blood pressure. Eventually, labaratory results confirmed Bartters Syndrome and now I follow both yahoo groups. > > >>>>>>>>>> > > >>>>>>>>>>> > > >>>>>>>>>>> Hi everyone, just joined today.

Thanks to all of you for this support!> > >>>>>>>>>>> > > >>>>>>>>>>> I tested high for aldosterone two years ago through a urine test. My ND at the time was not concerned, he thought it was due to the fact that I was a runner. I also thought that made since and was also following a low salt diet. So we ignored it.> > >>>>>>>>>>> > > >>>>>>>>>>> I am treAting a thyroid issue, thyroid hormone resistance, and through recent blood work tested high for aldosterone again. This time I decided not to ignore it! > > >>>>>>>>>>> > >

>>>>>>>>>>> I do not have a high blood pressure. It runs pretty normal to low. I don't have issues with potassium. This is all Very confusing as to why I have high aldosterone.> > >>>>>>>>>>> > > >>>>>>>>>>> I am trying to get into a endocrinologist but will take about three months. I need some education and advise on where to start.> > >>>>>>>>>>> > > >>>>>>>>>>> I don't even know if this is primary or secondary.> > >>>>>>>>>>> > > >>>>>>>>>>> My only real "health" issue, that I know about, has been hair loss. This was one

reason for exploring the thyroid but I am wondering if it has been the aldosterone all along. Maybe the aldosterone is what's causing my thyroid issues.> > >>>>>>>>>>> > > >>>>>>>>>>> Any comments or advice would be greatly appreciated.> > >>>>>>>>>>> > > >>>>>>>>>>> My labs:> > >>>>>>>>>>> > > >>>>>>>>>>> 9/26/2008> > >>>>>>>>>>> Aldosterone (urine)> > >>>>>>>>>>> High 54.3. (normal diet 6-25, low salt 17-44, high salt0-6)> >

>>>>>>>>>>> > > >>>>>>>>>>> Other adrenal hormones were fine at that time. Cortisol was pretty middle of the road. *Progesterone however was really high too. I can post if necessary.> > >>>>>>>>>>> > > >>>>>>>>>>> Rbc potassium 7/14/2010> > >>>>>>>>>>> 97. (90-111)> > >>>>>>>>>>> > > >>>>>>>>>>> Blood aldosterone 7/18/2010> > >>>>>>>>>>> 52.0. (1-16)> > >>>>>>>>>>> > >

>>>>>>>>>>> Blood aldosterone/renin 6/30/2010> > >>>>>>>>>>> Aldosterone 49. (1-16)> > >>>>>>>>>>> Renin. 3.3. (random ambulatory 0.8-2.5, non ambulatory 1.5-5.2)> > >>>>>>>>>>> I was sitting, fasting, taking two hours after waking before/around 8am> > >>>>>>>>>>> > > >>>>>>>>>>> Aldosterone renin ratio = 15> > >>>>>>>>>>> > > >>>>>>>>>>> Sodium. 138. (135-145)> > >>>>>>>>>>> Potassium. 4.5. (3.5-5.3)> > >>>>>>>>>>> Chloride. 106. (98-109)>

> >>>>>>>>>>> Co2. 23. (22-31)> > >>>>>>>>>>> Anion gap. 9. (5-16)> > >>>>>>>>>>> > > >>>>>>>>>>> Saliva cortisol 5/23/2010> > >>>>>>>>>>> 7am. 3.7. (3.7-9.5)> > >>>>>>>>>>> 11am. 1.6. (1.2-3.0)> > >>>>>>>>>>> 5pm. 1.3. (0.6-1.9)> > >>>>>>>>>>> 9pm. 0.5. (0.4-1.0)> > >>>>>>>>>>> > > >>>>>>>>>>> Rbc magnesium 5/26/2010> > >>>>>>>>>>> 4.2. (4.0-6.4)> >

>>>>>>>>>>> > > >>>>>>>>>>> Lot of test!!!!> > >>>>>>>>>>> > > >>>>>>>>>>> Thanks again for your kind support! Suzanne> > >>>>>>>>>>> > > >>>>>>>>>>> > > >>>>>>>>>> > > >>>>>>>>> > > >>>>>>>>> > > >>>>>>>> > > >>>>>>>> > > >>>>>>> > > >>>>>>> > > >>>>>> > > >>>>>> > > >>>>> > > >>>>> > > >>>> > > >>>> > > >>> > > >>> > > >> > > > > > >> >> > > Reply to sender |>

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Support for common questions. Or you can order the AHA HYPERTENSION PRIMER and read one chapter a night each week night and after a year or so you will know all the answers to your questions.FYI the spot urine cr con tells you nothing about kidney problems. If it was tome and u had the volume it might. It mostly tells us how much fluid you were drinking. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

so what's the support group for?Sent from my iPad

Once again this is what I get paid for. Contact me at lowerbp2@... for details of accessing my expertise for a year for only $500.CE Grim MDThanks!!Would

you mind explaining the difference between the creatinine random urine and the creatinine quantitative urine? I am concerned that my creat. rand is low meaning kidney trouble.I have been sitting here "researching" this for an hour or so and can't find an explanation.I won't been able to see my doctor until the end of this month and even then I don't think she is well educated in this area.I really wanted to rule out any kidney issues before December 28th.Thanks for your time and input! SuzanneSent from my iPad I assume

your Dr. gets paid for doing this sort of interpretation.I can do it one on one for a fee. They all look good to me.CE Grim MDI have some test results back that are worrying me. I don't have all the results so I will post them as I get them. Right now I am

concerned with what my creatinine levels mean. Please help!!!Blood creatinineCREAT 0.77 (0.44-1.00)BUN 14 (6-20)urine creatinine (there were two results for this)CREAT,RAND UR 40.86 L (80.00-170 mg./dl)CREAT, UR QUANT 1.0 (0.6-1.8 gm./dy)Should I be worried about the low CREAT, RAND UR?????THANKS, SUZANNESent from my iPadOn Dec 3, 2010, at 7:21 AM, Clarence Grim

wrote: It varies. Do a pubmed.CE Grim MDWhat significance does our menstrual cycle play in blood pressure?During my luteal phase my blood pressure ranges from

115/65 to 120/75 but then once menses begins i run a lot lower 90/60.I am in the process of doing the 24 hour urine. should have those numbers in a few days.thanks,suzanneSent from my iPad Yea but you usually are an alcoholic who does not each much or cancer pt who cannot eat and is starving. CE Grim MDI have read that a magnesium deficiency can cause low K.Sent from my iPad Better to DASH I would think.If you can get it in food why take a pill?CE Grim MDare you

serious? I am asking if I should take a b vitamin supplement?Sent from my iPad Still no question?CE Grim MD Was there a question here?Hi Dr. Grim,Is it recommended to take a b-complex vitamin?I have been holding off from taking mine (complete b-complex from life extension) because i am afraid it might encourage more aldosterone production! Am I crazy for worrying about this? I know the adrenals love b vitamins and I don't need anything that will cause me to produce more aldosterone. However, I know for a woman of my age and activity level that the b's are very important and could really benefit my body!!Thanks,

SuzanneSent from my iPad They are all competitors for the receptors but I

do not know the measures of association that permits one to quantitate the relative effect of aldo in occupying each of the receptors. Also they circulate in much greater quantities that aldo as I recall. So the effect would seem likely to be weak.CE Grim MD Hi Dr. Grim, I wanted to ask if high aldosterone levels will block progesterone, testosterone, and estrogen receptors? Thanks, SuzanneTo: hyperaldosteronism Cc: Clarence Grim Sent: Sun, November 7, 2010 7:36:01 PMSubject: Re:

Re: 42 yo woman runner who has had aldo 52 and renin 3.3 normal bp That's what this paper says. No one has looked at in anymore detail that I can find.CE Grim MDOk, by doing this it will be ok to test

any time of my cycle?Sent from my iPadOn Nov 7, 2010, at 6:02 PM, Clarence Grim

wrote: Ask your lab to use plasma renin activity not direct renin assay.CE Grim MDThis is the article I did read. I didn't feel like it gave a definitive

answer. I have read it is best to test aldosterone on the third day of the menstrual cycle but not sure how that will go seeing it is a urine test and not a simple blood draw. Any advice would be greatly appreciated. ThanksSent from my iPad Guess you did not search aldosterone renin ratio.Here is one.J Clin Endocrinol Metab. 2010 Oct 20. [Epub ahead of print]Are Women More at Risk of False-Positive Primary Aldosteronism Screening and Unnecessary Suppression Testing than Men?Ahmed AH, Gordon RD, PJ, Ward G, Pimenta E, Stowasser M.Endocrine Hypertension Research Centre (A.H.A., R.D.G., P.J.T., E.P., M.S.), University of Queensland School of Medicine, Greenslopes and Princess andra Hospitals, Brisbane, Queensland 4102, Australia; and Sullivan and Nicolaides Pathology (G.W.), Brisbane, 4068 Queensland, Australia.AbstractBackground: Because primary aldosteronism is not uncommon, specifically treatable and in some cases curable, and carries higher risks for cardiovascular morbidity and mortality than essential

hypertension, screening hypertensive patients for its presence by measuring aldosterone to renin ratio (ARR) is increasingly common. A significantly higher false-positive ARR rate for women than men, resulting in unnecessary suppression tests has previously been reported. Methods: Using a new, highly accurate aldosterone assay and both of the currently widely used renin assays, ARR was measured in 19 normal, ovulating women at three time points in the menstrual cycle and compared with single measurements in 21 normal males of similar age. Results: ARRs in males were possibly too well down in the current normal range. Although normotensive and normokalemic, two women had raised ARRs in the luteal phase but only when direct renin concentration (DRC) was used. Their DRC levels were low at all sampling times [despite midrange plasma renin activity levels], whereas their progesterone and aldosterone levels were highest for the group. Saline suppression

testing, performed in one of them, showed normal aldosterone suppressibility. Conclusion: False-positive ARRs in normal women during the luteal phase only when DRC is used may explain the higher incidence of false-positive ARRs in hypertensive women than men and suggest the following: 1) plasma renin activity is preferable to DRC in determination of ARR and 2) new reference ranges for ARR that take into account gender and sex hormone levels are required.Thanks, I did do some reading on pubmed like you suggested about testing and menses but never came up with an answer. Hoping you had the answer. I know aldosterone is naturally higher during the luteal phase but I only want to do this once and I want to get it exactly right . Sent from my iPad I think I sent an abstract recently on menses and testing. If you cant find it let me know.Dr. Grim's Perfect Primary

Aldosteronism Blood and Urine Testing to diagnose PA in one day. 1. Eat a regular to high salt diet for 2 weeks.2. No BP meds in last 4-12 weeks depending on meds.3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do not lose a drop of this liquid gold. It is impossible to interpret the renin and aldo without this.4. The morning you finish the 24 hr urine have fasting blood drawn for renin, aldo and K using our guidelines to get an accurate K. Try to get this done about 4 hours after you have been out of bed.5. Send us the results with the normal values for your lab.6. If you ever have a salt (saline) infusion test for PA be certain to ask them to measure how much

you pee during the 4 hours of the infusion. If it is 1-1.5 liter of urine it strongly suggests that you may have PA. If more tha 1.5 L you almost certainly have PA. Hi, I am calling my Natural Path tomorrow to have her order test to

see if we can figure out why I have high alodsterone. Here are the test I am requesting: (PLEASE LET ME KNOW IF I AM MISSING SOMETHING) -24 hour urine NA, K, Creatinine, Aldosterone -blood draw Renin, Aldosterone, and K Anything else????Also where can I get the info on how to collect K correctly?See our files on how to draw blood.One last question, when during my menstrual cycle is the best time to do these test?'see a recent email re this issue.Thanks so much for you time, SuzanneTo: hyperaldosteronism Cc: Clarence Grim Sent: Fri, November 5, 2010 7:04:29 AMSubject: Re: Re: 42 yo woman runner who has had aldo 52 and renin 3.3 normal bp your team is who you have decided you want to manage your health. Can a Natural Path write prescriptions and order blood tests?CE Grim MDWhat if I don't have a team? Or do you consider a Natural Path my team?Sent from my iPad yes I can work with your team for $500 per year.CE Grim MDHi Dr Grim , I agree I am afraid I am going to make this 400 mile trip and get nowhere! I don't have a dr other than a Natural Path. Can you be my dr and take care of all of this online?Sent from my iPad she does not seem to understand PA as she did not order a renin.CE Grim MDSend her my article on the evolution of PA and the Endo guidelines in our files---BEFORE you see her. You want to know how many PAs she has treated and followed for at least 10 years.CE Grim MDThanks for the info. I am so frustrated with dr's in my area. It seems NO one knows the correct test around here! My natural path is very willing to order the test but she's the first one to admit that she won't know what to do with the results.I live in Whitefish, Montana and Kalispell is about 15 minutes away. Missoula is about 200 miles but I would drive it if someone could make a recommendation ( preferably first hand experience). I am doing Dr. grimes ideal test in December and then at the end of December I am scheduled to see an endocrinologist in Missoula. I don't have faith that the

endo knows much about hyperaldosteronism but at this point she is my only hope. This endo's name is Dr. Eyler. She has ordered the following test ( which I don't believe are ideal): hypothyroid panel, comprehensive metabolic panel, vitamin d, hemogram, LH, FSH, 24 hr urine aldosterone.Any comments or feedback would be so appreciated! Thanks, SuzanneSent from my iPad See Dr Grim's ideal test.You cannot interpret the aldo/renin ratio without having a 24 hr urine Na. But maybe your health care team knows how to do this. If so they need to let us know.CE GrimMDWelcome to the exciting world of Hyperaldosteronism! You are in the right place! I am Dr. CE Grim a retired Professor of Medicine and Endocrinology. I have a long standing interest is Primary Aldosteronism since medical school days when I saw my first patient with Primary Aldosteronism in 1963. I trained with Dr. Conn in Endocrinology and Metabolism 1969-70 and have published over 240 papers and book chapters in most areas of the broad discipline of High Blood Pressure. My CV is in our files for

details. The goal of our group is to teach you and your health care team about the ins and outs of the causes, diagnosis and control of the many forms of hyperaldosteronism. The steps below will introduce you into the fascinating world of high blood pressure, salt and potassium and the role of the adrenal hormone aldosterone in health and disease. Doing these in sequence will save you time and effort in getting up to speed in taking control of you health and educating your own health care team. While we can’t make you a doctor we will make you into a pretty good BP doctor-a skill that you will have for life. 1. A brief history of Primary Aldosteronsim and why it is so common today in drug resistant high blood pressure. Read my article in our files on the

evolution of PA (Evolution_of_PA-Grim.pdf ) and take to all members of health care team. Tell us what stage you believe you are in. This is a brief review of most causes of hyperaldosteronism, high blood pressure, low potassium (K). 2. Read about other patients with hyperaldosteronism (Conn’s syndrome). Read our Conn's stories in our files and then give us your own in as much detail as you can. Dr. Conn was the first to describe this disease process and the syndrome is named after him.To see others' stories, on the Hyperaldosteronism home page, go to Files/Conn’s Stories. You'll find instructions in "A - How to put your story here.doc " First send us your story in an email and they we may have questions and suggestions before you upload it to our files. 3. DASH to lower your BP.

Your and my tax dollars funded the most important series of studies on how to improve blood pressure, blood sugar, blood lipids and make your heart smaller: The DASH Eating Plan to control high blood pressure due to hyperaldosteronism and most others with high blood pressure. This will reduce your need for medications and in many will get your BP and K to goal without meds.. Get the DASH diet book by T. et al, (http://www.amazon.com/DASH-Diet-Hypertension--/dp/0743202953) read it and use it: ~$8 in paperback at your local bookstore or online. If they don’t have it ask them to order it for you. You can also get the hardback larger print version as well at Amazon.

Learning to eat the DASH way will play a major role in your road to good BP and K control and, in many of our folks here, will revolutionize your life. See http://en.wikipedia.org/wiki/DASH_diet for an overview and more details. In the book go to chapter 9 and do the 14 day challenge.

Tell your Dr you are doing this as your BP may plummet if you are on other meds. Measure your BP every day and post to us. or go to http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf download this 64 page booklet free and do the Week on the DASH Diet for 2 weeks. If you are on BP meds be prepared for a large fall in BP (20/10 mm Hg or more) and let your Dr. know you are doing this. And/Or go to (but costs money monthly) DASH Diet for Health Program (http://www.dashforhealth.com/pages/public/tour.php)The DASH Diet for Health Program is designed to help you improve your eating and exercise habits. Twice each week they will provide you with information on our website about food, food preparation, eating out, losing weight, getting fit and much more. In addition to providing new information each week on the website, they create a web page

specially for you where you can track progress in areas such as your weight, blood pressure, and exercise. I strongly recommend you get this book and read it. 4. Measure your BP: Measure your BP daily so you can see if it is getting better. If you are taking meds be sure to tell your health care team you are doing this as your BP may plummet to normal quickly. We recommend you use a device you listen to and will help you learn how to do this. If this is not something you want to do we can teach a significant other how to do it. See sharedcareinc.com or email to sharedcare@... to order a video on how to do this. If you already have one we will teach you how to teach your health care team how to validate your device. Your life and health depends on accurate BP measurements. Go to the amricanheart.org and download the Guidelines for Human Blood Pressure Measurement. Insist the your health care team do BP the AHA way. Never trust your life to an automatic BP machine unless you know it is accurate on YOU. 5. Genetics and your BP: Go to familyhistory.hhs.gov and do your detailed family medical history so we can review with you to help Dx familial causes of high blood pressure and heart disease. If BP runs in your family you may save lives in your family by checking their BP yourself. 6. How to DX and treat PA: Go to our file/Conn's Articles of Note/Medications/Bravo spir 1973.pdf and read this

article and take to your health care team. It is old but still one of the best in the medical management of PA. Also see our file from the Endocrine Society Guidelines on PA. Dr. Grim's Perfect Primary Aldosteronism Blood and Urine Testing to diagnose PA in one day. 1. Eat a regular to high salt diet for 2 weeks.2. No BP meds in last 4-12 weeks depending on meds.3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do not lose a drop of this liquid gold. It is impossible to interpret the renin and aldo without this.4. The morning you finish the 24 hr urine have fasting blood drawn for renin, aldo and K using our guidelines to get an accurate K. Try to get this done about 4 hours after you have been out of bed.5. Send us the results with the normal values for your lab.6. If

you ever have a salt (saline) infusion test for PA be certain to ask them to measure how much you pee during the 4 hours of the infusion. If it is 1-1.5 liter of urine it strongly suggests that you may have PA. If more tha 1.5 L you almost certainly have PA. 8. Become a participant in our PA Registry and contribute to our large database on PA: If you have been Dxed with PA already and are on Rx or have had surgery please go to http://www.kwiksurveys.com/online-survey.php?surveyID=HIJIO_f2685379 and complete our survey with as much information as you know. If there is some information you don't know ask us and we will help. If you need to update this as you journey thru the

diagnostic/treatment process you can add another entry but label it as Nameyymmdd. For example today 6/12/09 for me would be Grim090612. This ever increasing number will allow us and you to sort your multiple entries into a dated order. 9. Learn the language: If you are new to medical lingo then download the acroyms from http://health.groups.yahoo.com/group/bloodpressureline/message/2918610. Salt and high blood pressure: To learn the state of the science of salt and blood pressure please spend some time looking at http://www.worldactiononsalt.com/evidence/treatment_trials.htm11. Become a HBP expert

consumer: Expect that it will take at least several weeks to get all this digested and to learn the new language of high blood pressure health care. As most doctors and nurses in practice have had very little training in high blood pressure you must become an expert yourself. For example most have never had anyone listen with them with a double stethoscope to verify that they can hear BP sounds. We cannot make you a doctor but we will make you a pretty good BP doctor.12. How High Blood Pressure should be managed: Go to nih.gov and download and read the Joint National Commission (JNC) Report 7 to get an

overview on current guidelines. I ask all my secretaries to read this so they can communicate the importance of high blood pressure to my patients. JNC 8 will be out soon.Then: get (and study) the Hypertension Primer from americanheart.org. This is the most up-to-date compendium of what is known about high blood pressure and what every Dr. should know when they graduate from Medical School. Every chapter is only 2-3 pages. Read one chapter every week-night and you will finish it in about a year. I am working on a reading guide for lay people for the Primer. Stay

tuned.13. Ask us questions: Ask any questions about high blood pressure you want answered. That is what we are here for. We have had this site for 10 years and over 30,000 emails are searchable. This is the largest collection of communications about Conn's Syndrome in the World. 14. One-on-one Consulting: I can provide individual consulting if you do not want to go public. If you want individual one-on-one consulting for you and your Doctor contract me directly at lowerbp2@....May your pressure be low!Clarence E. Grim BS, MS, MD, FACP, FACC, FAHABoard Certified in Internal Medicine, Geriatrics, and High Blood Pressure Retired Faculty/Professor of Medicine (U of MO, Indiana, UCLA/DREW, Medical College of Wisconsin and Cardiology, Endocrinology, Nephrology, and Epidemiology. Specializing in Primary Aldosteronism and Difficult to Control

High Blood Pressure. I'm going in on Thursday for the following test: basic panel and serum aldosterone.Shouldn't there be a urine test? Are these

test a waste of my time if I want real answers to why I have high aldosterone.What would be the ideal test? Please help I am feeling pressured for time! Thank youSent from my iPadOn Nov 1, 2010, at 8:02 PM, Clarence Grim

wrote: Not that I know of or can make a connection to in my wildest Endocrine/Heme thoughs. But then another reason we need a good data base.Do you do data bases?CE Grim,MDIs there any connection between high aldosterone and low ferritin?Sent from my iPad If your BP and K is normal you may not need to DASH.Runners may have aldo if it was collected after a run.Drink when you are thirsty. A low Na suggests you are drinking too much.CE Grim MDCould I get some input on water intake? I tried searching the web-site about dashing but couldn't find what I was looking for.I know are bodies are constantly trying to keep things in balance so I feel like h2o consumption is just as important as sodium intake. However, I don't think I can assume the average 8 cups a day will be my norm.Here are a few things that I think might influence my sodium/h20 consumption: I have lowish serum sodium 138 (135-145), I have low blood pressure110/65, high aldosterone (24 hr urine 54.3 ( 17-44) and I am active ( runner)I feel it is reasonable that I keep my sodium intake at the higher end of the Dashing Diet , because of low sodium and low blood pressure and activity level, but I also want

to try and lower aldosterone naturally ( if possible) and I'm hoping maybe it's a matter of the right amount of daily water and sodium consumption. Are there any right ratios for this? For example, if you consume 1,500 mg of sodium you should have 8 cups of h2o or maybe if you consume 2,300 mg of sodium you should shoot for 10 cups of h2o?Thanks so much! Really trying to get it right!Sent from my iPad Keep us posted. so you have high renin and high aldo and low K and low BP?CE Grim MDHi Dr. Grim, The following post grabbed my attention. I started following you and this site when I was thought to have primary hyperaldosteronism. I had all the expected abnormal lab results except for low to normal blood pressure. Eventually, labaratory results confirmed Bartters Syndrome and now I follow both yahoo groups. > > >>>>>>>>>> > > >>>>>>>>>>> > > >>>>>>>>>>> Hi everyone, just joined today.

Thanks to all of you for this support!> > >>>>>>>>>>> > > >>>>>>>>>>> I tested high for aldosterone two years ago through a urine test. My ND at the time was not concerned, he thought it was due to the fact that I was a runner. I also thought that made since and was also following a low salt diet. So we ignored it.> > >>>>>>>>>>> > > >>>>>>>>>>> I am treAting a thyroid issue, thyroid hormone resistance, and through recent blood work tested high for aldosterone again. This time I decided not to ignore it! > > >>>>>>>>>>> > >

>>>>>>>>>>> I do not have a high blood pressure. It runs pretty normal to low. I don't have issues with potassium. This is all Very confusing as to why I have high aldosterone.> > >>>>>>>>>>> > > >>>>>>>>>>> I am trying to get into a endocrinologist but will take about three months. I need some education and advise on where to start.> > >>>>>>>>>>> > > >>>>>>>>>>> I don't even know if this is primary or secondary.> > >>>>>>>>>>> > > >>>>>>>>>>> My only real "health" issue, that I know about, has been hair loss. This was one

reason for exploring the thyroid but I am wondering if it has been the aldosterone all along. Maybe the aldosterone is what's causing my thyroid issues.> > >>>>>>>>>>> > > >>>>>>>>>>> Any comments or advice would be greatly appreciated.> > >>>>>>>>>>> > > >>>>>>>>>>> My labs:> > >>>>>>>>>>> > > >>>>>>>>>>> 9/26/2008> > >>>>>>>>>>> Aldosterone (urine)> > >>>>>>>>>>> High 54.3. (normal diet 6-25, low salt 17-44, high salt0-6)> >

>>>>>>>>>>> > > >>>>>>>>>>> Other adrenal hormones were fine at that time. Cortisol was pretty middle of the road. *Progesterone however was really high too. I can post if necessary.> > >>>>>>>>>>> > > >>>>>>>>>>> Rbc potassium 7/14/2010> > >>>>>>>>>>> 97. (90-111)> > >>>>>>>>>>> > > >>>>>>>>>>> Blood aldosterone 7/18/2010> > >>>>>>>>>>> 52.0. (1-16)> > >>>>>>>>>>> > >

>>>>>>>>>>> Blood aldosterone/renin 6/30/2010> > >>>>>>>>>>> Aldosterone 49. (1-16)> > >>>>>>>>>>> Renin. 3.3. (random ambulatory 0.8-2.5, non ambulatory 1.5-5.2)> > >>>>>>>>>>> I was sitting, fasting, taking two hours after waking before/around 8am> > >>>>>>>>>>> > > >>>>>>>>>>> Aldosterone renin ratio = 15> > >>>>>>>>>>> > > >>>>>>>>>>> Sodium. 138. (135-145)> > >>>>>>>>>>> Potassium. 4.5. (3.5-5.3)> > >>>>>>>>>>> Chloride. 106. (98-109)>

> >>>>>>>>>>> Co2. 23. (22-31)> > >>>>>>>>>>> Anion gap. 9. (5-16)> > >>>>>>>>>>> > > >>>>>>>>>>> Saliva cortisol 5/23/2010> > >>>>>>>>>>> 7am. 3.7. (3.7-9.5)> > >>>>>>>>>>> 11am. 1.6. (1.2-3.0)> > >>>>>>>>>>> 5pm. 1.3. (0.6-1.9)> > >>>>>>>>>>> 9pm. 0.5. (0.4-1.0)> > >>>>>>>>>>> > > >>>>>>>>>>> Rbc magnesium 5/26/2010> > >>>>>>>>>>> 4.2. (4.0-6.4)> >

>>>>>>>>>>> > > >>>>>>>>>>> Lot of test!!!!> > >>>>>>>>>>> > > >>>>>>>>>>> Thanks again for your kind support! Suzanne> > >>>>>>>>>>> > > >>>>>>>>>>> > > >>>>>>>>>> > > >>>>>>>>> > > >>>>>>>>> > > >>>>>>>> > > >>>>>>>> > > >>>>>>> > > >>>>>>> > > >>>>>> > > >>>>>> > > >>>>> > > >>>>> > > >>>> > > >>>> > > >>> > > >>> > > >> > > > > > >> >> > > Reply to sender |>

[Guest guest]

YOU KNOW DR. GRIM I HAVE SPENT THE LAST FOUR YEARS OF MY LIFE DEDICATED TO READING ABOUT ALL TYPES OF HEALTH ISSUES, MOSTLY THYROID, IRON, AND HORMONES, BECAUSE TIME AND TIME AGAIN DOCTORS HAVE FAILED ME! EVERYTIME I HAD A QUESTION LIKE THIS NO ONE COULD OR WOULD ANSWER THEM. SO I SPEND A LOT OF TIME RESEARCHING AND FINDING MY OWN ANSWERS WHILE STILL PAYING DOCTORS IN HOPES SOMEONE WILL HELP. SADLY, AFTER MUCH TIME I AM THE ONE WHO HAS TO FIND MY OWN ANSWERS BUT SOMEHOW STILL END UP PAYING DOCTORS TO TELL ME NOTHING. I DON'T WANT TO WASTE ANOTHER YEAR OF MY LIFE READING WHAT DOCTORS SHOULD HAVE ALREADY TOLD ME! I HAVE BEEN THROUGH AT LEAST 7 DOCTORS AND THOUSANDS AND THOUSANDS OF DOLLARS. I HAVE GIVEN UP SO MUCH OF MY LIFE, AND TIME WITH MY FAMILY BECAUSE DOCTORS DIDN'T CARE ENOUGH OR KNOW ENOUGH TO HELP ME. I THOUGHT THIS SUPPORT GROUP WAS DIFFERENT! CAN YOU NOT UNDERSTAND THE

FRUSTRATION THIS SITUATION CAUSES???ARE THERE ANY DOCTORS LEFT WHO WENT TO MEDICAL SCHOOL BECAUSE THEY ACTUALLY HAD A DESIRE TO HELP PEOPLE, OR ARE THEY ALL JUST OUT TO MAKE MONEY?SUZANNE Sent from my iPad

Support for common questions. Or you can order the AHA HYPERTENSION PRIMER and read one chapter a night each week night and after a year or so you will know all the answers to your questions.FYI the spot urine cr con tells you nothing about kidney problems. If it was tome and u had the volume it might. It mostly tells us how much fluid you were drinking. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

so what's the support group for?Sent from my iPad

Once again this is what I get paid for. Contact me at lowerbp2@... for details of accessing my expertise for a year for only $500.CE Grim MDThanks!!Would

you mind explaining the difference between the creatinine random urine and the creatinine quantitative urine? I am concerned that my creat. rand is low meaning kidney trouble.I have been sitting here "researching" this for an hour or so and can't find an explanation.I won't been able to see my doctor until the end of this month and even then I don't think she is well educated in this area.I really wanted to rule out any kidney issues before December 28th.Thanks for your time and input! SuzanneSent from my iPad I assume

your Dr. gets paid for doing this sort of interpretation.I can do it one on one for a fee. They all look good to me.CE Grim MDI have some test results back that are worrying me. I don't have all the results so I will post them as I get them. Right now I am

concerned with what my creatinine levels mean. Please help!!!Blood creatinineCREAT 0.77 (0.44-1.00)BUN 14 (6-20)urine creatinine (there were two results for this)CREAT,RAND UR 40.86 L (80.00-170 mg./dl)CREAT, UR QUANT 1.0 (0.6-1.8 gm./dy)Should I be worried about the low CREAT, RAND UR?????THANKS, SUZANNESent from my iPadOn Dec 3, 2010, at 7:21 AM, Clarence Grim

wrote: It varies. Do a pubmed.CE Grim MDWhat significance does our menstrual cycle play in blood pressure?During my luteal phase my blood pressure ranges from

115/65 to 120/75 but then once menses begins i run a lot lower 90/60.I am in the process of doing the 24 hour urine. should have those numbers in a few days.thanks,suzanneSent from my iPad Yea but you usually are an alcoholic who does not each much or cancer pt who cannot eat and is starving. CE Grim MDOn Nov 22, 2010, at 10:04 PM,

Suzanne Kann wrote:I have read that a magnesium deficiency can cause low K.Sent from my iPad Better to DASH I would think.If you can get it in food why take a pill?CE Grim MDare you

serious? I am asking if I should take a b vitamin supplement?Sent from my iPad Still no question?CE Grim MD Was there a question here?Hi Dr. Grim,Is it recommended to take a b-complex vitamin?I have been holding off from taking mine (complete b-complex from life extension) because i am afraid it might encourage more aldosterone production! Am I crazy for worrying about this? I know the adrenals love b vitamins and I don't need anything that will cause me to produce more aldosterone. However, I know for a woman of my age and activity level that the b's are very important and could really benefit my body!!Thanks,

SuzanneSent from my iPad They are all competitors for the receptors but I

do not know the measures of association that permits one to quantitate the relative effect of aldo in occupying each of the receptors. Also they circulate in much greater quantities that aldo as I recall. So the effect would seem likely to be weak.CE Grim MD Hi Dr. Grim, I wanted to ask if high aldosterone levels will block progesterone, testosterone, and estrogen receptors? Thanks, SuzanneTo: hyperaldosteronism Cc: Clarence Grim Sent: Sun, November 7, 2010 7:36:01 PMSubject: Re:

Re: 42 yo woman runner who has had aldo 52 and renin 3.3 normal bp That's what this paper says. No one has looked at in anymore detail that I can find.CE Grim MDOk, by doing this it will be ok to test

any time of my cycle?Sent from my iPadOn Nov 7, 2010, at 6:02 PM, Clarence Grim

wrote: Ask your lab to use plasma renin activity not direct renin assay.CE Grim MDThis is the article I did read. I didn't feel like it gave a definitive

answer. I have read it is best to test aldosterone on the third day of the menstrual cycle but not sure how that will go seeing it is a urine test and not a simple blood draw. Any advice would be greatly appreciated. ThanksSent from my iPad Guess you did not search aldosterone renin ratio.Here is one.J Clin Endocrinol Metab. 2010 Oct 20. [Epub ahead of print]Are Women More at Risk of False-Positive Primary Aldosteronism Screening and Unnecessary Suppression Testing than Men?Ahmed AH, Gordon RD, PJ, Ward G, Pimenta E, Stowasser M.Endocrine Hypertension Research Centre (A.H.A., R.D.G., P.J.T., E.P., M.S.), University of Queensland School of Medicine, Greenslopes and Princess andra Hospitals, Brisbane, Queensland 4102, Australia; and Sullivan and Nicolaides Pathology (G.W.), Brisbane, 4068 Queensland, Australia.AbstractBackground: Because primary aldosteronism is not uncommon, specifically treatable and in some cases curable, and carries higher risks for cardiovascular morbidity and mortality than essential

hypertension, screening hypertensive patients for its presence by measuring aldosterone to renin ratio (ARR) is increasingly common. A significantly higher false-positive ARR rate for women than men, resulting in unnecessary suppression tests has previously been reported. Methods: Using a new, highly accurate aldosterone assay and both of the currently widely used renin assays, ARR was measured in 19 normal, ovulating women at three time points in the menstrual cycle and compared with single measurements in 21 normal males of similar age. Results: ARRs in males were possibly too well down in the current normal range. Although normotensive and normokalemic, two women had raised ARRs in the luteal phase but only when direct renin concentration (DRC) was used. Their DRC levels were low at all sampling times [despite midrange plasma renin activity levels], whereas their progesterone and aldosterone levels were highest for the group. Saline suppression

testing, performed in one of them, showed normal aldosterone suppressibility. Conclusion: False-positive ARRs in normal women during the luteal phase only when DRC is used may explain the higher incidence of false-positive ARRs in hypertensive women than men and suggest the following: 1) plasma renin activity is preferable to DRC in determination of ARR and 2) new reference ranges for ARR that take into account gender and sex hormone levels are required.Thanks, I did do some reading on pubmed like you suggested about testing and menses but never came up with an answer. Hoping you had the answer. I know aldosterone is naturally higher during the luteal phase but I only want to do this once and I want to get it exactly right . Sent from my iPad I think I sent an abstract recently on menses and testing. If you cant find it let me

know.Dr. Grim's Perfect Primary

Aldosteronism Blood and Urine Testing to diagnose PA in one day. 1. Eat a regular to high salt diet for 2 weeks.2. No BP meds in last 4-12 weeks depending on meds.3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do not lose a drop of this liquid gold. It is impossible to interpret the renin and aldo without this.4. The morning you finish the 24 hr urine have fasting blood drawn for renin, aldo and K using our guidelines to get an accurate K. Try to get this done about 4 hours after you have been out of bed.5. Send us the results with the normal values for your lab.6. If you ever have a salt (saline) infusion test for PA be certain to ask them to measure how much

you pee during the 4 hours of the infusion. If it is 1-1.5 liter of urine it strongly suggests that you may have PA. If more tha 1.5 L you almost certainly have PA. Hi, I am calling my Natural Path tomorrow to have her order test to

see if we can figure out why I have high alodsterone. Here are the test I am requesting: (PLEASE LET ME KNOW IF I AM MISSING SOMETHING) -24 hour urine NA, K, Creatinine, Aldosterone -blood draw Renin, Aldosterone, and K Anything else????Also where can I get the info on how to collect K correctly?See our files on how to draw blood.One last question, when during my menstrual cycle is the best time to do these test?'see a recent email re this issue.Thanks so much for you time, SuzanneTo: hyperaldosteronism Cc: Clarence Grim Sent: Fri, November 5, 2010 7:04:29 AMSubject: Re: Re: 42 yo woman runner who has had aldo 52 and renin 3.3 normal bp your team is who you have decided you want to manage your health. Can a Natural Path write prescriptions and order blood tests?CE Grim MDWhat if I don't have a team? Or do you consider a Natural Path my team?Sent from my iPad yes I can work with your team for $500 per year.CE Grim MDHi Dr Grim , I agree I am afraid I am going to make this 400 mile trip and get nowhere! I don't have a dr other than a Natural Path. Can you be my dr and take care of all of this online?Sent from my iPad she does not seem to understand PA as she did not order a renin.CE Grim MDSend her my article on the evolution of PA and the Endo guidelines in our files---BEFORE you see her. You want to know how many PAs she has treated and followed for at least 10 years.CE Grim MDThanks for the info. I am so frustrated with dr's in my area. It seems NO one knows the correct test around here! My natural path is very willing to order the test but she's the first one to admit that she won't know what to do with the results.I live in Whitefish, Montana and Kalispell is about 15 minutes away. Missoula is about 200 miles but I would drive it if someone could make a recommendation ( preferably first hand experience). I am doing Dr. grimes ideal test in December and then at the end of December I am scheduled to see an endocrinologist in Missoula. I don't have faith that the

endo knows much about hyperaldosteronism but at this point she is my only hope. This endo's name is Dr. Eyler. She has ordered the following test ( which I don't believe are ideal): hypothyroid panel, comprehensive metabolic panel, vitamin d, hemogram, LH, FSH, 24 hr urine aldosterone.Any comments or feedback would be so appreciated! Thanks, SuzanneSent from my iPad See Dr Grim's ideal test.You cannot interpret the aldo/renin ratio without having a 24 hr urine Na. But maybe your health care team knows how to do this. If so they need to let us know.CE GrimMDWelcome to the exciting world of Hyperaldosteronism! You are in the right place! I am Dr. CE Grim a retired Professor of Medicine and Endocrinology. I have a long standing interest is Primary Aldosteronism since medical school days when I saw my first patient with Primary Aldosteronism in 1963. I trained with Dr. Conn in Endocrinology and Metabolism 1969-70 and have published over 240 papers and book chapters in most areas of the broad discipline of High Blood Pressure. My CV is in our files for

details. The goal of our group is to teach you and your health care team about the ins and outs of the causes, diagnosis and control of the many forms of hyperaldosteronism. The steps below will introduce you into the fascinating world of high blood pressure, salt and potassium and the role of the adrenal hormone aldosterone in health and disease. Doing these in sequence will save you time and effort in getting up to speed in taking control of you health and educating your own health care team. While we can’t make you a doctor we will make you into a pretty good BP doctor-a skill that you will have for life. 1. A brief history of Primary Aldosteronsim and why it is so common today in drug resistant high blood pressure. Read my article in our files on the

evolution of PA (Evolution_of_PA-Grim.pdf ) and take to all members of health care team. Tell us what stage you believe you are in. This is a brief review of most causes of hyperaldosteronism, high blood pressure, low potassium (K). 2. Read about other patients with hyperaldosteronism (Conn’s syndrome). Read our Conn's stories in our files and then give us your own in as much detail as you can. Dr. Conn was the first to describe this disease process and the syndrome is named after him.To see others' stories, on the Hyperaldosteronism home page, go to Files/Conn’s Stories. You'll find instructions in "A - How to put your story here.doc " First send us your story in an email and they we may have questions and suggestions before you upload it to our files. 3. DASH to lower your BP.

Your and my tax dollars funded the most important series of studies on how to improve blood pressure, blood sugar, blood lipids and make your heart smaller: The DASH Eating Plan to control high blood pressure due to hyperaldosteronism and most others with high blood pressure. This will reduce your need for medications and in many will get your BP and K to goal without meds.. Get the DASH diet book by T. et al, (http://www.amazon.com/DASH-Diet-Hypertension--/dp/0743202953) read it and use it: ~$8 in

paperback at your local bookstore or online. If they don’t have it ask them to order it for you. You can also get the hardback larger print version as well at Amazon.

Learning to eat the DASH way will play a major role in your road to good BP and K control and, in many of our folks here, will revolutionize your life. See http://en.wikipedia.org/wiki/DASH_diet for an overview and more

details. In the book go to chapter 9 and do the 14 day challenge.

Tell your Dr you are doing this as your BP may plummet if you are on other meds. Measure your BP every day and post to us. or go to http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf download this 64 page booklet free and do the Week on the DASH Diet for 2 weeks. If you are on BP meds be prepared for a large fall in BP (20/10 mm Hg or more) and let your Dr. know you are doing this. And/Or go to (but costs money monthly) DASH Diet for Health Program (http://www.dashforhealth.com/pages/public/tour.php)The DASH Diet for Health Program is designed to help you improve your

eating and exercise habits. Twice each week they will provide you with information on our website about food, food preparation, eating out, losing weight, getting fit and much more. In addition to providing new information each week on the website, they create a web page

specially for you where you can track progress in areas such as your weight, blood pressure, and exercise. I strongly recommend you get this book and read it. 4. Measure your BP: Measure your BP daily so you can see if it is getting better. If you are taking meds be sure to tell your health care team you are doing this as your BP may plummet to normal quickly. We recommend you use a device you listen to and will help you learn how to do this. If this is not something you want to do we can teach a significant other how to do it. See sharedcareinc.com or email to sharedcare@... to order a video on how to do this. If you already have one we will teach you how to teach your health care team how to validate your device. Your life and health depends on accurate BP measurements. Go to the amricanheart.org and download the Guidelines for Human Blood Pressure Measurement. Insist the your health care team do BP the AHA way. Never trust your life

to an automatic BP machine unless you know it is accurate on YOU. 5. Genetics and your BP: Go to familyhistory.hhs.gov and do your detailed family medical history so we can review with you to help Dx familial causes of high blood pressure and heart disease. If BP runs in your family you may save lives in your family by checking their BP yourself. 6. How to DX and treat PA: Go to our

file/Conn's Articles of Note/Medications/Bravo spir 1973.pdf and read this

article and take to your health care team. It is old but still one of the best in the medical management of PA. Also see our file from the Endocrine Society Guidelines on PA. Dr. Grim's Perfect Primary Aldosteronism Blood and Urine Testing to diagnose PA in one day. 1. Eat a regular to high salt diet for 2 weeks.2. No BP meds in last 4-12 weeks depending on meds.3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do not lose a drop of this liquid gold. It is impossible to interpret the renin and aldo without this.4. The morning you finish the 24 hr urine have fasting blood drawn for renin, aldo and K using our guidelines to get an accurate K. Try to get this done about 4 hours after you have been out of bed.5. Send us the results with the normal values for your lab.6. If

you ever have a salt (saline) infusion test for PA be certain to ask them to measure how much you pee during the 4 hours of the infusion. If it is 1-1.5 liter of urine it strongly suggests that you may have PA. If more tha 1.5 L you almost certainly have PA. 8. Become a participant in our PA Registry and contribute to our large database on PA: If you have been Dxed with PA already and are on Rx or have had surgery please go to http://www.kwiksurveys.com/online-survey.php?surveyID=HIJIO_f2685379 and complete our survey with as

much information as you know. If there is some information you don't know ask us and we will help. If you need to update this as you journey thru the

diagnostic/treatment process you can add another entry but label it as Nameyymmdd. For example today 6/12/09 for me would be Grim090612. This ever increasing number will allow us and you to sort your multiple entries into a dated order. 9. Learn the language: If you are new to medical lingo then download the acroyms from http://health.groups.yahoo.com/group/bloodpressureline/message/2918610. Salt and high blood pressure: To learn the state of the science of salt and blood

pressure please spend some time looking at http://www.worldactiononsalt.com/evidence/treatment_trials.htm11. Become a HBP expert

consumer: Expect that it will take at least several weeks to get all this digested and to learn the new language of high blood pressure health care. As most doctors and nurses in practice have had very little training in high blood pressure you must become an expert yourself. For example most have never had anyone listen with them with a double stethoscope to verify that they can hear BP sounds. We cannot make you a doctor but we will make you a pretty good BP doctor.12. How High Blood Pressure should be managed: Go to nih.gov and download and read

the Joint National Commission (JNC) Report 7 to get an

overview on current guidelines. I ask all my secretaries to read this so they can communicate the importance of high blood pressure to my patients. JNC 8 will be out soon.Then: get (and study) the Hypertension Primer from americanheart.org. This is the most up-to-date compendium of what is known about high blood pressure and what every Dr. should know when they graduate from Medical School. Every chapter is only 2-3 pages. Read one chapter every week-night and you will finish it in about a year. I am working

on a reading guide for lay people for the Primer. Stay

tuned.13. Ask us questions: Ask any questions about high blood pressure you want answered. That is what we are here for. We have had this site for 10 years and over 30,000 emails are searchable. This is the largest collection of communications about Conn's Syndrome in the World. 14. One-on-one Consulting: I can provide individual consulting if you do not want to go public. If you want individual one-on-one consulting for you and your Doctor contract me directly at lowerbp2@....May your pressure be low!Clarence E. Grim BS, MS, MD, FACP, FACC, FAHABoard Certified in Internal Medicine, Geriatrics, and High Blood Pressure Retired Faculty/Professor of Medicine (U of MO, Indiana, UCLA/DREW, Medical College of Wisconsin and Cardiology, Endocrinology, Nephrology, and

Epidemiology. Specializing in Primary Aldosteronism and Difficult to Control

High Blood Pressure. I'm going in on Thursday for the following test: basic panel and serum aldosterone.Shouldn't there be a urine test? Are these

test a waste of my time if I want real answers to why I have high aldosterone.What would be the ideal test? Please help I am feeling pressured for time! Thank youSent from my iPadOn Nov 1, 2010, at 8:02 PM, Clarence Grim

wrote: Not that I know of or can make a connection to in my wildest Endocrine/Heme thoughs. But then another reason we need a good data base.Do you do data bases?CE Grim,MDIs there any connection between high aldosterone and low ferritin?Sent from my iPad If your BP and K is normal you may not need to DASH.Runners may have aldo if it was collected after a run.Drink when you are thirsty. A low Na suggests you are drinking too much.CE Grim MDCould I get some input on water intake? I tried searching the web-site about dashing but couldn't find what I was looking for.I know are bodies are constantly trying to keep things in balance so I feel like h2o consumption is just as important as sodium intake. However, I don't think I can assume the average 8 cups a day will be my norm.Here are a few things that I think might influence my sodium/h20 consumption: I have lowish serum sodium 138 (135-145), I have low blood pressure110/65, high aldosterone (24 hr urine 54.3 ( 17-44) and I am active ( runner)I feel it is reasonable that I keep my sodium intake at the higher end of the Dashing Diet , because of low sodium and low blood pressure and activity level, but I also want

to try and lower aldosterone naturally ( if possible) and I'm hoping maybe it's a matter of the right amount of daily water and sodium consumption. Are there any right ratios for this? For example, if you consume 1,500 mg of sodium you should have 8 cups of h2o or maybe if you consume 2,300 mg of sodium you should shoot for 10 cups of h2o?Thanks so much! Really trying to get it right!Sent from my iPad Keep us posted. so you have high renin and high aldo and low K and low BP?CE Grim MDHi Dr. Grim, The following post grabbed my attention. I started following you and this site when I was thought to have primary hyperaldosteronism. I had all the expected abnormal lab results except for low to normal blood pressure. Eventually, labaratory results confirmed Bartters Syndrome and now I follow both yahoo groups. > > >>>>>>>>>> > > >>>>>>>>>>> > > >>>>>>>>>>> Hi everyone, just joined today.

Thanks to all of you for this support!> > >>>>>>>>>>> > > >>>>>>>>>>> I tested high for aldosterone two years ago through a urine test. My ND at the time was not concerned, he thought it was due to the fact that I was a runner. I also thought that made since and was also following a low salt diet. So we ignored it.> > >>>>>>>>>>> > > >>>>>>>>>>> I am treAting a thyroid issue, thyroid hormone resistance, and through recent blood work tested high for aldosterone again. This time I decided not to ignore it! > > >>>>>>>>>>> > >

>>>>>>>>>>> I do not have a high blood pressure. It runs pretty normal to low. I don't have issues with potassium. This is all Very confusing as to why I have high aldosterone.> > >>>>>>>>>>> > > >>>>>>>>>>> I am trying to get into a endocrinologist but will take about three months. I need some education and advise on where to start.> > >>>>>>>>>>> > > >>>>>>>>>>> I don't even know if this is primary or secondary.> > >>>>>>>>>>> > > >>>>>>>>>>> My only real "health" issue, that I know about, has been hair loss. This was one

reason for exploring the thyroid but I am wondering if it has been the aldosterone all along. Maybe the aldosterone is what's causing my thyroid issues.> > >>>>>>>>>>> > > >>>>>>>>>>> Any comments or advice would be greatly appreciated.> > >>>>>>>>>>> > > >>>>>>>>>>> My labs:> > >>>>>>>>>>> > > >>>>>>>>>>> 9/26/2008> > >>>>>>>>>>> Aldosterone (urine)> > >>>>>>>>>>> High 54.3. (normal diet 6-25, low salt 17-44, high salt0-6)> >

>>>>>>>>>>> > > >>>>>>>>>>> Other adrenal hormones were fine at that time. Cortisol was pretty middle of the road. *Progesterone however was really high too. I can post if necessary.> > >>>>>>>>>>> > > >>>>>>>>>>> Rbc potassium 7/14/2010> > >>>>>>>>>>> 97. (90-111)> > >>>>>>>>>>> > > >>>>>>>>>>> Blood aldosterone 7/18/2010> > >>>>>>>>>>> 52.0. (1-16)> > >>>>>>>>>>> > >

>>>>>>>>>>> Blood aldosterone/renin 6/30/2010> > >>>>>>>>>>> Aldosterone 49. (1-16)> > >>>>>>>>>>> Renin. 3.3. (random ambulatory 0.8-2.5, non ambulatory 1.5-5.2)> > >>>>>>>>>>> I was sitting, fasting, taking two hours after waking before/around 8am> > >>>>>>>>>>> > > >>>>>>>>>>> Aldosterone renin ratio = 15> > >>>>>>>>>>> > > >>>>>>>>>>> Sodium. 138. (135-145)> > >>>>>>>>>>> Potassium. 4.5. (3.5-5.3)> > >>>>>>>>>>> Chloride. 106. (98-109)>

> >>>>>>>>>>> Co2. 23. (22-31)> > >>>>>>>>>>> Anion gap. 9. (5-16)> > >>>>>>>>>>> > > >>>>>>>>>>> Saliva cortisol 5/23/2010> > >>>>>>>>>>> 7am. 3.7. (3.7-9.5)> > >>>>>>>>>>> 11am. 1.6. (1.2-3.0)> > >>>>>>>>>>> 5pm. 1.3. (0.6-1.9)> > >>>>>>>>>>> 9pm. 0.5. (0.4-1.0)> > >>>>>>>>>>> > > >>>>>>>>>>> Rbc magnesium 5/26/2010> > >>>>>>>>>>> 4.2. (4.0-6.4)> >

>>>>>>>>>>> > > >>>>>>>>>>> Lot of test!!!!> > >>>>>>>>>>> > > >>>>>>>>>>> Thanks again for your kind support! Suzanne> > >>>>>>>>>>> > > >>>>>>>>>>> > > >>>>>>>>>> > > >>>>>>>>> > > >>>>>>>>> > > >>>>>>>> > > >>>>>>>> > > >>>>>>> > > >>>>>>> > > >>>>>> > > >>>>>> > > >>>>> > > >>>>> > > >>>> > > >>>> > > >>> > > >>> > > >> > > > > > >> >> > > Reply to sender |>

[Guest guest]

WHAT IS CONSIDERED A "COMMON" QUESTION? WOULD LABS NOT BE SOMETHING WE ALL HAVE IN COMMON?Sent from my iPad

Support for common questions. Or you can order the AHA HYPERTENSION PRIMER and read one chapter a night each week night and after a year or so you will know all the answers to your questions.FYI the spot urine cr con tells you nothing about kidney problems. If it was tome and u had the volume it might. It mostly tells us how much fluid you were drinking. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

so what's the support group for?Sent from my iPad

Once again this is what I get paid for. Contact me at lowerbp2@... for details of accessing my expertise for a year for only $500.CE Grim MDThanks!!Would

you mind explaining the difference between the creatinine random urine and the creatinine quantitative urine? I am concerned that my creat. rand is low meaning kidney trouble.I have been sitting here "researching" this for an hour or so and can't find an explanation.I won't been able to see my doctor until the end of this month and even then I don't think she is well educated in this area.I really wanted to rule out any kidney issues before December 28th.Thanks for your time and input! SuzanneSent from my iPad I assume

your Dr. gets paid for doing this sort of interpretation.I can do it one on one for a fee. They all look good to me.CE Grim MDI have some test results back that are worrying me. I don't have all the results so I will post them as I get them. Right now I am

concerned with what my creatinine levels mean. Please help!!!Blood creatinineCREAT 0.77 (0.44-1.00)BUN 14 (6-20)urine creatinine (there were two results for this)CREAT,RAND UR 40.86 L (80.00-170 mg./dl)CREAT, UR QUANT 1.0 (0.6-1.8 gm./dy)Should I be worried about the low CREAT, RAND UR?????THANKS, SUZANNESent from my iPadOn Dec 3, 2010, at 7:21 AM, Clarence Grim

wrote: It varies. Do a pubmed.CE Grim MDWhat significance does our menstrual cycle play in blood pressure?During my luteal phase my blood pressure ranges from

115/65 to 120/75 but then once menses begins i run a lot lower 90/60.I am in the process of doing the 24 hour urine. should have those numbers in a few days.thanks,suzanneSent from my iPad Yea but you usually are an alcoholic who does not each much or cancer pt who cannot eat and is starving. CE Grim MDOn Nov 22, 2010, at 10:04 PM,

Suzanne Kann wrote:I have read that a magnesium deficiency can cause low K.Sent from my iPad Better to DASH I would think.If you can get it in food why take a pill?CE Grim MDare you

serious? I am asking if I should take a b vitamin supplement?Sent from my iPad Still no question?CE Grim MD Was there a question here?Hi Dr. Grim,Is it recommended to take a b-complex vitamin?I have been holding off from taking mine (complete b-complex from life extension) because i am afraid it might encourage more aldosterone production! Am I crazy for worrying about this? I know the adrenals love b vitamins and I don't need anything that will cause me to produce more aldosterone. However, I know for a woman of my age and activity level that the b's are very important and could really benefit my body!!Thanks,

SuzanneSent from my iPad They are all competitors for the receptors but I

do not know the measures of association that permits one to quantitate the relative effect of aldo in occupying each of the receptors. Also they circulate in much greater quantities that aldo as I recall. So the effect would seem likely to be weak.CE Grim MD Hi Dr. Grim, I wanted to ask if high aldosterone levels will block progesterone, testosterone, and estrogen receptors? Thanks, SuzanneTo: hyperaldosteronism Cc: Clarence Grim Sent: Sun, November 7, 2010 7:36:01 PMSubject: Re:

Re: 42 yo woman runner who has had aldo 52 and renin 3.3 normal bp That's what this paper says. No one has looked at in anymore detail that I can find.CE Grim MDOk, by doing this it will be ok to test

any time of my cycle?Sent from my iPadOn Nov 7, 2010, at 6:02 PM, Clarence Grim

wrote: Ask your lab to use plasma renin activity not direct renin assay.CE Grim MDThis is the article I did read. I didn't feel like it gave a definitive

answer. I have read it is best to test aldosterone on the third day of the menstrual cycle but not sure how that will go seeing it is a urine test and not a simple blood draw. Any advice would be greatly appreciated. ThanksSent from my iPad Guess you did not search aldosterone renin ratio.Here is one.J Clin Endocrinol Metab. 2010 Oct 20. [Epub ahead of print]Are Women More at Risk of False-Positive Primary Aldosteronism Screening and Unnecessary Suppression Testing than Men?Ahmed AH, Gordon RD, PJ, Ward G, Pimenta E, Stowasser M.Endocrine Hypertension Research Centre (A.H.A., R.D.G., P.J.T., E.P., M.S.), University of Queensland School of Medicine, Greenslopes and Princess andra Hospitals, Brisbane, Queensland 4102, Australia; and Sullivan and Nicolaides Pathology (G.W.), Brisbane, 4068 Queensland, Australia.AbstractBackground: Because primary aldosteronism is not uncommon, specifically treatable and in some cases curable, and carries higher risks for cardiovascular morbidity and mortality than essential

hypertension, screening hypertensive patients for its presence by measuring aldosterone to renin ratio (ARR) is increasingly common. A significantly higher false-positive ARR rate for women than men, resulting in unnecessary suppression tests has previously been reported. Methods: Using a new, highly accurate aldosterone assay and both of the currently widely used renin assays, ARR was measured in 19 normal, ovulating women at three time points in the menstrual cycle and compared with single measurements in 21 normal males of similar age. Results: ARRs in males were possibly too well down in the current normal range. Although normotensive and normokalemic, two women had raised ARRs in the luteal phase but only when direct renin concentration (DRC) was used. Their DRC levels were low at all sampling times [despite midrange plasma renin activity levels], whereas their progesterone and aldosterone levels were highest for the group. Saline suppression

testing, performed in one of them, showed normal aldosterone suppressibility. Conclusion: False-positive ARRs in normal women during the luteal phase only when DRC is used may explain the higher incidence of false-positive ARRs in hypertensive women than men and suggest the following: 1) plasma renin activity is preferable to DRC in determination of ARR and 2) new reference ranges for ARR that take into account gender and sex hormone levels are required.Thanks, I did do some reading on pubmed like you suggested about testing and menses but never came up with an answer. Hoping you had the answer. I know aldosterone is naturally higher during the luteal phase but I only want to do this once and I want to get it exactly right . Sent from my iPad I think I sent an abstract recently on menses and testing. If you cant find it let me

know.Dr. Grim's Perfect Primary

Aldosteronism Blood and Urine Testing to diagnose PA in one day. 1. Eat a regular to high salt diet for 2 weeks.2. No BP meds in last 4-12 weeks depending on meds.3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do not lose a drop of this liquid gold. It is impossible to interpret the renin and aldo without this.4. The morning you finish the 24 hr urine have fasting blood drawn for renin, aldo and K using our guidelines to get an accurate K. Try to get this done about 4 hours after you have been out of bed.5. Send us the results with the normal values for your lab.6. If you ever have a salt (saline) infusion test for PA be certain to ask them to measure how much

you pee during the 4 hours of the infusion. If it is 1-1.5 liter of urine it strongly suggests that you may have PA. If more tha 1.5 L you almost certainly have PA. Hi, I am calling my Natural Path tomorrow to have her order test to

see if we can figure out why I have high alodsterone. Here are the test I am requesting: (PLEASE LET ME KNOW IF I AM MISSING SOMETHING) -24 hour urine NA, K, Creatinine, Aldosterone -blood draw Renin, Aldosterone, and K Anything else????Also where can I get the info on how to collect K correctly?See our files on how to draw blood.One last question, when during my menstrual cycle is the best time to do these test?'see a recent email re this issue.Thanks so much for you time, SuzanneTo: hyperaldosteronism Cc: Clarence Grim Sent: Fri, November 5, 2010 7:04:29 AMSubject: Re: Re: 42 yo woman runner who has had aldo 52 and renin 3.3 normal bp your team is who you have decided you want to manage your health. Can a Natural Path write prescriptions and order blood tests?CE Grim MDWhat if I don't have a team? Or do you consider a Natural Path my team?Sent from my iPad yes I can work with your team for $500 per year.CE Grim MDHi Dr Grim , I agree I am afraid I am going to make this 400 mile trip and get nowhere! I don't have a dr other than a Natural Path. Can you be my dr and take care of all of this online?Sent from my iPad she does not seem to understand PA as she did not order a renin.CE Grim MDSend her my article on the evolution of PA and the Endo guidelines in our files---BEFORE you see her. You want to know how many PAs she has treated and followed for at least 10 years.CE Grim MDThanks for the info. I am so frustrated with dr's in my area. It seems NO one knows the correct test around here! My natural path is very willing to order the test but she's the first one to admit that she won't know what to do with the results.I live in Whitefish, Montana and Kalispell is about 15 minutes away. Missoula is about 200 miles but I would drive it if someone could make a recommendation ( preferably first hand experience). I am doing Dr. grimes ideal test in December and then at the end of December I am scheduled to see an endocrinologist in Missoula. I don't have faith that the

endo knows much about hyperaldosteronism but at this point she is my only hope. This endo's name is Dr. Eyler. She has ordered the following test ( which I don't believe are ideal): hypothyroid panel, comprehensive metabolic panel, vitamin d, hemogram, LH, FSH, 24 hr urine aldosterone.Any comments or feedback would be so appreciated! Thanks, SuzanneSent from my iPad See Dr Grim's ideal test.You cannot interpret the aldo/renin ratio without having a 24 hr urine Na. But maybe your health care team knows how to do this. If so they need to let us know.CE GrimMDWelcome to the exciting world of Hyperaldosteronism! You are in the right place! I am Dr. CE Grim a retired Professor of Medicine and Endocrinology. I have a long standing interest is Primary Aldosteronism since medical school days when I saw my first patient with Primary Aldosteronism in 1963. I trained with Dr. Conn in Endocrinology and Metabolism 1969-70 and have published over 240 papers and book chapters in most areas of the broad discipline of High Blood Pressure. My CV is in our files for

details. The goal of our group is to teach you and your health care team about the ins and outs of the causes, diagnosis and control of the many forms of hyperaldosteronism. The steps below will introduce you into the fascinating world of high blood pressure, salt and potassium and the role of the adrenal hormone aldosterone in health and disease. Doing these in sequence will save you time and effort in getting up to speed in taking control of you health and educating your own health care team. While we can’t make you a doctor we will make you into a pretty good BP doctor-a skill that you will have for life. 1. A brief history of Primary Aldosteronsim and why it is so common today in drug resistant high blood pressure. Read my article in our files on the

evolution of PA (Evolution_of_PA-Grim.pdf ) and take to all members of health care team. Tell us what stage you believe you are in. This is a brief review of most causes of hyperaldosteronism, high blood pressure, low potassium (K). 2. Read about other patients with hyperaldosteronism (Conn’s syndrome). Read our Conn's stories in our files and then give us your own in as much detail as you can. Dr. Conn was the first to describe this disease process and the syndrome is named after him.To see others' stories, on the Hyperaldosteronism home page, go to Files/Conn’s Stories. You'll find instructions in "A - How to put your story here.doc " First send us your story in an email and they we may have questions and suggestions before you upload it to our files. 3. DASH to lower your BP.

Your and my tax dollars funded the most important series of studies on how to improve blood pressure, blood sugar, blood lipids and make your heart smaller: The DASH Eating Plan to control high blood pressure due to hyperaldosteronism and most others with high blood pressure. This will reduce your need for medications and in many will get your BP and K to goal without meds.. Get the DASH diet book by T. et al, (http://www.amazon.com/DASH-Diet-Hypertension--/dp/0743202953) read it and use it: ~$8 in

paperback at your local bookstore or online. If they don’t have it ask them to order it for you. You can also get the hardback larger print version as well at Amazon.

Learning to eat the DASH way will play a major role in your road to good BP and K control and, in many of our folks here, will revolutionize your life. See http://en.wikipedia.org/wiki/DASH_diet for an overview and more

details. In the book go to chapter 9 and do the 14 day challenge.

Tell your Dr you are doing this as your BP may plummet if you are on other meds. Measure your BP every day and post to us. or go to http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf download this 64 page booklet free and do the Week on the DASH Diet for 2 weeks. If you are on BP meds be prepared for a large fall in BP (20/10 mm Hg or more) and let your Dr. know you are doing this. And/Or go to (but costs money monthly) DASH Diet for Health Program (http://www.dashforhealth.com/pages/public/tour.php)The DASH Diet for Health Program is designed to help you improve your

eating and exercise habits. Twice each week they will provide you with information on our website about food, food preparation, eating out, losing weight, getting fit and much more. In addition to providing new information each week on the website, they create a web page

specially for you where you can track progress in areas such as your weight, blood pressure, and exercise. I strongly recommend you get this book and read it. 4. Measure your BP: Measure your BP daily so you can see if it is getting better. If you are taking meds be sure to tell your health care team you are doing this as your BP may plummet to normal quickly. We recommend you use a device you listen to and will help you learn how to do this. If this is not something you want to do we can teach a significant other how to do it. See sharedcareinc.com or email to sharedcare@... to order a video on how to do this. If you already have one we will teach you how to teach your health care team how to validate your device. Your life and health depends on accurate BP measurements. Go to the amricanheart.org and download the Guidelines for Human Blood Pressure Measurement. Insist the your health care team do BP the AHA way. Never trust your life

to an automatic BP machine unless you know it is accurate on YOU. 5. Genetics and your BP: Go to familyhistory.hhs.gov and do your detailed family medical history so we can review with you to help Dx familial causes of high blood pressure and heart disease. If BP runs in your family you may save lives in your family by checking their BP yourself. 6. How to DX and treat PA: Go to our

file/Conn's Articles of Note/Medications/Bravo spir 1973.pdf and read this

article and take to your health care team. It is old but still one of the best in the medical management of PA. Also see our file from the Endocrine Society Guidelines on PA. Dr. Grim's Perfect Primary Aldosteronism Blood and Urine Testing to diagnose PA in one day. 1. Eat a regular to high salt diet for 2 weeks.2. No BP meds in last 4-12 weeks depending on meds.3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do not lose a drop of this liquid gold. It is impossible to interpret the renin and aldo without this.4. The morning you finish the 24 hr urine have fasting blood drawn for renin, aldo and K using our guidelines to get an accurate K. Try to get this done about 4 hours after you have been out of bed.5. Send us the results with the normal values for your lab.6. If

you ever have a salt (saline) infusion test for PA be certain to ask them to measure how much you pee during the 4 hours of the infusion. If it is 1-1.5 liter of urine it strongly suggests that you may have PA. If more tha 1.5 L you almost certainly have PA. 8. Become a participant in our PA Registry and contribute to our large database on PA: If you have been Dxed with PA already and are on Rx or have had surgery please go to http://www.kwiksurveys.com/online-survey.php?surveyID=HIJIO_f2685379 and complete our survey with as

much information as you know. If there is some information you don't know ask us and we will help. If you need to update this as you journey thru the

diagnostic/treatment process you can add another entry but label it as Nameyymmdd. For example today 6/12/09 for me would be Grim090612. This ever increasing number will allow us and you to sort your multiple entries into a dated order. 9. Learn the language: If you are new to medical lingo then download the acroyms from http://health.groups.yahoo.com/group/bloodpressureline/message/2918610. Salt and high blood pressure: To learn the state of the science of salt and blood

pressure please spend some time looking at http://www.worldactiononsalt.com/evidence/treatment_trials.htm11. Become a HBP expert

consumer: Expect that it will take at least several weeks to get all this digested and to learn the new language of high blood pressure health care. As most doctors and nurses in practice have had very little training in high blood pressure you must become an expert yourself. For example most have never had anyone listen with them with a double stethoscope to verify that they can hear BP sounds. We cannot make you a doctor but we will make you a pretty good BP doctor.12. How High Blood Pressure should be managed: Go to nih.gov and download and read

the Joint National Commission (JNC) Report 7 to get an

overview on current guidelines. I ask all my secretaries to read this so they can communicate the importance of high blood pressure to my patients. JNC 8 will be out soon.Then: get (and study) the Hypertension Primer from americanheart.org. This is the most up-to-date compendium of what is known about high blood pressure and what every Dr. should know when they graduate from Medical School. Every chapter is only 2-3 pages. Read one chapter every week-night and you will finish it in about a year. I am working

on a reading guide for lay people for the Primer. Stay

tuned.13. Ask us questions: Ask any questions about high blood pressure you want answered. That is what we are here for. We have had this site for 10 years and over 30,000 emails are searchable. This is the largest collection of communications about Conn's Syndrome in the World. 14. One-on-one Consulting: I can provide individual consulting if you do not want to go public. If you want individual one-on-one consulting for you and your Doctor contract me directly at lowerbp2@....May your pressure be low!Clarence E. Grim BS, MS, MD, FACP, FACC, FAHABoard Certified in Internal Medicine, Geriatrics, and High Blood Pressure Retired Faculty/Professor of Medicine (U of MO, Indiana, UCLA/DREW, Medical College of Wisconsin and Cardiology, Endocrinology, Nephrology, and

Epidemiology. Specializing in Primary Aldosteronism and Difficult to Control

High Blood Pressure. I'm going in on Thursday for the following test: basic panel and serum aldosterone.Shouldn't there be a urine test? Are these

test a waste of my time if I want real answers to why I have high aldosterone.What would be the ideal test? Please help I am feeling pressured for time! Thank youSent from my iPadOn Nov 1, 2010, at 8:02 PM, Clarence Grim

wrote: Not that I know of or can make a connection to in my wildest Endocrine/Heme thoughs. But then another reason we need a good data base.Do you do data bases?CE Grim,MDIs there any connection between high aldosterone and low ferritin?Sent from my iPad If your BP and K is normal you may not need to DASH.Runners may have aldo if it was collected after a run.Drink when you are thirsty. A low Na suggests you are drinking too much.CE Grim MDCould I get some input on water intake? I tried searching the web-site about dashing but couldn't find what I was looking for.I know are bodies are constantly trying to keep things in balance so I feel like h2o consumption is just as important as sodium intake. However, I don't think I can assume the average 8 cups a day will be my norm.Here are a few things that I think might influence my sodium/h20 consumption: I have lowish serum sodium 138 (135-145), I have low blood pressure110/65, high aldosterone (24 hr urine 54.3 ( 17-44) and I am active ( runner)I feel it is reasonable that I keep my sodium intake at the higher end of the Dashing Diet , because of low sodium and low blood pressure and activity level, but I also want

to try and lower aldosterone naturally ( if possible) and I'm hoping maybe it's a matter of the right amount of daily water and sodium consumption. Are there any right ratios for this? For example, if you consume 1,500 mg of sodium you should have 8 cups of h2o or maybe if you consume 2,300 mg of sodium you should shoot for 10 cups of h2o?Thanks so much! Really trying to get it right!Sent from my iPad Keep us posted. so you have high renin and high aldo and low K and low BP?CE Grim MDHi Dr. Grim, The following post grabbed my attention. I started following you and this site when I was thought to have primary hyperaldosteronism. I had all the expected abnormal lab results except for low to normal blood pressure. Eventually, labaratory results confirmed Bartters Syndrome and now I follow both yahoo groups. > > >>>>>>>>>> > > >>>>>>>>>>> > > >>>>>>>>>>> Hi everyone, just joined today.

Thanks to all of you for this support!> > >>>>>>>>>>> > > >>>>>>>>>>> I tested high for aldosterone two years ago through a urine test. My ND at the time was not concerned, he thought it was due to the fact that I was a runner. I also thought that made since and was also following a low salt diet. So we ignored it.> > >>>>>>>>>>> > > >>>>>>>>>>> I am treAting a thyroid issue, thyroid hormone resistance, and through recent blood work tested high for aldosterone again. This time I decided not to ignore it! > > >>>>>>>>>>> > >

>>>>>>>>>>> I do not have a high blood pressure. It runs pretty normal to low. I don't have issues with potassium. This is all Very confusing as to why I have high aldosterone.> > >>>>>>>>>>> > > >>>>>>>>>>> I am trying to get into a endocrinologist but will take about three months. I need some education and advise on where to start.> > >>>>>>>>>>> > > >>>>>>>>>>> I don't even know if this is primary or secondary.> > >>>>>>>>>>> > > >>>>>>>>>>> My only real "health" issue, that I know about, has been hair loss. This was one

reason for exploring the thyroid but I am wondering if it has been the aldosterone all along. Maybe the aldosterone is what's causing my thyroid issues.> > >>>>>>>>>>> > > >>>>>>>>>>> Any comments or advice would be greatly appreciated.> > >>>>>>>>>>> > > >>>>>>>>>>> My labs:> > >>>>>>>>>>> > > >>>>>>>>>>> 9/26/2008> > >>>>>>>>>>> Aldosterone (urine)> > >>>>>>>>>>> High 54.3. (normal diet 6-25, low salt 17-44, high salt0-6)> >

>>>>>>>>>>> > > >>>>>>>>>>> Other adrenal hormones were fine at that time. Cortisol was pretty middle of the road. *Progesterone however was really high too. I can post if necessary.> > >>>>>>>>>>> > > >>>>>>>>>>> Rbc potassium 7/14/2010> > >>>>>>>>>>> 97. (90-111)> > >>>>>>>>>>> > > >>>>>>>>>>> Blood aldosterone 7/18/2010> > >>>>>>>>>>> 52.0. (1-16)> > >>>>>>>>>>> > >

>>>>>>>>>>> Blood aldosterone/renin 6/30/2010> > >>>>>>>>>>> Aldosterone 49. (1-16)> > >>>>>>>>>>> Renin. 3.3. (random ambulatory 0.8-2.5, non ambulatory 1.5-5.2)> > >>>>>>>>>>> I was sitting, fasting, taking two hours after waking before/around 8am> > >>>>>>>>>>> > > >>>>>>>>>>> Aldosterone renin ratio = 15> > >>>>>>>>>>> > > >>>>>>>>>>> Sodium. 138. (135-145)> > >>>>>>>>>>> Potassium. 4.5. (3.5-5.3)> > >>>>>>>>>>> Chloride. 106. (98-109)>

> >>>>>>>>>>> Co2. 23. (22-31)> > >>>>>>>>>>> Anion gap. 9. (5-16)> > >>>>>>>>>>> > > >>>>>>>>>>> Saliva cortisol 5/23/2010> > >>>>>>>>>>> 7am. 3.7. (3.7-9.5)> > >>>>>>>>>>> 11am. 1.6. (1.2-3.0)> > >>>>>>>>>>> 5pm. 1.3. (0.6-1.9)> > >>>>>>>>>>> 9pm. 0.5. (0.4-1.0)> > >>>>>>>>>>> > > >>>>>>>>>>> Rbc magnesium 5/26/2010> > >>>>>>>>>>> 4.2. (4.0-6.4)> >

>>>>>>>>>>> > > >>>>>>>>>>> Lot of test!!!!> > >>>>>>>>>>> > > >>>>>>>>>>> Thanks again for your kind support! Suzanne> > >>>>>>>>>>> > > >>>>>>>>>>> > > >>>>>>>>>> > > >>>>>>>>> > > >>>>>>>>> > > >>>>>>>> > > >>>>>>>> > > >>>>>>> > > >>>>>>> > > >>>>>> > > >>>>>> > > >>>>> > > >>>>> > > >>>> > > >>>> > > >>> > > >>> > > >> > > > > > >> >> > > Reply to sender |>

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I did but I still have to eat and pay rent and heat and lights and eat and am semi-retired. I suppose you and your husband share your skills and knowledge for free to the world.I have been doing this site for 10 years. so if you search thru our site's 30,000+ messages(which are searchable BTW) you can find the answer to almost anything.My guess is tapping into my knowledge base would have saved you lots of time and money but one usually gets what you pay for.So lets say I answer 500 of your questions over the next year. Is that not worth something? Or you can put them on here and I will answer them when I have time. To explain the creatinine issue for example will take an hour of my time to do it rigSince I only have a limited number of hours left in my life that means I am giving you a part of my life. I don't do that as much as I used to for free.CE Grim MDYOU KNOW DR. GRIM I HAVE SPENT THE LAST FOUR YEARS OF MY LIFE DEDICATED TO READING ABOUT ALL TYPES OF HEALTH ISSUES, MOSTLY THYROID, IRON, AND HORMONES, BECAUSE TIME AND TIME AGAIN DOCTORS HAVE FAILED ME! EVERYTIME I HAD A QUESTION LIKE THIS NO ONE COULD OR WOULD ANSWER THEM. SO I SPEND A LOT OF TIME RESEARCHING AND FINDING MY OWN ANSWERS WHILE STILL PAYING DOCTORS IN HOPES SOMEONE WILL HELP. SADLY, AFTER MUCH TIME I AM THE ONE WHO HAS TO FIND MY OWN ANSWERS BUT SOMEHOW STILL END UP PAYING DOCTORS TO TELL ME NOTHING. I DON'T WANT TO WASTE ANOTHER YEAR OF MY LIFE READING WHAT DOCTORS SHOULD HAVE ALREADY TOLD ME! I HAVE BEEN THROUGH AT LEAST 7 DOCTORS AND THOUSANDS AND THOUSANDS OF DOLLARS. I HAVE GIVEN UP SO MUCH OF MY LIFE, AND TIME WITH MY FAMILY BECAUSE DOCTORS DIDN'T CARE ENOUGH OR KNOW ENOUGH TO HELP ME. I THOUGHT THIS SUPPORT GROUP WAS DIFFERENT! CAN YOU NOT UNDERSTAND THE FRUSTRATION THIS SITUATION CAUSES???ARE THERE ANY DOCTORS LEFT WHO WENT TO MEDICAL SCHOOL BECAUSE THEY ACTUALLY HAD A DESIRE TO HELP PEOPLE, OR ARE THEY ALL JUST OUT TO MAKE MONEY?SUZANNE Sent from my iPad Support for common questions. Or you can order the AHA HYPERTENSION PRIMER and read one chapter a night each week night and after a year or so you will know all the answers to your questions.FYI the spot urine cr con tells you nothing about kidney problems. If it was tome and u had the volume it might. It mostly tells us how much fluid you were drinking. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension so what's the support group for?Sent from my iPad Once again this is what I get paid for. Contact me at lowerbp2@... for details of accessing my expertise for a year for only $500.CE Grim MDThanks!!Would you mind explaining the difference between the creatinine random urine and the creatinine quantitative urine? I am concerned that my creat. rand is low meaning kidney trouble.I have been sitting here "researching" this for an hour or so and can't find an explanation.I won't been able to see my doctor until the end of this month and even then I don't think she is well educated in this area.I really wanted to rule out any kidney issues before December 28th.Thanks for your time and input! SuzanneSent from my iPad I assume your Dr. gets paid for doing this sort of interpretation.I can do it one on one for a fee. They all look good to me.CE Grim MDI have some test results back that are worrying me. I don't have all the results so I will post them as I get them. Right now I am concerned with what my creatinine levels mean. Please help!!!Blood creatinineCREAT 0.77 (0.44-1.00)BUN 14 (6-20)urine creatinine (there were two results for this)CREAT,RAND UR 40.86 L (80.00-170 mg./dl)CREAT, UR QUANT 1.0 (0.6-1.8 gm./dy)Should I be worried about the low CREAT, RAND UR?????THANKS, SUZANNESent from my iPad It varies. Do a pubmed.CE Grim MDWhat significance does our menstrual cycle play in blood pressure?During my luteal phase my blood pressure ranges from 115/65 to 120/75 but then once menses begins i run a lot lower 90/60.I am in the process of doing the 24 hour urine. should have those numbers in a few days.thanks,suzanneSent from my iPad Yea but you usually are an alcoholic who does not each much or cancer pt who cannot eat and is starving. CE Grim MDI have read that a magnesium deficiency can cause low K.Sent from my iPad Better to DASH I would think.If you can get it in food why take a pill?CE Grim MDare you serious? I am asking if I should take a b vitamin supplement?Sent from my iPad Still no question?CE Grim MD Was there a question here?Hi Dr. Grim,Is it recommended to take a b-complex vitamin?I have been holding off from taking mine (complete b-complex from life extension) because i am afraid it might encourage more aldosterone production! Am I crazy for worrying about this? I know the adrenals love b vitamins and I don't need anything that will cause me to produce more aldosterone. However, I know for a woman of my age and activity level that the b's are very important and could really benefit my body!!Thanks, SuzanneSent from my iPad They are all competitors for the receptors but I do not know the measures of association that permits one to quantitate the relative effect of aldo in occupying each of the receptors. Also they circulate in much greater quantities that aldo as I recall. So the effect would seem likely to be weak.CE Grim MD Hi Dr. Grim, I wanted to ask if high aldosterone levels will block progesterone, testosterone, and estrogen receptors? Thanks, SuzanneTo: hyperaldosteronism Cc: Clarence Grim Sent: Sun, November 7, 2010 7:36:01 PMSubject: Re: Re: 42 yo woman runner who has had aldo 52 and renin 3.3 normal bp That's what this paper says. No one has looked at in anymore detail that I can find.CE Grim MDOk, by doing this it will be ok to test any time of my cycle?Sent from my iPad Ask your lab to use plasma renin activity not direct renin assay.CE Grim MDThis is the article I did read. I didn't feel like it gave a definitive answer. I have read it is best to test aldosterone on the third day of the menstrual cycle but not sure how that will go seeing it is a urine test and not a simple blood draw. Any advice would be greatly appreciated. ThanksSent from my iPad Guess you did not search aldosterone renin ratio.Here is one.J Clin Endocrinol Metab. 2010 Oct 20. [Epub ahead of print]Are Women More at Risk of False-Positive Primary Aldosteronism Screening and Unnecessary Suppression Testing than Men?Ahmed AH, Gordon RD, PJ, Ward G, Pimenta E, Stowasser M.Endocrine Hypertension Research Centre (A.H.A., R.D.G., P.J.T., E.P., M.S.), University of Queensland School of Medicine, Greenslopes and Princess andra Hospitals, Brisbane, Queensland 4102, Australia; and Sullivan and Nicolaides Pathology (G.W.), Brisbane, 4068 Queensland, Australia.AbstractBackground: Because primary aldosteronism is not uncommon, specifically treatable and in some cases curable, and carries higher risks for cardiovascular morbidity and mortality than essential hypertension, screening hypertensive patients for its presence by measuring aldosterone to renin ratio (ARR) is increasingly common. A significantly higher false-positive ARR rate for women than men, resulting in unnecessary suppression tests has previously been reported. Methods: Using a new, highly accurate aldosterone assay and both of the currently widely used renin assays, ARR was measured in 19 normal, ovulating women at three time points in the menstrual cycle and compared with single measurements in 21 normal males of similar age. Results: ARRs in males were possibly too well down in the current normal range. Although normotensive and normokalemic, two women had raised ARRs in the luteal phase but only when direct renin concentration (DRC) was used. Their DRC levels were low at all sampling times [despite midrange plasma renin activity levels], whereas their progesterone and aldosterone levels were highest for the group. Saline suppression testing, performed in one of them, showed normal aldosterone suppressibility. Conclusion: False-positive ARRs in normal women during the luteal phase only when DRC is used may explain the higher incidence of false-positive ARRs in hypertensive women than men and suggest the following: 1) plasma renin activity is preferable to DRC in determination of ARR and 2) new reference ranges for ARR that take into account gender and sex hormone levels are required.Thanks, I did do some reading on pubmed like you suggested about testing and menses but never came up with an answer. Hoping you had the answer. I know aldosterone is naturally higher during the luteal phase but I only want to do this once and I want to get it exactly right . Sent from my iPad I think I sent an abstract recently on menses and testing. If you cant find it let me know.Dr. Grim's Perfect Primary Aldosteronism Blood and Urine Testing to diagnose PA in one day. 1. Eat a regular to high salt diet for 2 weeks.2. No BP meds in last 4-12 weeks depending on meds.3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do not lose a drop of this liquid gold. It is impossible to interpret the renin and aldo without this.4. The morning you finish the 24 hr urine have fasting blood drawn for renin, aldo and K using our guidelines to get an accurate K. Try to get this done about 4 hours after you have been out of bed.5. Send us the results with the normal values for your lab.6. If you ever have a salt (saline) infusion test for PA be certain to ask them to measure how much you pee during the 4 hours of the infusion. If it is 1-1.5 liter of urine it strongly suggests that you may have PA. If more tha 1.5 L you almost certainly have PA. Hi, I am calling my Natural Path tomorrow to have her order test to see if we can figure out why I have high alodsterone. Here are the test I am requesting: (PLEASE LET ME KNOW IF I AM MISSING SOMETHING) -24 hour urine NA, K, Creatinine, Aldosterone -blood draw Renin, Aldosterone, and K Anything else????Also where can I get the info on how to collect K correctly?See our files on how to draw blood.One last question, when during my menstrual cycle is the best time to do these test?'see a recent email re this issue.Thanks so much for you time, SuzanneTo: hyperaldosteronism Cc: Clarence Grim Sent: Fri, November 5, 2010 7:04:29 AMSubject: Re: Re: 42 yo woman runner who has had aldo 52 and renin 3.3 normal bp your team is who you have decided you want to manage your health. Can a Natural Path write prescriptions and order blood tests?CE Grim MDWhat if I don't have a team? Or do you consider a Natural Path my team?Sent from my iPad yes I can work with your team for $500 per year.CE Grim MDHi Dr Grim , I agree I am afraid I am going to make this 400 mile trip and get nowhere! I don't have a dr other than a Natural Path. Can you be my dr and take care of all of this online?Sent from my iPad she does not seem to understand PA as she did not order a renin.CE Grim MDSend her my article on the evolution of PA and the Endo guidelines in our files---BEFORE you see her. You want to know how many PAs she has treated and followed for at least 10 years.CE Grim MDThanks for the info. I am so frustrated with dr's in my area. It seems NO one knows the correct test around here! My natural path is very willing to order the test but she's the first one to admit that she won't know what to do with the results.I live in Whitefish, Montana and Kalispell is about 15 minutes away. Missoula is about 200 miles but I would drive it if someone could make a recommendation ( preferably first hand experience). I am doing Dr. grimes ideal test in December and then at the end of December I am scheduled to see an endocrinologist in Missoula. I don't have faith that the endo knows much about hyperaldosteronism but at this point she is my only hope. This endo's name is Dr. Eyler. She has ordered the following test ( which I don't believe are ideal): hypothyroid panel, comprehensive metabolic panel, vitamin d, hemogram, LH, FSH, 24 hr urine aldosterone.Any comments or feedback would be so appreciated! Thanks, SuzanneSent from my iPad See Dr Grim's ideal test.You cannot interpret the aldo/renin ratio without having a 24 hr urine Na. But maybe your health care team knows how to do this. If so they need to let us know.CE GrimMDWelcome to the exciting world of Hyperaldosteronism! You are in the right place! I am Dr. CE Grim a retired Professor of Medicine and Endocrinology. I have a long standing interest is Primary Aldosteronism since medical school days when I saw my first patient with Primary Aldosteronism in 1963. I trained with Dr. Conn in Endocrinology and Metabolism 1969-70 and have published over 240 papers and book chapters in most areas of the broad discipline of High Blood Pressure. My CV is in our files for details. The goal of our group is to teach you and your health care team about the ins and outs of the causes, diagnosis and control of the many forms of hyperaldosteronism. The steps below will introduce you into the fascinating world of high blood pressure, salt and potassium and the role of the adrenal hormone aldosterone in health and disease. Doing these in sequence will save you time and effort in getting up to speed in taking control of you health and educating your own health care team. While we can’t make you a doctor we will make you into a pretty good BP doctor-a skill that you will have for life. 1. A brief history of Primary Aldosteronsim and why it is so common today in drug resistant high blood pressure. Read my article in our files on the evolution of PA (Evolution_of_PA-Grim.pdf ) and take to all members of health care team. Tell us what stage you believe you are in. This is a brief review of most causes of hyperaldosteronism, high blood pressure, low potassium (K). 2. Read about other patients with hyperaldosteronism (Conn’s syndrome). Read our Conn's stories in our files and then give us your own in as much detail as you can. Dr. Conn was the first to describe this disease process and the syndrome is named after him.To see others' stories, on the Hyperaldosteronism home page, go to Files/Conn’s Stories. You'll find instructions in "A - How to put your story here.doc " First send us your story in an email and they we may have questions and suggestions before you upload it to our files. 3. DASH to lower your BP. Your and my tax dollars funded the most important series of studies on how to improve blood pressure, blood sugar, blood lipids and make your heart smaller: The DASH Eating Plan to control high blood pressure due to hyperaldosteronism and most others with high blood pressure. This will reduce your need for medications and in many will get your BP and K to goal without meds.. Get the DASH diet book by T. et al, (http://www.amazon.com/DASH-Diet-Hypertension--/dp/0743202953) read it and use it: ~$8 in paperback at your local bookstore or online. If they don’t have it ask them to order it for you. You can also get the hardback larger print version as well at Amazon. Learning to eat the DASH way will play a major role in your road to good BP and K control and, in many of our folks here, will revolutionize your life. See http://en.wikipedia.org/wiki/DASH_diet for an overview and more details. In the book go to chapter 9 and do the 14 day challenge. Tell your Dr you are doing this as your BP may plummet if you are on other meds. Measure your BP every day and post to us. or go to http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf download this 64 page booklet free and do the Week on the DASH Diet for 2 weeks. If you are on BP meds be prepared for a large fall in BP (20/10 mm Hg or more) and let your Dr. know you are doing this. And/Or go to (but costs money monthly) DASH Diet for Health Program (http://www.dashforhealth.com/pages/public/tour.php)The DASH Diet for Health Program is designed to help you improve your eating and exercise habits. Twice each week they will provide you with information on our website about food, food preparation, eating out, losing weight, getting fit and much more. In addition to providing new information each week on the website, they create a web page specially for you where you can track progress in areas such as your weight, blood pressure, and exercise. I strongly recommend you get this book and read it. 4. Measure your BP: Measure your BP daily so you can see if it is getting better. If you are taking meds be sure to tell your health care team you are doing this as your BP may plummet to normal quickly. We recommend you use a device you listen to and will help you learn how to do this. If this is not something you want to do we can teach a significant other how to do it. See sharedcareinc.com or email to sharedcare@... to order a video on how to do this. If you already have one we will teach you how to teach your health care team how to validate your device. Your life and health depends on accurate BP measurements. Go to the amricanheart.org and download the Guidelines for Human Blood Pressure Measurement. Insist the your health care team do BP the AHA way. Never trust your life to an automatic BP machine unless you know it is accurate on YOU. 5. Genetics and your BP: Go to familyhistory.hhs.gov and do your detailed family medical history so we can review with you to help Dx familial causes of high blood pressure and heart disease. If BP runs in your family you may save lives in your family by checking their BP yourself. 6. How to DX and treat PA: Go to our file/Conn's Articles of Note/Medications/Bravo spir 1973.pdf and read this article and take to your health care team. It is old but still one of the best in the medical management of PA. Also see our file from the Endocrine Society Guidelines on PA. Dr. Grim's Perfect Primary Aldosteronism Blood and Urine Testing to diagnose PA in one day. 1. Eat a regular to high salt diet for 2 weeks.2. No BP meds in last 4-12 weeks depending on meds.3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do not lose a drop of this liquid gold. It is impossible to interpret the renin and aldo without this.4. The morning you finish the 24 hr urine have fasting blood drawn for renin, aldo and K using our guidelines to get an accurate K. Try to get this done about 4 hours after you have been out of bed.5. Send us the results with the normal values for your lab.6. If you ever have a salt (saline) infusion test for PA be certain to ask them to measure how much you pee during the 4 hours of the infusion. If it is 1-1.5 liter of urine it strongly suggests that you may have PA. If more tha 1.5 L you almost certainly have PA. 8. Become a participant in our PA Registry and contribute to our large database on PA: If you have been Dxed with PA already and are on Rx or have had surgery please go to http://www.kwiksurveys.com/online-survey.php?surveyID=HIJIO_f2685379 and complete our survey with as much information as you know. If there is some information you don't know ask us and we will help. If you need to update this as you journey thru the diagnostic/treatment process you can add another entry but label it as Nameyymmdd. For example today 6/12/09 for me would be Grim090612. This ever increasing number will allow us and you to sort your multiple entries into a dated order. 9. Learn the language: If you are new to medical lingo then download the acroyms from http://health.groups.yahoo.com/group/bloodpressureline/message/2918610. Salt and high blood pressure: To learn the state of the science of salt and blood pressure please spend some time looking at http://www.worldactiononsalt.com/evidence/treatment_trials.htm11. Become a HBP expert consumer: Expect that it will take at least several weeks to get all this digested and to learn the new language of high blood pressure health care. As most doctors and nurses in practice have had very little training in high blood pressure you must become an expert yourself. For example most have never had anyone listen with them with a double stethoscope to verify that they can hear BP sounds. We cannot make you a doctor but we will make you a pretty good BP doctor.12. How High Blood Pressure should be managed: Go to nih.gov and download and read the Joint National Commission (JNC) Report 7 to get an overview on current guidelines. I ask all my secretaries to read this so they can communicate the importance of high blood pressure to my patients. JNC 8 will be out soon.Then: get (and study) the Hypertension Primer from americanheart.org. This is the most up-to-date compendium of what is known about high blood pressure and what every Dr. should know when they graduate from Medical School. Every chapter is only 2-3 pages. Read one chapter every week-night and you will finish it in about a year. I am working on a reading guide for lay people for the Primer. Stay tuned.13. Ask us questions: Ask any questions about high blood pressure you want answered. That is what we are here for. We have had this site for 10 years and over 30,000 emails are searchable. This is the largest collection of communications about Conn's Syndrome in the World. 14. One-on-one Consulting: I can provide individual consulting if you do not want to go public. If you want individual one-on-one consulting for you and your Doctor contract me directly at lowerbp2@....May your pressure be low!Clarence E. Grim BS, MS, MD, FACP, FACC, FAHABoard Certified in Internal Medicine, Geriatrics, and High Blood Pressure Retired Faculty/Professor of Medicine (U of MO, Indiana, UCLA/DREW, Medical College of Wisconsin and Cardiology, Endocrinology, Nephrology, and Epidemiology. Specializing in Primary Aldosteronism and Difficult to Control High Blood Pressure. I'm going in on Thursday for the following test: basic panel and serum aldosterone.Shouldn't there be a urine test? Are these test a waste of my time if I want real answers to why I have high aldosterone.What would be the ideal test? Please help I am feeling pressured for time! Thank youSent from my iPad Not that I know of or can make a connection to in my wildest Endocrine/Heme thoughs. But then another reason we need a good data base.Do you do data bases?CE Grim,MDIs there any connection between high aldosterone and low ferritin?Sent from my iPad If your BP and K is normal you may not need to DASH.Runners may have aldo if it was collected after a run.Drink when you are thirsty. A low Na suggests you are drinking too much.CE Grim MDCould I get some input on water intake? I tried searching the web-site about dashing but couldn't find what I was looking for.I know are bodies are constantly trying to keep things in balance so I feel like h2o consumption is just as important as sodium intake. However, I don't think I can assume the average 8 cups a day will be my norm.Here are a few things that I think might influence my sodium/h20 consumption: I have lowish serum sodium 138 (135-145), I have low blood pressure110/65, high aldosterone (24 hr urine 54.3 ( 17-44) and I am active ( runner)I feel it is reasonable that I keep my sodium intake at the higher end of the Dashing Diet , because of low sodium and low blood pressure and activity level, but I also want to try and lower aldosterone naturally ( if possible) and I'm hoping maybe it's a matter of the right amount of daily water and sodium consumption. Are there any right ratios for this? For example, if you consume 1,500 mg of sodium you should have 8 cups of h2o or maybe if you consume 2,300 mg of sodium you should shoot for 10 cups of h2o?Thanks so much! Really trying to get it right!Sent from my iPad Keep us posted. so you have high renin and high aldo and low K and low BP?CE Grim MDHi Dr. Grim, The following post grabbed my attention. I started following you and this site when I was thought to have primary hyperaldosteronism. I had all the expected abnormal lab results except for low to normal blood pressure. Eventually, labaratory results confirmed Bartters Syndrome and now I follow both yahoo groups. > > >>>>>>>>>> > > >>>>>>>>>>> > > >>>>>>>>>>> Hi everyone, just joined today. Thanks to all of you for this support!> > >>>>>>>>>>> > > >>>>>>>>>>> I tested high for aldosterone two years ago through a urine test. My ND at the time was not concerned, he thought it was due to the fact that I was a runner. I also thought that made since and was also following a low salt diet. So we ignored it.> > >>>>>>>>>>> > > >>>>>>>>>>> I am treAting a thyroid issue, thyroid hormone resistance, and through recent blood work tested high for aldosterone again. This time I decided not to ignore it! > > >>>>>>>>>>> > > >>>>>>>>>>> I do not have a high blood pressure. It runs pretty normal to low. I don't have issues with potassium. This is all Very confusing as to why I have high aldosterone.> > >>>>>>>>>>> > > >>>>>>>>>>> I am trying to get into a endocrinologist but will take about three months. I need some education and advise on where to start.> > >>>>>>>>>>> > > >>>>>>>>>>> I don't even know if this is primary or secondary.> > >>>>>>>>>>> > > >>>>>>>>>>> My only real "health" issue, that I know about, has been hair loss. This was one reason for exploring the thyroid but I am wondering if it has been the aldosterone all along. Maybe the aldosterone is what's causing my thyroid issues.> > >>>>>>>>>>> > > >>>>>>>>>>> Any comments or advice would be greatly appreciated.> > >>>>>>>>>>> > > >>>>>>>>>>> My labs:> > >>>>>>>>>>> > > >>>>>>>>>>> 9/26/2008> > >>>>>>>>>>> Aldosterone (urine)> > >>>>>>>>>>> High 54.3. (normal diet 6-25, low salt 17-44, high salt0-6)> > >>>>>>>>>>> > > >>>>>>>>>>> Other adrenal hormones were fine at that time. Cortisol was pretty middle of the road. *Progesterone however was really high too. I can post if necessary.> > >>>>>>>>>>> > > >>>>>>>>>>> Rbc potassium 7/14/2010> > >>>>>>>>>>> 97. (90-111)> > >>>>>>>>>>> > > >>>>>>>>>>> Blood aldosterone 7/18/2010> > >>>>>>>>>>> 52.0. (1-16)> > >>>>>>>>>>> > > >>>>>>>>>>> Blood aldosterone/renin 6/30/2010> > >>>>>>>>>>> Aldosterone 49. (1-16)> > >>>>>>>>>>> Renin. 3.3. (random ambulatory 0.8-2.5, non ambulatory 1.5-5.2)> > >>>>>>>>>>> I was sitting, fasting, taking two hours after waking before/around 8am> > >>>>>>>>>>> > > >>>>>>>>>>> Aldosterone renin ratio = 15> > >>>>>>>>>>> > > >>>>>>>>>>> Sodium. 138. (135-145)> > >>>>>>>>>>> Potassium. 4.5. (3.5-5.3)> > >>>>>>>>>>> Chloride. 106. (98-109)> > >>>>>>>>>>> Co2. 23. (22-31)> > >>>>>>>>>>> Anion gap. 9. (5-16)> > >>>>>>>>>>> > > >>>>>>>>>>> Saliva cortisol 5/23/2010> > >>>>>>>>>>> 7am. 3.7. (3.7-9.5)> > >>>>>>>>>>> 11am. 1.6. (1.2-3.0)> > >>>>>>>>>>> 5pm. 1.3. (0.6-1.9)> > >>>>>>>>>>> 9pm. 0.5. (0.4-1.0)> > >>>>>>>>>>> > > >>>>>>>>>>> Rbc magnesium 5/26/2010> > >>>>>>>>>>> 4.2. (4.0-6.4)> > >>>>>>>>>>> > > >>>>>>>>>>> Lot of test!!!!> > >>>>>>>>>>> > > >>>>>>>>>>> Thanks again for your kind support! Suzanne> > >>>>>>>>>>> > > >>>>>>>>>>> > > >>>>>>>>>> > > >>>>>>>>> > > >>>>>>>>> > > >>>>>>>> > > >>>>>>>> > > >>>>>>> > > >>>>>>> > > >>>>>> > > >>>>>> > > >>>>> > > >>>>> > > >>>> > > >>>> > > >>> > > >>> > > >> > > > > > >> >> > > Reply to sender |>

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Yes and many hundreds (likely thousands) have been answered here by me and a few others.WHAT IS CONSIDERED A "COMMON" QUESTION? WOULD LABS NOT BE SOMETHING WE ALL HAVE IN COMMON?Sent from my iPad Support for common questions. Or you can order the AHA HYPERTENSION PRIMER and read one chapter a night each week night and after a year or so you will know all the answers to your questions.FYI the spot urine cr con tells you nothing about kidney problems. If it was tome and u had the volume it might. It mostly tells us how much fluid you were drinking. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension so what's the support group for?Sent from my iPad Once again this is what I get paid for. Contact me at lowerbp2@... for details of accessing my expertise for a year for only $500.CE Grim MDThanks!!Would you mind explaining the difference between the creatinine random urine and the creatinine quantitative urine? I am concerned that my creat. rand is low meaning kidney trouble.I have been sitting here "researching" this for an hour or so and can't find an explanation.I won't been able to see my doctor until the end of this month and even then I don't think she is well educated in this area.I really wanted to rule out any kidney issues before December 28th.Thanks for your time and input! SuzanneSent from my iPad I assume your Dr. gets paid for doing this sort of interpretation.I can do it one on one for a fee. They all look good to me.CE Grim MDI have some test results back that are worrying me. I don't have all the results so I will post them as I get them. Right now I am concerned with what my creatinine levels mean. Please help!!!Blood creatinineCREAT 0.77 (0.44-1.00)BUN 14 (6-20)urine creatinine (there were two results for this)CREAT,RAND UR 40.86 L (80.00-170 mg./dl)CREAT, UR QUANT 1.0 (0.6-1.8 gm./dy)Should I be worried about the low CREAT, RAND UR?????THANKS, SUZANNESent from my iPad It varies. Do a pubmed.CE Grim MDWhat significance does our menstrual cycle play in blood pressure?During my luteal phase my blood pressure ranges from 115/65 to 120/75 but then once menses begins i run a lot lower 90/60.I am in the process of doing the 24 hour urine. should have those numbers in a few days.thanks,suzanneSent from my iPad Yea but you usually are an alcoholic who does not each much or cancer pt who cannot eat and is starving. CE Grim MDI have read that a magnesium deficiency can cause low K.Sent from my iPad Better to DASH I would think.If you can get it in food why take a pill?CE Grim MDare you serious? I am asking if I should take a b vitamin supplement?Sent from my iPad Still no question?CE Grim MD Was there a question here?Hi Dr. Grim,Is it recommended to take a b-complex vitamin?I have been holding off from taking mine (complete b-complex from life extension) because i am afraid it might encourage more aldosterone production! Am I crazy for worrying about this? I know the adrenals love b vitamins and I don't need anything that will cause me to produce more aldosterone. However, I know for a woman of my age and activity level that the b's are very important and could really benefit my body!!Thanks, SuzanneSent from my iPad They are all competitors for the receptors but I do not know the measures of association that permits one to quantitate the relative effect of aldo in occupying each of the receptors. Also they circulate in much greater quantities that aldo as I recall. So the effect would seem likely to be weak.CE Grim MD Hi Dr. Grim, I wanted to ask if high aldosterone levels will block progesterone, testosterone, and estrogen receptors? Thanks, SuzanneTo: hyperaldosteronism Cc: Clarence Grim Sent: Sun, November 7, 2010 7:36:01 PMSubject: Re: Re: 42 yo woman runner who has had aldo 52 and renin 3.3 normal bp That's what this paper says. No one has looked at in anymore detail that I can find.CE Grim MDOk, by doing this it will be ok to test any time of my cycle?Sent from my iPad Ask your lab to use plasma renin activity not direct renin assay.CE Grim MDThis is the article I did read. I didn't feel like it gave a definitive answer. I have read it is best to test aldosterone on the third day of the menstrual cycle but not sure how that will go seeing it is a urine test and not a simple blood draw. Any advice would be greatly appreciated. ThanksSent from my iPad Guess you did not search aldosterone renin ratio.Here is one.J Clin Endocrinol Metab. 2010 Oct 20. [Epub ahead of print]Are Women More at Risk of False-Positive Primary Aldosteronism Screening and Unnecessary Suppression Testing than Men?Ahmed AH, Gordon RD, PJ, Ward G, Pimenta E, Stowasser M.Endocrine Hypertension Research Centre (A.H.A., R.D.G., P.J.T., E.P., M.S.), University of Queensland School of Medicine, Greenslopes and Princess andra Hospitals, Brisbane, Queensland 4102, Australia; and Sullivan and Nicolaides Pathology (G.W.), Brisbane, 4068 Queensland, Australia.AbstractBackground: Because primary aldosteronism is not uncommon, specifically treatable and in some cases curable, and carries higher risks for cardiovascular morbidity and mortality than essential hypertension, screening hypertensive patients for its presence by measuring aldosterone to renin ratio (ARR) is increasingly common. A significantly higher false-positive ARR rate for women than men, resulting in unnecessary suppression tests has previously been reported. Methods: Using a new, highly accurate aldosterone assay and both of the currently widely used renin assays, ARR was measured in 19 normal, ovulating women at three time points in the menstrual cycle and compared with single measurements in 21 normal males of similar age. Results: ARRs in males were possibly too well down in the current normal range. Although normotensive and normokalemic, two women had raised ARRs in the luteal phase but only when direct renin concentration (DRC) was used. Their DRC levels were low at all sampling times [despite midrange plasma renin activity levels], whereas their progesterone and aldosterone levels were highest for the group. Saline suppression testing, performed in one of them, showed normal aldosterone suppressibility. Conclusion: False-positive ARRs in normal women during the luteal phase only when DRC is used may explain the higher incidence of false-positive ARRs in hypertensive women than men and suggest the following: 1) plasma renin activity is preferable to DRC in determination of ARR and 2) new reference ranges for ARR that take into account gender and sex hormone levels are required.Thanks, I did do some reading on pubmed like you suggested about testing and menses but never came up with an answer. Hoping you had the answer. I know aldosterone is naturally higher during the luteal phase but I only want to do this once and I want to get it exactly right . Sent from my iPad I think I sent an abstract recently on menses and testing. If you cant find it let me know.Dr. Grim's Perfect Primary Aldosteronism Blood and Urine Testing to diagnose PA in one day. 1. Eat a regular to high salt diet for 2 weeks.2. No BP meds in last 4-12 weeks depending on meds.3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do not lose a drop of this liquid gold. It is impossible to interpret the renin and aldo without this.4. The morning you finish the 24 hr urine have fasting blood drawn for renin, aldo and K using our guidelines to get an accurate K. Try to get this done about 4 hours after you have been out of bed.5. Send us the results with the normal values for your lab.6. If you ever have a salt (saline) infusion test for PA be certain to ask them to measure how much you pee during the 4 hours of the infusion. If it is 1-1.5 liter of urine it strongly suggests that you may have PA. If more tha 1.5 L you almost certainly have PA. Hi, I am calling my Natural Path tomorrow to have her order test to see if we can figure out why I have high alodsterone. Here are the test I am requesting: (PLEASE LET ME KNOW IF I AM MISSING SOMETHING) -24 hour urine NA, K, Creatinine, Aldosterone -blood draw Renin, Aldosterone, and K Anything else????Also where can I get the info on how to collect K correctly?See our files on how to draw blood.One last question, when during my menstrual cycle is the best time to do these test?'see a recent email re this issue.Thanks so much for you time, SuzanneTo: hyperaldosteronism Cc: Clarence Grim Sent: Fri, November 5, 2010 7:04:29 AMSubject: Re: Re: 42 yo woman runner who has had aldo 52 and renin 3.3 normal bp your team is who you have decided you want to manage your health. Can a Natural Path write prescriptions and order blood tests?CE Grim MDWhat if I don't have a team? Or do you consider a Natural Path my team?Sent from my iPad yes I can work with your team for $500 per year.CE Grim MDHi Dr Grim , I agree I am afraid I am going to make this 400 mile trip and get nowhere! I don't have a dr other than a Natural Path. Can you be my dr and take care of all of this online?Sent from my iPad she does not seem to understand PA as she did not order a renin.CE Grim MDSend her my article on the evolution of PA and the Endo guidelines in our files---BEFORE you see her. You want to know how many PAs she has treated and followed for at least 10 years.CE Grim MDThanks for the info. I am so frustrated with dr's in my area. It seems NO one knows the correct test around here! My natural path is very willing to order the test but she's the first one to admit that she won't know what to do with the results.I live in Whitefish, Montana and Kalispell is about 15 minutes away. Missoula is about 200 miles but I would drive it if someone could make a recommendation ( preferably first hand experience). I am doing Dr. grimes ideal test in December and then at the end of December I am scheduled to see an endocrinologist in Missoula. I don't have faith that the endo knows much about hyperaldosteronism but at this point she is my only hope. This endo's name is Dr. Eyler. She has ordered the following test ( which I don't believe are ideal): hypothyroid panel, comprehensive metabolic panel, vitamin d, hemogram, LH, FSH, 24 hr urine aldosterone.Any comments or feedback would be so appreciated! Thanks, SuzanneSent from my iPad See Dr Grim's ideal test.You cannot interpret the aldo/renin ratio without having a 24 hr urine Na. But maybe your health care team knows how to do this. If so they need to let us know.CE GrimMDWelcome to the exciting world of Hyperaldosteronism! You are in the right place! I am Dr. CE Grim a retired Professor of Medicine and Endocrinology. I have a long standing interest is Primary Aldosteronism since medical school days when I saw my first patient with Primary Aldosteronism in 1963. I trained with Dr. Conn in Endocrinology and Metabolism 1969-70 and have published over 240 papers and book chapters in most areas of the broad discipline of High Blood Pressure. My CV is in our files for details. The goal of our group is to teach you and your health care team about the ins and outs of the causes, diagnosis and control of the many forms of hyperaldosteronism. The steps below will introduce you into the fascinating world of high blood pressure, salt and potassium and the role of the adrenal hormone aldosterone in health and disease. Doing these in sequence will save you time and effort in getting up to speed in taking control of you health and educating your own health care team. While we can’t make you a doctor we will make you into a pretty good BP doctor-a skill that you will have for life. 1. A brief history of Primary Aldosteronsim and why it is so common today in drug resistant high blood pressure. Read my article in our files on the evolution of PA (Evolution_of_PA-Grim.pdf ) and take to all members of health care team. Tell us what stage you believe you are in. This is a brief review of most causes of hyperaldosteronism, high blood pressure, low potassium (K). 2. Read about other patients with hyperaldosteronism (Conn’s syndrome). Read our Conn's stories in our files and then give us your own in as much detail as you can. Dr. Conn was the first to describe this disease process and the syndrome is named after him.To see others' stories, on the Hyperaldosteronism home page, go to Files/Conn’s Stories. You'll find instructions in "A - How to put your story here.doc " First send us your story in an email and they we may have questions and suggestions before you upload it to our files. 3. DASH to lower your BP. Your and my tax dollars funded the most important series of studies on how to improve blood pressure, blood sugar, blood lipids and make your heart smaller: The DASH Eating Plan to control high blood pressure due to hyperaldosteronism and most others with high blood pressure. This will reduce your need for medications and in many will get your BP and K to goal without meds.. Get the DASH diet book by T. et al, (http://www.amazon.com/DASH-Diet-Hypertension--/dp/0743202953) read it and use it: ~$8 in paperback at your local bookstore or online. If they don’t have it ask them to order it for you. You can also get the hardback larger print version as well at Amazon. Learning to eat the DASH way will play a major role in your road to good BP and K control and, in many of our folks here, will revolutionize your life. See http://en.wikipedia.org/wiki/DASH_diet for an overview and more details. In the book go to chapter 9 and do the 14 day challenge. Tell your Dr you are doing this as your BP may plummet if you are on other meds. Measure your BP every day and post to us. or go to http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf download this 64 page booklet free and do the Week on the DASH Diet for 2 weeks. If you are on BP meds be prepared for a large fall in BP (20/10 mm Hg or more) and let your Dr. know you are doing this. And/Or go to (but costs money monthly) DASH Diet for Health Program (http://www.dashforhealth.com/pages/public/tour.php)The DASH Diet for Health Program is designed to help you improve your eating and exercise habits. Twice each week they will provide you with information on our website about food, food preparation, eating out, losing weight, getting fit and much more. In addition to providing new information each week on the website, they create a web page specially for you where you can track progress in areas such as your weight, blood pressure, and exercise. I strongly recommend you get this book and read it. 4. Measure your BP: Measure your BP daily so you can see if it is getting better. If you are taking meds be sure to tell your health care team you are doing this as your BP may plummet to normal quickly. We recommend you use a device you listen to and will help you learn how to do this. If this is not something you want to do we can teach a significant other how to do it. See sharedcareinc.com or email to sharedcare@... to order a video on how to do this. If you already have one we will teach you how to teach your health care team how to validate your device. Your life and health depends on accurate BP measurements. Go to the amricanheart.org and download the Guidelines for Human Blood Pressure Measurement. Insist the your health care team do BP the AHA way. Never trust your life to an automatic BP machine unless you know it is accurate on YOU. 5. Genetics and your BP: Go to familyhistory.hhs.gov and do your detailed family medical history so we can review with you to help Dx familial causes of high blood pressure and heart disease. If BP runs in your family you may save lives in your family by checking their BP yourself. 6. How to DX and treat PA: Go to our file/Conn's Articles of Note/Medications/Bravo spir 1973.pdf and read this article and take to your health care team. It is old but still one of the best in the medical management of PA. Also see our file from the Endocrine Society Guidelines on PA. Dr. Grim's Perfect Primary Aldosteronism Blood and Urine Testing to diagnose PA in one day. 1. Eat a regular to high salt diet for 2 weeks.2. No BP meds in last 4-12 weeks depending on meds.3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do not lose a drop of this liquid gold. It is impossible to interpret the renin and aldo without this.4. The morning you finish the 24 hr urine have fasting blood drawn for renin, aldo and K using our guidelines to get an accurate K. Try to get this done about 4 hours after you have been out of bed.5. Send us the results with the normal values for your lab.6. If you ever have a salt (saline) infusion test for PA be certain to ask them to measure how much you pee during the 4 hours of the infusion. If it is 1-1.5 liter of urine it strongly suggests that you may have PA. If more tha 1.5 L you almost certainly have PA. 8. Become a participant in our PA Registry and contribute to our large database on PA: If you have been Dxed with PA already and are on Rx or have had surgery please go to http://www.kwiksurveys.com/online-survey.php?surveyID=HIJIO_f2685379 and complete our survey with as much information as you know. If there is some information you don't know ask us and we will help. If you need to update this as you journey thru the diagnostic/treatment process you can add another entry but label it as Nameyymmdd. For example today 6/12/09 for me would be Grim090612. This ever increasing number will allow us and you to sort your multiple entries into a dated order. 9. Learn the language: If you are new to medical lingo then download the acroyms from http://health.groups.yahoo.com/group/bloodpressureline/message/2918610. Salt and high blood pressure: To learn the state of the science of salt and blood pressure please spend some time looking at http://www.worldactiononsalt.com/evidence/treatment_trials.htm11. Become a HBP expert consumer: Expect that it will take at least several weeks to get all this digested and to learn the new language of high blood pressure health care. As most doctors and nurses in practice have had very little training in high blood pressure you must become an expert yourself. For example most have never had anyone listen with them with a double stethoscope to verify that they can hear BP sounds. We cannot make you a doctor but we will make you a pretty good BP doctor.12. How High Blood Pressure should be managed: Go to nih.gov and download and read the Joint National Commission (JNC) Report 7 to get an overview on current guidelines. I ask all my secretaries to read this so they can communicate the importance of high blood pressure to my patients. JNC 8 will be out soon.Then: get (and study) the Hypertension Primer from americanheart.org. This is the most up-to-date compendium of what is known about high blood pressure and what every Dr. should know when they graduate from Medical School. Every chapter is only 2-3 pages. Read one chapter every week-night and you will finish it in about a year. I am working on a reading guide for lay people for the Primer. Stay tuned.13. Ask us questions: Ask any questions about high blood pressure you want answered. That is what we are here for. We have had this site for 10 years and over 30,000 emails are searchable. This is the largest collection of communications about Conn's Syndrome in the World. 14. One-on-one Consulting: I can provide individual consulting if you do not want to go public. If you want individual one-on-one consulting for you and your Doctor contract me directly at lowerbp2@....May your pressure be low!Clarence E. Grim BS, MS, MD, FACP, FACC, FAHABoard Certified in Internal Medicine, Geriatrics, and High Blood Pressure Retired Faculty/Professor of Medicine (U of MO, Indiana, UCLA/DREW, Medical College of Wisconsin and Cardiology, Endocrinology, Nephrology, and Epidemiology. Specializing in Primary Aldosteronism and Difficult to Control High Blood Pressure. I'm going in on Thursday for the following test: basic panel and serum aldosterone.Shouldn't there be a urine test? Are these test a waste of my time if I want real answers to why I have high aldosterone.What would be the ideal test? Please help I am feeling pressured for time! Thank youSent from my iPad Not that I know of or can make a connection to in my wildest Endocrine/Heme thoughs. But then another reason we need a good data base.Do you do data bases?CE Grim,MDIs there any connection between high aldosterone and low ferritin?Sent from my iPad If your BP and K is normal you may not need to DASH.Runners may have aldo if it was collected after a run.Drink when you are thirsty. A low Na suggests you are drinking too much.CE Grim MDCould I get some input on water intake? I tried searching the web-site about dashing but couldn't find what I was looking for.I know are bodies are constantly trying to keep things in balance so I feel like h2o consumption is just as important as sodium intake. However, I don't think I can assume the average 8 cups a day will be my norm.Here are a few things that I think might influence my sodium/h20 consumption: I have lowish serum sodium 138 (135-145), I have low blood pressure110/65, high aldosterone (24 hr urine 54.3 ( 17-44) and I am active ( runner)I feel it is reasonable that I keep my sodium intake at the higher end of the Dashing Diet , because of low sodium and low blood pressure and activity level, but I also want to try and lower aldosterone naturally ( if possible) and I'm hoping maybe it's a matter of the right amount of daily water and sodium consumption. Are there any right ratios for this? For example, if you consume 1,500 mg of sodium you should have 8 cups of h2o or maybe if you consume 2,300 mg of sodium you should shoot for 10 cups of h2o?Thanks so much! Really trying to get it right!Sent from my iPad Keep us posted. so you have high renin and high aldo and low K and low BP?CE Grim MDHi Dr. Grim, The following post grabbed my attention. I started following you and this site when I was thought to have primary hyperaldosteronism. I had all the expected abnormal lab results except for low to normal blood pressure. Eventually, labaratory results confirmed Bartters Syndrome and now I follow both yahoo groups. > > >>>>>>>>>> > > >>>>>>>>>>> > > >>>>>>>>>>> Hi everyone, just joined today. Thanks to all of you for this support!> > >>>>>>>>>>> > > >>>>>>>>>>> I tested high for aldosterone two years ago through a urine test. My ND at the time was not concerned, he thought it was due to the fact that I was a runner. I also thought that made since and was also following a low salt diet. So we ignored it.> > >>>>>>>>>>> > > >>>>>>>>>>> I am treAting a thyroid issue, thyroid hormone resistance, and through recent blood work tested high for aldosterone again. This time I decided not to ignore it! > > >>>>>>>>>>> > > >>>>>>>>>>> I do not have a high blood pressure. It runs pretty normal to low. I don't have issues with potassium. This is all Very confusing as to why I have high aldosterone.> > >>>>>>>>>>> > > >>>>>>>>>>> I am trying to get into a endocrinologist but will take about three months. I need some education and advise on where to start.> > >>>>>>>>>>> > > >>>>>>>>>>> I don't even know if this is primary or secondary.> > >>>>>>>>>>> > > >>>>>>>>>>> My only real "health" issue, that I know about, has been hair loss. This was one reason for exploring the thyroid but I am wondering if it has been the aldosterone all along. Maybe the aldosterone is what's causing my thyroid issues.> > >>>>>>>>>>> > > >>>>>>>>>>> Any comments or advice would be greatly appreciated.> > >>>>>>>>>>> > > >>>>>>>>>>> My labs:> > >>>>>>>>>>> > > >>>>>>>>>>> 9/26/2008> > >>>>>>>>>>> Aldosterone (urine)> > >>>>>>>>>>> High 54.3. (normal diet 6-25, low salt 17-44, high salt0-6)> > >>>>>>>>>>> > > >>>>>>>>>>> Other adrenal hormones were fine at that time. Cortisol was pretty middle of the road. *Progesterone however was really high too. I can post if necessary.> > >>>>>>>>>>> > > >>>>>>>>>>> Rbc potassium 7/14/2010> > >>>>>>>>>>> 97. (90-111)> > >>>>>>>>>>> > > >>>>>>>>>>> Blood aldosterone 7/18/2010> > >>>>>>>>>>> 52.0. (1-16)> > >>>>>>>>>>> > > >>>>>>>>>>> Blood aldosterone/renin 6/30/2010> > >>>>>>>>>>> Aldosterone 49. (1-16)> > >>>>>>>>>>> Renin. 3.3. (random ambulatory 0.8-2.5, non ambulatory 1.5-5.2)> > >>>>>>>>>>> I was sitting, fasting, taking two hours after waking before/around 8am> > >>>>>>>>>>> > > >>>>>>>>>>> Aldosterone renin ratio = 15> > >>>>>>>>>>> > > >>>>>>>>>>> Sodium. 138. (135-145)> > >>>>>>>>>>> Potassium. 4.5. (3.5-5.3)> > >>>>>>>>>>> Chloride. 106. (98-109)> > >>>>>>>>>>> Co2. 23. (22-31)> > >>>>>>>>>>> Anion gap. 9. (5-16)> > >>>>>>>>>>> > > >>>>>>>>>>> Saliva cortisol 5/23/2010> > >>>>>>>>>>> 7am. 3.7. (3.7-9.5)> > >>>>>>>>>>> 11am. 1.6. (1.2-3.0)> > >>>>>>>>>>> 5pm. 1.3. (0.6-1.9)> > >>>>>>>>>>> 9pm. 0.5. (0.4-1.0)> > >>>>>>>>>>> > > >>>>>>>>>>> Rbc magnesium 5/26/2010> > >>>>>>>>>>> 4.2. (4.0-6.4)> > >>>>>>>>>>> > > >>>>>>>>>>> Lot of test!!!!> > >>>>>>>>>>> > > >>>>>>>>>>> Thanks again for your kind support! Suzanne> > >>>>>>>>>>> > > >>>>>>>>>>> > > >>>>>>>>>> > > >>>>>>>>> > > >>>>>>>>> > > >>>>>>>> > > >>>>>>>> > > >>>>>>> > > >>>>>>> > > >>>>>> > > >>>>>> > > >>>>> > > >>>>> > > >>>> > > >>>> > > >>> > > >>> > > >> > > > > > >> >> > > Reply to sender |>

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WE ALL HAVE TO EAT AND PAY OUR BILLS. MY HUSBAND AND I ARE STRUGGLING IN THIS ECONOMY! WE HAVE ALSO PAID OUT LOTS OF MONEY FOR MEDICAL ADVICE THAT GOT US NOWHERE! I HAVE ASKED A HUNDRED QUESTIONS (PAID FOR THEM ALL) AND THE BEST ANSWERS I GOT GOT CAME FROM MY OWN TIME/RESEARCH. AND I WOULD SHARE THE VALUABLE INFO I HAVE GAINED FREE OF CHARGE TO ANYONE WHO WOULD BENEFIT, AND I ALREADY HAVE BEEN DOING SO. SOMETIMES THERE ARE MORE IMPORTANT THINGS IN LIFE THAN MONEY.I DISAGREE ON YOUR STATEMENT "THAT ONE GET WHAT THEY PAY FOR" , I HAVE PAID ALL KINDS OF DOCTORS, LOTS OF MONEY, AND HERE I SIT FOUR YEARS LATER STILL WITH SO MANY UNANSWERED QUESTIONS. MAYBE IF I HAD FOUND YOU IN THE BEGINNING, PAID YOU AND ALL ISSUES WERE RESOLVED MY OUTLOOK ON THIS WOULD BE DIFFERENT, HOWEVER, THIS HAS NOT BEEN THE CASE. THE MEDICAL WORLD HAS LET ME DOWN, AND MANY OTHERS. I HAVE NO FAITH OR TRUST AT THIS POINT. IT

REALLY HAS BEEN ALL UP TO ME TO TAKE CONTROL OF MY "ISSUES" BECAUSE I HAVE FOUND NO ONE TO DATE WHO IS QUALIFIED.YES, YOU ANSWERING MY QUESTIONS HAS GREAT VALUE! I DO APPRECIATE THE TIME YOU HAVE GIVEN, BUT I AM NOT SURE THERE IS A CLEAR LINE BETWEEN WHAT I CAN EXPECT I NEED TO PAY FOR AND WHAT I DON'T. I DON'T EVEN KNOW IF I AM IN A POSITION TO PAY AS I AM ALREADY PAYING TWO OTHER DOCTORS TO HELP WITH THIS. REALLY I DON'T NEED AN HOUR OF CREATININE EXPLANATION, I REALLY JUST WANTED TO KNOW HOW IMPORTANT THE RANDOM URINE WAS IN RELATION TO THE QUANTITATIVE WHEN DOING A 24 HOUR URINE. I DON'T HAVE ACCESS TO MY DOCTOR UNTIL THE END OF THE MONTH AND DIDN'T WANT TO SPEND THE TIME WORRYING ABOUT THIS RESULT IF I DIDN'T NEED TO. BUT BECAUSE IT WAS LOW CONCERNED ME AND I JUST WANTED SOMEONE TO SAY IT WAS OK IF IT WAS LOW.I DON'T WANT TO TAKE ADVANTAGE OF YOUR TIME, I JUST NEED

SOME PEACE AND RESOLUTION WITH THIS ISSUE.SUZANNE Sent from my iPad

I did but I still have to eat and pay rent and heat and lights and eat and am semi-retired. I suppose you and your husband share your skills and knowledge for free to the world.I have been doing this site for 10 years. so if you search thru our site's 30,000+ messages(which are searchable BTW) you can find the answer to almost anything.My guess is tapping into my knowledge base would have saved you lots of time and money but one usually gets what you pay for.So lets say I answer 500 of your questions over the next year. Is that not worth something? Or you can put them on here and I will answer them when I have time. To explain the creatinine issue for example will take an hour of my time to do it rigSince I only have a limited number of hours left in my life that means I

am giving you a part of my life. I don't do that as much as I used to for free.CE Grim MDYOU KNOW DR. GRIM I HAVE SPENT THE LAST FOUR YEARS OF MY LIFE DEDICATED TO READING ABOUT ALL TYPES OF HEALTH ISSUES, MOSTLY THYROID,

IRON, AND HORMONES, BECAUSE TIME AND TIME AGAIN DOCTORS HAVE FAILED ME! EVERYTIME I HAD A QUESTION LIKE THIS NO ONE COULD OR WOULD ANSWER THEM. SO I SPEND A LOT OF TIME RESEARCHING AND FINDING MY OWN ANSWERS WHILE STILL PAYING DOCTORS IN HOPES SOMEONE WILL HELP. SADLY, AFTER MUCH TIME I AM THE ONE WHO HAS TO FIND MY OWN ANSWERS BUT SOMEHOW STILL END UP PAYING DOCTORS TO TELL ME NOTHING. I DON'T WANT TO WASTE ANOTHER YEAR OF MY LIFE READING WHAT DOCTORS SHOULD HAVE ALREADY TOLD ME! I HAVE BEEN THROUGH AT LEAST 7 DOCTORS AND THOUSANDS AND THOUSANDS OF DOLLARS. I HAVE GIVEN UP SO MUCH OF MY LIFE, AND TIME WITH MY FAMILY BECAUSE DOCTORS DIDN'T CARE ENOUGH OR KNOW ENOUGH TO HELP ME. I THOUGHT THIS SUPPORT GROUP WAS DIFFERENT! CAN YOU NOT UNDERSTAND THE FRUSTRATION THIS SITUATION CAUSES???ARE THERE ANY DOCTORS LEFT WHO WENT TO MEDICAL SCHOOL BECAUSE THEY ACTUALLY HAD A DESIRE TO HELP PEOPLE, OR

ARE THEY ALL JUST OUT TO MAKE MONEY?SUZANNE Sent from my iPad Support for common questions. Or you can order the AHA HYPERTENSION PRIMER and read one chapter a night each week night and after a year or so you will know all the answers to your questions.FYI the spot urine cr con tells you nothing about kidney problems. If it was tome and u had the volume it might. It mostly tells us how much fluid you were drinking. Tiped sad Send

form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension so what's the support group for?Sent from my iPad Once again this is what I get paid for. Contact me at lowerbp2@... for details of accessing my expertise for a year for only $500.CE Grim MDThanks!!Would you mind explaining the difference between the creatinine random urine and the creatinine quantitative urine? I am concerned that my creat. rand is low meaning kidney trouble.I have been sitting here "researching" this for an hour or so and can't find an explanation.I won't been able to see my doctor until the end of this month and even then I don't think she is

well educated in this area.I really wanted to rule out any kidney issues before December 28th.Thanks for your time and input! SuzanneSent from my iPad I assume your Dr. gets paid for doing this sort of interpretation.I can do it one on one for a fee. They all look good to me.CE

Grim MDI have some test results back that are worrying me. I don't have all the results so I will post them as I get them. Right now I am concerned with what my creatinine levels mean. Please help!!!Blood creatinineCREAT 0.77

(0.44-1.00)BUN 14 (6-20)urine creatinine (there were two results for this)CREAT,RAND UR 40.86 L (80.00-170 mg./dl)CREAT, UR QUANT 1.0 (0.6-1.8 gm./dy)Should I be worried about the low CREAT, RAND UR?????THANKS, SUZANNESent from my iPad It varies. Do a pubmed.CE Grim MDWhat significance does our menstrual cycle play in blood

pressure?During my luteal phase my blood pressure ranges from 115/65 to 120/75 but then once menses begins i run a lot lower 90/60.I am in the process of doing the 24 hour urine. should have those numbers in a few days.thanks,suzanneSent from my iPad Yea but you usually are an alcoholic who does not each much or cancer pt who cannot eat and is starving. CE Grim MDI have read that a magnesium deficiency can cause low K.Sent from my iPad Better to DASH I would think.If you can get it in food why take a pill?CE Grim MDare you serious? I am asking if I should take a b vitamin supplement?Sent from my iPad Still no question?CE Grim MD Was there a question here?Hi Dr. Grim,Is it recommended to take a b-complex vitamin?I have been holding off from taking mine (complete b-complex from life extension) because i am afraid it might encourage more aldosterone production! Am I crazy for worrying about this? I know the adrenals love b vitamins and I don't need anything that will cause me to produce more aldosterone. However, I know for a woman of my age and activity level that the b's are very important and could really benefit my body!!Thanks, SuzanneSent from my iPad They are all competitors for the receptors but I do

not know the measures of association that permits one to quantitate the relative effect of aldo in occupying each of the receptors. Also they circulate in much greater quantities that aldo as I recall. So the effect would seem likely to be weak.CE Grim MD Hi Dr. Grim, I wanted to ask if high aldosterone levels will block progesterone, testosterone, and estrogen receptors? Thanks, SuzanneTo: hyperaldosteronism Cc: Clarence Grim Sent: Sun, November 7, 2010 7:36:01 PMSubject: Re: Re: 42 yo woman runner who has had aldo 52 and renin 3.3 normal bp That's what this paper says. No one has looked at in anymore detail that I can find.CE Grim

MDOk, by doing this it will be ok to test any time of my cycle?Sent from my iPad Ask your lab to use plasma renin activity not direct renin assay.CE Grim MDThis is the article I did read. I didn't feel like it gave a definitive answer. I have read it is best to test aldosterone on the third day of the menstrual cycle but not sure

how that will go seeing it is a urine test and not a simple blood draw. Any advice would be greatly appreciated. ThanksSent from my iPad Guess you did not search aldosterone renin ratio.Here is one.J Clin Endocrinol Metab. 2010 Oct 20. [Epub ahead of print]Are Women More at Risk of False-Positive Primary Aldosteronism Screening and Unnecessary Suppression Testing than Men?Ahmed AH, Gordon RD, PJ, Ward G, Pimenta E, Stowasser M.Endocrine Hypertension Research Centre (A.H.A., R.D.G., P.J.T., E.P., M.S.), University of Queensland School of Medicine, Greenslopes and Princess andra Hospitals, Brisbane, Queensland 4102, Australia; and Sullivan and Nicolaides Pathology (G.W.), Brisbane, 4068 Queensland, Australia.AbstractBackground: Because primary aldosteronism is not uncommon, specifically treatable and in some

cases curable, and carries higher risks for cardiovascular morbidity and mortality than essential hypertension, screening hypertensive patients for its presence by measuring aldosterone to renin ratio (ARR) is increasingly common. A significantly higher false-positive ARR rate for women than men, resulting in unnecessary suppression tests has previously been reported. Methods: Using a new, highly accurate aldosterone assay and both of the currently widely used renin assays, ARR was measured in 19 normal, ovulating women at three time points in the menstrual cycle and compared with single measurements in 21 normal males of similar age. Results: ARRs in males were possibly too well down in the current normal range. Although normotensive and normokalemic, two women had raised ARRs in the luteal phase but only when direct renin concentration (DRC) was used. Their DRC levels were low at all sampling times [despite midrange plasma renin activity levels],

whereas their progesterone and aldosterone levels were highest for the group. Saline suppression testing, performed in one of them, showed normal aldosterone suppressibility. Conclusion: False-positive ARRs in normal women during the luteal phase only when DRC is used may explain the higher incidence of false-positive ARRs in hypertensive women than men and suggest the following: 1) plasma renin activity is preferable to DRC in determination of ARR and 2) new reference ranges for ARR that take into account gender and sex hormone levels are required.Thanks, I did do some reading on pubmed like you suggested about testing and menses but never came up with an answer. Hoping you had the answer. I know aldosterone is naturally higher during the luteal phase but I only want to do this once and I want to get it exactly right . Sent from my iPad I think I sent an abstract recently on menses and testing. If you cant find it let me know.Dr. Grim's Perfect Primary Aldosteronism Blood and Urine Testing to diagnose PA in one day. 1. Eat a regular to high salt diet for 2 weeks.2. No BP meds in last 4-12 weeks depending on meds.3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do not lose a drop of this liquid gold. It is impossible to interpret the renin and aldo without this.4. The morning you finish the 24 hr urine have fasting blood

drawn for renin, aldo and K using our guidelines to get an accurate K. Try to get this done about 4 hours after you have been out of bed.5. Send us the results with the normal values for your lab.6. If you ever have a salt (saline) infusion test for PA be certain to ask them to measure how much you pee during the 4 hours of the infusion. If it is 1-1.5 liter of urine it strongly suggests that you may have PA. If more tha 1.5 L you almost certainly have PA. Hi, I am calling my Natural Path tomorrow to have her order test to see if we can figure out why I have high alodsterone. Here are the test I am requesting: (PLEASE LET ME KNOW IF I AM MISSING SOMETHING) -24 hour urine NA, K, Creatinine, Aldosterone -blood draw Renin, Aldosterone, and K Anything else????Also where can I get the info on how to collect K correctly?See our files on how to draw

blood.One last question, when during my menstrual cycle is the best time to do these test?'see a recent email re this issue.Thanks so much for you time, SuzanneTo: hyperaldosteronism Cc: Clarence Grim Sent: Fri, November 5, 2010 7:04:29 AMSubject: Re: Re: 42 yo woman runner who has had aldo 52 and renin 3.3 normal bp your team is who you have decided you want to manage your health. Can a Natural Path write prescriptions and order blood tests?CE Grim MDWhat if I don't have a team? Or do you consider a Natural Path my team?Sent from my iPad yes I can work with your team for $500 per year.CE Grim MDHi Dr Grim , I agree I am afraid I am going to make this 400 mile trip and get nowhere! I don't have a dr other than a Natural Path. Can you be my dr and take care of all of this

online?Sent from my iPad she does not seem to understand PA as she did not order a renin.CE Grim

MDSend her my article on the evolution of PA and the Endo guidelines in our files---BEFORE you see her. You want to know how many PAs she has treated and followed for at least 10 years.CE Grim MDThanks for the info. I am so frustrated with dr's in my area.

It seems NO one knows the correct test around here! My natural path is very willing to order the test but she's the first one to admit that she won't know what to do with the results.I live in Whitefish, Montana and Kalispell is about 15 minutes away. Missoula is about 200 miles but I would drive it if someone could make a recommendation ( preferably first hand experience). I am doing Dr. grimes ideal test in December and then at the end of December I am scheduled to see an endocrinologist in Missoula. I don't have faith that the endo knows much about hyperaldosteronism but at this point she is my only hope. This endo's name is Dr. Eyler. She has ordered the following test ( which I don't believe are ideal): hypothyroid panel, comprehensive metabolic panel, vitamin d, hemogram, LH, FSH, 24 hr urine aldosterone.Any comments or feedback would be so appreciated! Thanks, SuzanneSent from my

iPad See Dr Grim's ideal test.You cannot interpret the aldo/renin ratio without having a 24 hr urine Na. But maybe your health care team knows how to do this. If so they need to let us know.CE GrimMDWelcome to the exciting world of Hyperaldosteronism! You are in the right place! I am Dr. CE Grim a retired Professor of Medicine and Endocrinology. I have a long standing interest is Primary Aldosteronism since medical school days when I saw my first patient with Primary Aldosteronism in 1963. I trained with Dr. Conn in Endocrinology and Metabolism 1969-70 and have published over 240 papers and book chapters in most areas of the broad discipline of High Blood Pressure. My CV is in our files for details. The goal of our group is to teach you and your health care team about the ins and outs of the causes, diagnosis and control of

the many forms of hyperaldosteronism. The steps below will introduce you into the fascinating world of high blood pressure, salt and potassium and the role of the adrenal hormone aldosterone in health and disease. Doing these in sequence will save you time and effort in getting up to speed in taking control of you health and educating your own health care team. While we can’t make you a doctor we will make you into a pretty good BP doctor-a skill that you will have for life. 1. A brief history of Primary Aldosteronsim and why it is so common today in drug resistant high blood pressure. Read my article in our files on the evolution of PA (Evolution_of_PA-Grim.pdf ) and take to all members of health care team. Tell us what stage you believe you are in. This is a brief review of most causes of hyperaldosteronism, high blood

pressure, low potassium (K). 2. Read about other patients with hyperaldosteronism (Conn’s syndrome). Read our Conn's stories in our files and then give us your own in as much detail as you can. Dr. Conn was the first to describe this disease process and the syndrome is named after him.To see others' stories, on the Hyperaldosteronism home page, go to Files/Conn’s Stories. You'll find instructions in "A - How to put your story here.doc " First send us your story in an email and they we may have questions and suggestions before you upload it to our files. 3. DASH to lower your BP. Your and my tax dollars funded the most important series of studies on how to improve blood pressure, blood sugar, blood lipids and make your heart smaller: The DASH Eating Plan to control high blood

pressure due to hyperaldosteronism and most others with high blood pressure. This will reduce your need for medications and in many will get your BP and K to goal without meds.. Get the DASH diet book by T. et al, (http://www.amazon.com/DASH-Diet-Hypertension--/dp/0743202953) read it and use it: ~$8 in paperback at your local bookstore or online. If they don’t have it ask them to order it for you. You can also get the hardback larger print

version as well at Amazon. Learning to eat the DASH way will play a major role in your road to good BP and K control and, in many of our folks here, will revolutionize your life. See http://en.wikipedia.org/wiki/DASH_diet for an overview and more details. In the book go to chapter 9 and do the 14 day challenge. Tell your Dr you are doing this as your BP may plummet if you are on other meds. Measure your BP every day and post to us. or go to http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf download this 64 page booklet free and do the Week on the DASH Diet for 2 weeks. If you are on BP meds be prepared for a large fall in BP (20/10 mm Hg or more) and let your Dr. know you are doing this. And/Or go to (but costs money monthly) DASH Diet for Health Program (http://www.dashforhealth.com/pages/public/tour.php)The DASH Diet for Health Program is designed to help you improve your eating and exercise habits. Twice each week they will provide you with information on our website about food, food preparation, eating out, losing weight, getting fit and much

more. In addition to providing new information each week on the website, they create a web page specially for you where you can track progress in areas such as your weight, blood pressure, and exercise. I strongly recommend you get this book and read it. 4. Measure your BP: Measure your BP daily so you can see if it is getting better. If you are taking meds be sure to tell your health care team you are doing this as your BP may plummet to normal quickly. We recommend you use a device you listen to and will help you learn how to do this. If this is not something you want to do we can teach a significant other how to do it. See sharedcareinc.com or email to sharedcare@... to order a video on how to do this. If you already have one we will teach you how to teach your health care team how to validate your device. Your life and health depends on accurate BP measurements. Go to the amricanheart.org and download the Guidelines for Human Blood Pressure Measurement. Insist the your health care team do BP the AHA way. Never trust your life to an automatic BP machine unless you know it is accurate on YOU. 5. Genetics and your BP: Go to familyhistory.hhs.gov and do your detailed family medical history so we can review with you to help Dx familial causes of high blood pressure and heart disease. If BP runs in your family you may save lives in your family by checking their BP yourself. 6. How to DX and treat PA: Go to our file/Conn's Articles of Note/Medications/Bravo spir 1973.pdf and read this article and take to your health care team. It is old but still one of

the best in the medical management of PA. Also see our file from the Endocrine Society Guidelines on PA. Dr. Grim's Perfect Primary Aldosteronism Blood and Urine Testing to diagnose PA in one day. 1. Eat a regular to high salt diet for 2 weeks.2. No BP meds in last 4-12 weeks depending on meds.3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do not lose a drop of this liquid gold. It is impossible to interpret the renin and aldo without this.4. The morning you finish the 24 hr urine have fasting blood drawn for renin, aldo and K using our guidelines to get an accurate K. Try to get this done about 4 hours after you have been out of bed.5. Send us the results with the normal values for your lab.6. If you ever have a salt (saline) infusion test for PA be certain to ask them

to measure how much you pee during the 4 hours of the infusion. If it is 1-1.5 liter of urine it strongly suggests that you may have PA. If more tha 1.5 L you almost certainly have PA. 8. Become a participant in our PA Registry and contribute to our large database on PA: If you have been Dxed with PA already and are on Rx or have had surgery please go to http://www.kwiksurveys.com/online-survey.php?surveyID=HIJIO_f2685379 and complete our survey with as much information as you know. If there is some information you don't know ask us and we will help. If you need to update this as you journey thru the diagnostic/treatment process you can add another entry but label it as Nameyymmdd. For example today 6/12/09 for me would be Grim090612. This ever increasing number will allow us and you to sort your multiple entries into a dated order. 9. Learn the language: If you are new to medical lingo then download the acroyms from http://health.groups.yahoo.com/group/bloodpressureline/message/2918610. Salt and high blood pressure: To learn the state of the science of salt and blood pressure please spend some time looking at http://www.worldactiononsalt.com/evidence/treatment_trials.htm11. Become a HBP expert consumer: Expect that it will take at least several weeks to get all this digested and to learn the new language of high blood pressure health care. As most doctors and nurses in practice have had very little training in high blood pressure you must become an expert yourself. For example most have never had anyone listen with them with a double stethoscope to verify that they can hear BP sounds. We cannot make you a doctor but we will make you a pretty good BP doctor.12. How High Blood Pressure should be managed: Go to nih.gov and download and read the Joint National Commission (JNC) Report 7 to get an overview on current guidelines. I ask all my secretaries to read this so they can communicate the importance of high blood pressure to my patients. JNC 8 will be out soon.Then: get (and study) the Hypertension Primer from americanheart.org. This is the most up-to-date compendium of what is known about high blood pressure and what every Dr. should know when they graduate from Medical School. Every chapter is only 2-3 pages. Read one chapter every week-night and you will finish it in about a year. I am working on a reading guide for lay people for the Primer. Stay tuned.13. Ask us questions: Ask any questions about high blood pressure you want answered. That is what we are here for. We have had this site for 10 years and over 30,000 emails are searchable. This is the largest collection of communications about Conn's

Syndrome in the World. 14. One-on-one Consulting: I can provide individual consulting if you do not want to go public. If you want individual one-on-one consulting for you and your Doctor contract me directly at lowerbp2@....May your pressure be low!Clarence E. Grim BS, MS, MD, FACP, FACC, FAHABoard Certified in Internal Medicine, Geriatrics, and High Blood Pressure Retired Faculty/Professor of Medicine (U of MO, Indiana, UCLA/DREW, Medical College of Wisconsin and Cardiology, Endocrinology, Nephrology, and Epidemiology. Specializing in Primary Aldosteronism and Difficult to Control High Blood

Pressure. I'm going in on Thursday for the following test: basic panel and serum aldosterone.Shouldn't there be a urine test? Are these test a waste

of my time if I want real answers to why I have high aldosterone.What would be the ideal test? Please help I am feeling pressured for time! Thank youSent from my iPad Not that I know of or can make a connection to in my wildest Endocrine/Heme thoughs. But then another reason we need a good data base.Do you do data bases?CE Grim,MDIs there any connection between high aldosterone and low ferritin?Sent from my iPad If your BP and K is normal you may not need to DASH.Runners may have aldo if it was collected after a run.Drink when you are thirsty. A low Na suggests you are drinking too much.CE Grim MDCould I get some input on water intake? I tried searching the web-site about dashing but couldn't find what I was looking for.I know are bodies are constantly trying to keep things in balance so I feel like h2o consumption is just as important as sodium intake. However, I don't think I can assume the average 8 cups a day will be my norm.Here are a few

things that I think might influence my sodium/h20 consumption: I have lowish serum sodium 138 (135-145), I have low blood pressure110/65, high aldosterone (24 hr urine 54.3 ( 17-44) and I am active ( runner)I feel it is reasonable that I keep my sodium intake at the higher end of the Dashing Diet , because of low sodium and low blood pressure and activity level, but I also want to try and lower aldosterone naturally ( if possible) and I'm hoping maybe it's a matter of the right amount of daily water and sodium consumption. Are there any right ratios for this? For example, if you consume 1,500 mg of sodium you should have 8 cups of h2o or maybe if you consume 2,300 mg of sodium you should shoot for 10 cups of h2o?Thanks so much! Really trying to get it right!Sent from my iPad Keep us posted. so you have high renin and high aldo and low K and low BP?CE Grim MDHi Dr. Grim, The following post grabbed my attention. I started following you and this site when I was thought to have primary hyperaldosteronism. I had all the expected abnormal lab results except for low to normal blood pressure. Eventually, labaratory results confirmed Bartters Syndrome and now I follow both yahoo groups. > > >>>>>>>>>> > > >>>>>>>>>>> > > >>>>>>>>>>> Hi everyone, just joined today.

Thanks to all of you for this support!> > >>>>>>>>>>> > > >>>>>>>>>>> I tested high for aldosterone two years ago through a urine test. My ND at the time was not concerned, he thought it was due to the fact that I was a runner. I also thought that made since and was also following a low salt diet. So we ignored it.> > >>>>>>>>>>> > > >>>>>>>>>>> I am treAting a thyroid issue, thyroid hormone resistance, and through recent blood work tested high for aldosterone again. This time I decided not to ignore it! > > >>>>>>>>>>> > >

>>>>>>>>>>> I do not have a high blood pressure. It runs pretty normal to low. I don't have issues with potassium. This is all Very confusing as to why I have high aldosterone.> > >>>>>>>>>>> > > >>>>>>>>>>> I am trying to get into a endocrinologist but will take about three months. I need some education and advise on where to start.> > >>>>>>>>>>> > > >>>>>>>>>>> I don't even know if this is primary or secondary.> > >>>>>>>>>>> > > >>>>>>>>>>> My only real "health" issue, that I know about, has been hair loss. This was one

reason for exploring the thyroid but I am wondering if it has been the aldosterone all along. Maybe the aldosterone is what's causing my thyroid issues.> > >>>>>>>>>>> > > >>>>>>>>>>> Any comments or advice would be greatly appreciated.> > >>>>>>>>>>> > > >>>>>>>>>>> My labs:> > >>>>>>>>>>> > > >>>>>>>>>>> 9/26/2008> > >>>>>>>>>>> Aldosterone (urine)> > >>>>>>>>>>> High 54.3. (normal diet 6-25, low salt 17-44, high salt0-6)> >

>>>>>>>>>>> > > >>>>>>>>>>> Other adrenal hormones were fine at that time. Cortisol was pretty middle of the road. *Progesterone however was really high too. I can post if necessary.> > >>>>>>>>>>> > > >>>>>>>>>>> Rbc potassium 7/14/2010> > >>>>>>>>>>> 97. (90-111)> > >>>>>>>>>>> > > >>>>>>>>>>> Blood aldosterone 7/18/2010> > >>>>>>>>>>> 52.0. (1-16)> > >>>>>>>>>>> > >

>>>>>>>>>>> Blood aldosterone/renin 6/30/2010> > >>>>>>>>>>> Aldosterone 49. (1-16)> > >>>>>>>>>>> Renin. 3.3. (random ambulatory 0.8-2.5, non ambulatory 1.5-5.2)> > >>>>>>>>>>> I was sitting, fasting, taking two hours after waking before/around 8am> > >>>>>>>>>>> > > >>>>>>>>>>> Aldosterone renin ratio = 15> > >>>>>>>>>>> > > >>>>>>>>>>> Sodium. 138. (135-145)> > >>>>>>>>>>> Potassium. 4.5. (3.5-5.3)> > >>>>>>>>>>> Chloride. 106. (98-109)>

> >>>>>>>>>>> Co2. 23. (22-31)> > >>>>>>>>>>> Anion gap. 9. (5-16)> > >>>>>>>>>>> > > >>>>>>>>>>> Saliva cortisol 5/23/2010> > >>>>>>>>>>> 7am. 3.7. (3.7-9.5)> > >>>>>>>>>>> 11am. 1.6. (1.2-3.0)> > >>>>>>>>>>> 5pm. 1.3. (0.6-1.9)> > >>>>>>>>>>> 9pm. 0.5. (0.4-1.0)> > >>>>>>>>>>> > > >>>>>>>>>>> Rbc magnesium 5/26/2010> > >>>>>>>>>>> 4.2. (4.0-6.4)> >

>>>>>>>>>>> > > >>>>>>>>>>> Lot of test!!!!> > >>>>>>>>>>> > > >>>>>>>>>>> Thanks again for your kind support! Suzanne> > >>>>>>>>>>> > > >>>>>>>>>>> > > >>>>>>>>>> > > >>>>>>>>> > > >>>>>>>>> > > >>>>>>>> > > >>>>>>>> > > >>>>>>> > > >>>>>>> > > >>>>>> > > >>>>>> > > >>>>> > > >>>>> > > >>>> > > >>>> > > >>> > > >>> > > >> > > > > > >> >> > > Reply to sender |>

[Guest guest]

GLAD TO SEE THAT ANOTHER MEMBER HERE LIKE ME STILL IS USING OLD TELEX MACHINES OF 1960S AND 70S.

I DISAGREE ON YOUR STATEMENT "THAT ONE GET WHAT THEY PAY FOR" , I HAVE PAID ALL KINDS OF DOCTORS, LOTS OF MONEY, AND HERE I SIT FOUR YEARS LATER STILL WITH SO MANY UNANSWERED QUESTIONS. MAYBE IF I HAD FOUND YOU IN THE BEGINNING, PAID YOU AND ALL ISSUES WERE RESOLVED MY OUTLOOK ON THIS WOULD BE DIFFERENT, HOWEVER, THIS HAS NOT BEEN THE CASE. THE MEDICAL WORLD HAS LET ME DOWN, AND MANY OTHERS. I HAVE NO FAITH OR TRUST AT THIS POINT. IT REALLY HAS BEEN ALL UP TO ME TO TAKE CONTROL OF MY "ISSUES" BECAUSE I HAVE FOUND NO ONE TO DATE WHO IS QUALIFIED.

[Guest guest]

;-)CEGLAD TO SEE THAT ANOTHER MEMBER HERE LIKE ME STILL IS USING OLD TELEX MACHINES OF 1960S AND 70S. I DISAGREE ON YOUR STATEMENT "THAT ONE GET WHAT THEY PAY FOR" , I HAVE PAID ALL KINDS OF DOCTORS, LOTS OF MONEY, AND HERE I SIT FOUR YEARS LATER STILL WITH SO MANY UNANSWERED QUESTIONS. MAYBE IF I HAD FOUND YOU IN THE BEGINNING, PAID YOU AND ALL ISSUES WERE RESOLVED MY OUTLOOK ON THIS WOULD BE DIFFERENT, HOWEVER, THIS HAS NOT BEEN THE CASE. THE MEDICAL WORLD HAS LET ME DOWN, AND MANY OTHERS. I HAVE NO FAITH OR TRUST AT THIS POINT. IT REALLY HAS BEEN ALL UP TO ME TO TAKE CONTROL OF MY "ISSUES" BECAUSE I HAVE FOUND NO ONE TO DATE WHO IS QUALIFIED.

[Guest guest]

You might want to query some here who have used me as a one on one consultant (including working with their Drs) and seen considerable benefits and time savings.random urines tell you nothing about 24 hr creatinine.CE Grim MDWE ALL HAVE TO EAT AND PAY OUR BILLS. MY HUSBAND AND I ARE STRUGGLING IN THIS ECONOMY! WE HAVE ALSO PAID OUT LOTS OF MONEY FOR MEDICAL ADVICE THAT GOT US NOWHERE! I HAVE ASKED A HUNDRED QUESTIONS (PAID FOR THEM ALL) AND THE BEST ANSWERS I GOT GOT CAME FROM MY OWN TIME/RESEARCH. AND I WOULD SHARE THE VALUABLE INFO I HAVE GAINED FREE OF CHARGE TO ANYONE WHO WOULD BENEFIT, AND I ALREADY HAVE BEEN DOING SO. SOMETIMES THERE ARE MORE IMPORTANT THINGS IN LIFE THAN MONEY.I DISAGREE ON YOUR STATEMENT "THAT ONE GET WHAT THEY PAY FOR" , I HAVE PAID ALL KINDS OF DOCTORS, LOTS OF MONEY, AND HERE I SIT FOUR YEARS LATER STILL WITH SO MANY UNANSWERED QUESTIONS. MAYBE IF I HAD FOUND YOU IN THE BEGINNING, PAID YOU AND ALL ISSUES WERE RESOLVED MY OUTLOOK ON THIS WOULD BE DIFFERENT, HOWEVER, THIS HAS NOT BEEN THE CASE. THE MEDICAL WORLD HAS LET ME DOWN, AND MANY OTHERS. I HAVE NO FAITH OR TRUST AT THIS POINT. IT REALLY HAS BEEN ALL UP TO ME TO TAKE CONTROL OF MY "ISSUES" BECAUSE I HAVE FOUND NO ONE TO DATE WHO IS QUALIFIED.YES, YOU ANSWERING MY QUESTIONS HAS GREAT VALUE! I DO APPRECIATE THE TIME YOU HAVE GIVEN, BUT I AM NOT SURE THERE IS A CLEAR LINE BETWEEN WHAT I CAN EXPECT I NEED TO PAY FOR AND WHAT I DON'T. I DON'T EVEN KNOW IF I AM IN A POSITION TO PAY AS I AM ALREADY PAYING TWO OTHER DOCTORS TO HELP WITH THIS. REALLY I DON'T NEED AN HOUR OF CREATININE EXPLANATION, I REALLY JUST WANTED TO KNOW HOW IMPORTANT THE RANDOM URINE WAS IN RELATION TO THE QUANTITATIVE WHEN DOING A 24 HOUR URINE. I DON'T HAVE ACCESS TO MY DOCTOR UNTIL THE END OF THE MONTH AND DIDN'T WANT TO SPEND THE TIME WORRYING ABOUT THIS RESULT IF I DIDN'T NEED TO. BUT BECAUSE IT WAS LOW CONCERNED ME AND I JUST WANTED SOMEONE TO SAY IT WAS OK IF IT WAS LOW.I DON'T WANT TO TAKE ADVANTAGE OF YOUR TIME, I JUST NEED SOME PEACE AND RESOLUTION WITH THIS ISSUE.SUZANNE Sent from my iPad I did but I still have to eat and pay rent and heat and lights and eat and am semi-retired. I suppose you and your husband share your skills and knowledge for free to the world.I have been doing this site for 10 years. so if you search thru our site's 30,000+ messages(which are searchable BTW) you can find the answer to almost anything.My guess is tapping into my knowledge base would have saved you lots of time and money but one usually gets what you pay for.So lets say I answer 500 of your questions over the next year. Is that not worth something? Or you can put them on here and I will answer them when I have time. To explain the creatinine issue for example will take an hour of my time to do it rigSince I only have a limited number of hours left in my life that means I am giving you a part of my life. I don't do that as much as I used to for free.CE Grim MDYOU KNOW DR. GRIM I HAVE SPENT THE LAST FOUR YEARS OF MY LIFE DEDICATED TO READING ABOUT ALL TYPES OF HEALTH ISSUES, MOSTLY THYROID, IRON, AND HORMONES, BECAUSE TIME AND TIME AGAIN DOCTORS HAVE FAILED ME! EVERYTIME I HAD A QUESTION LIKE THIS NO ONE COULD OR WOULD ANSWER THEM. SO I SPEND A LOT OF TIME RESEARCHING AND FINDING MY OWN ANSWERS WHILE STILL PAYING DOCTORS IN HOPES SOMEONE WILL HELP. SADLY, AFTER MUCH TIME I AM THE ONE WHO HAS TO FIND MY OWN ANSWERS BUT SOMEHOW STILL END UP PAYING DOCTORS TO TELL ME NOTHING. I DON'T WANT TO WASTE ANOTHER YEAR OF MY LIFE READING WHAT DOCTORS SHOULD HAVE ALREADY TOLD ME! I HAVE BEEN THROUGH AT LEAST 7 DOCTORS AND THOUSANDS AND THOUSANDS OF DOLLARS. I HAVE GIVEN UP SO MUCH OF MY LIFE, AND TIME WITH MY FAMILY BECAUSE DOCTORS DIDN'T CARE ENOUGH OR KNOW ENOUGH TO HELP ME. I THOUGHT THIS SUPPORT GROUP WAS DIFFERENT! CAN YOU NOT UNDERSTAND THE FRUSTRATION THIS SITUATION CAUSES???ARE THERE ANY DOCTORS LEFT WHO WENT TO MEDICAL SCHOOL BECAUSE THEY ACTUALLY HAD A DESIRE TO HELP PEOPLE, OR ARE THEY ALL JUST OUT TO MAKE MONEY?SUZANNE Sent from my iPad Support for common questions. Or you can order the AHA HYPERTENSION PRIMER and read one chapter a night each week night and after a year or so you will know all the answers to your questions.FYI the spot urine cr con tells you nothing about kidney problems. If it was tome and u had the volume it might. It mostly tells us how much fluid you were drinking. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension so what's the support group for?Sent from my iPad Once again this is what I get paid for. Contact me at lowerbp2@... for details of accessing my expertise for a year for only $500.CE Grim MDThanks!!Would you mind explaining the difference between the creatinine random urine and the creatinine quantitative urine? I am concerned that my creat. rand is low meaning kidney trouble.I have been sitting here "researching" this for an hour or so and can't find an explanation.I won't been able to see my doctor until the end of this month and even then I don't think she is well educated in this area.I really wanted to rule out any kidney issues before December 28th.Thanks for your time and input! SuzanneSent from my iPad I assume your Dr. gets paid for doing this sort of interpretation.I can do it one on one for a fee. They all look good to me.CE Grim MDI have some test results back that are worrying me. I don't have all the results so I will post them as I get them. Right now I am concerned with what my creatinine levels mean. Please help!!!Blood creatinineCREAT 0.77 (0.44-1.00)BUN 14 (6-20)urine creatinine (there were two results for this)CREAT,RAND UR 40.86 L (80.00-170 mg./dl)CREAT, UR QUANT 1.0 (0.6-1.8 gm./dy)Should I be worried about the low CREAT, RAND UR?????THANKS, SUZANNESent from my iPad It varies. Do a pubmed.CE Grim MDWhat significance does our menstrual cycle play in blood pressure?During my luteal phase my blood pressure ranges from 115/65 to 120/75 but then once menses begins i run a lot lower 90/60.I am in the process of doing the 24 hour urine. should have those numbers in a few days.thanks,suzanneSent from my iPad Yea but you usually are an alcoholic who does not each much or cancer pt who cannot eat and is starving. CE Grim MDI have read that a magnesium deficiency can cause low K.Sent from my iPad Better to DASH I would think.If you can get it in food why take a pill?CE Grim MDare you serious? I am asking if I should take a b vitamin supplement?Sent from my iPad Still no question?CE Grim MD Was there a question here?Hi Dr. Grim,Is it recommended to take a b-complex vitamin?I have been holding off from taking mine (complete b-complex from life extension) because i am afraid it might encourage more aldosterone production! Am I crazy for worrying about this? I know the adrenals love b vitamins and I don't need anything that will cause me to produce more aldosterone. However, I know for a woman of my age and activity level that the b's are very important and could really benefit my body!!Thanks, SuzanneSent from my iPad They are all competitors for the receptors but I do not know the measures of association that permits one to quantitate the relative effect of aldo in occupying each of the receptors. Also they circulate in much greater quantities that aldo as I recall. So the effect would seem likely to be weak.CE Grim MD Hi Dr. Grim, I wanted to ask if high aldosterone levels will block progesterone, testosterone, and estrogen receptors? Thanks, SuzanneTo: hyperaldosteronism Cc: Clarence Grim Sent: Sun, November 7, 2010 7:36:01 PMSubject: Re: Re: 42 yo woman runner who has had aldo 52 and renin 3.3 normal bp That's what this paper says. No one has looked at in anymore detail that I can find.CE Grim MDOk, by doing this it will be ok to test any time of my cycle?Sent from my iPad Ask your lab to use plasma renin activity not direct renin assay.CE Grim MDThis is the article I did read. I didn't feel like it gave a definitive answer. I have read it is best to test aldosterone on the third day of the menstrual cycle but not sure how that will go seeing it is a urine test and not a simple blood draw. Any advice would be greatly appreciated. ThanksSent from my iPad Guess you did not search aldosterone renin ratio.Here is one.J Clin Endocrinol Metab. 2010 Oct 20. [Epub ahead of print]Are Women More at Risk of False-Positive Primary Aldosteronism Screening and Unnecessary Suppression Testing than Men?Ahmed AH, Gordon RD, PJ, Ward G, Pimenta E, Stowasser M.Endocrine Hypertension Research Centre (A.H.A., R.D.G., P.J.T., E.P., M.S.), University of Queensland School of Medicine, Greenslopes and Princess andra Hospitals, Brisbane, Queensland 4102, Australia; and Sullivan and Nicolaides Pathology (G.W.), Brisbane, 4068 Queensland, Australia.AbstractBackground: Because primary aldosteronism is not uncommon, specifically treatable and in some cases curable, and carries higher risks for cardiovascular morbidity and mortality than essential hypertension, screening hypertensive patients for its presence by measuring aldosterone to renin ratio (ARR) is increasingly common. A significantly higher false-positive ARR rate for women than men, resulting in unnecessary suppression tests has previously been reported. Methods: Using a new, highly accurate aldosterone assay and both of the currently widely used renin assays, ARR was measured in 19 normal, ovulating women at three time points in the menstrual cycle and compared with single measurements in 21 normal males of similar age. Results: ARRs in males were possibly too well down in the current normal range. Although normotensive and normokalemic, two women had raised ARRs in the luteal phase but only when direct renin concentration (DRC) was used. Their DRC levels were low at all sampling times [despite midrange plasma renin activity levels], whereas their progesterone and aldosterone levels were highest for the group. Saline suppression testing, performed in one of them, showed normal aldosterone suppressibility. Conclusion: False-positive ARRs in normal women during the luteal phase only when DRC is used may explain the higher incidence of false-positive ARRs in hypertensive women than men and suggest the following: 1) plasma renin activity is preferable to DRC in determination of ARR and 2) new reference ranges for ARR that take into account gender and sex hormone levels are required.Thanks, I did do some reading on pubmed like you suggested about testing and menses but never came up with an answer. Hoping you had the answer. I know aldosterone is naturally higher during the luteal phase but I only want to do this once and I want to get it exactly right . Sent from my iPad I think I sent an abstract recently on menses and testing. If you cant find it let me know.Dr. Grim's Perfect Primary Aldosteronism Blood and Urine Testing to diagnose PA in one day. 1. Eat a regular to high salt diet for 2 weeks.2. No BP meds in last 4-12 weeks depending on meds.3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do not lose a drop of this liquid gold. It is impossible to interpret the renin and aldo without this.4. The morning you finish the 24 hr urine have fasting blood drawn for renin, aldo and K using our guidelines to get an accurate K. Try to get this done about 4 hours after you have been out of bed.5. Send us the results with the normal values for your lab.6. If you ever have a salt (saline) infusion test for PA be certain to ask them to measure how much you pee during the 4 hours of the infusion. If it is 1-1.5 liter of urine it strongly suggests that you may have PA. If more tha 1.5 L you almost certainly have PA. Hi, I am calling my Natural Path tomorrow to have her order test to see if we can figure out why I have high alodsterone. Here are the test I am requesting: (PLEASE LET ME KNOW IF I AM MISSING SOMETHING) -24 hour urine NA, K, Creatinine, Aldosterone -blood draw Renin, Aldosterone, and K Anything else????Also where can I get the info on how to collect K correctly?See our files on how to draw blood.One last question, when during my menstrual cycle is the best time to do these test?'see a recent email re this issue.Thanks so much for you time, SuzanneTo: hyperaldosteronism Cc: Clarence Grim Sent: Fri, November 5, 2010 7:04:29 AMSubject: Re: Re: 42 yo woman runner who has had aldo 52 and renin 3.3 normal bp your team is who you have decided you want to manage your health. Can a Natural Path write prescriptions and order blood tests?CE Grim MDWhat if I don't have a team? Or do you consider a Natural Path my team?Sent from my iPad yes I can work with your team for $500 per year.CE Grim MDHi Dr Grim , I agree I am afraid I am going to make this 400 mile trip and get nowhere! I don't have a dr other than a Natural Path. Can you be my dr and take care of all of this online?Sent from my iPad she does not seem to understand PA as she did not order a renin.CE Grim MDSend her my article on the evolution of PA and the Endo guidelines in our files---BEFORE you see her. You want to know how many PAs she has treated and followed for at least 10 years.CE Grim MDThanks for the info. I am so frustrated with dr's in my area. It seems NO one knows the correct test around here! My natural path is very willing to order the test but she's the first one to admit that she won't know what to do with the results.I live in Whitefish, Montana and Kalispell is about 15 minutes away. Missoula is about 200 miles but I would drive it if someone could make a recommendation ( preferably first hand experience). I am doing Dr. grimes ideal test in December and then at the end of December I am scheduled to see an endocrinologist in Missoula. I don't have faith that the endo knows much about hyperaldosteronism but at this point she is my only hope. This endo's name is Dr. Eyler. She has ordered the following test ( which I don't believe are ideal): hypothyroid panel, comprehensive metabolic panel, vitamin d, hemogram, LH, FSH, 24 hr urine aldosterone.Any comments or feedback would be so appreciated! Thanks, SuzanneSent from my iPad See Dr Grim's ideal test.You cannot interpret the aldo/renin ratio without having a 24 hr urine Na. But maybe your health care team knows how to do this. If so they need to let us know.CE GrimMDWelcome to the exciting world of Hyperaldosteronism! You are in the right place! I am Dr. CE Grim a retired Professor of Medicine and Endocrinology. I have a long standing interest is Primary Aldosteronism since medical school days when I saw my first patient with Primary Aldosteronism in 1963. I trained with Dr. Conn in Endocrinology and Metabolism 1969-70 and have published over 240 papers and book chapters in most areas of the broad discipline of High Blood Pressure. My CV is in our files for details. The goal of our group is to teach you and your health care team about the ins and outs of the causes, diagnosis and control of the many forms of hyperaldosteronism. The steps below will introduce you into the fascinating world of high blood pressure, salt and potassium and the role of the adrenal hormone aldosterone in health and disease. Doing these in sequence will save you time and effort in getting up to speed in taking control of you health and educating your own health care team. While we can’t make you a doctor we will make you into a pretty good BP doctor-a skill that you will have for life. 1. A brief history of Primary Aldosteronsim and why it is so common today in drug resistant high blood pressure. Read my article in our files on the evolution of PA (Evolution_of_PA-Grim.pdf ) and take to all members of health care team. Tell us what stage you believe you are in. This is a brief review of most causes of hyperaldosteronism, high blood pressure, low potassium (K). 2. Read about other patients with hyperaldosteronism (Conn’s syndrome). Read our Conn's stories in our files and then give us your own in as much detail as you can. Dr. Conn was the first to describe this disease process and the syndrome is named after him.To see others' stories, on the Hyperaldosteronism home page, go to Files/Conn’s Stories. You'll find instructions in "A - How to put your story here.doc " First send us your story in an email and they we may have questions and suggestions before you upload it to our files. 3. DASH to lower your BP. Your and my tax dollars funded the most important series of studies on how to improve blood pressure, blood sugar, blood lipids and make your heart smaller: The DASH Eating Plan to control high blood pressure due to hyperaldosteronism and most others with high blood pressure. This will reduce your need for medications and in many will get your BP and K to goal without meds.. Get the DASH diet book by T. et al, (http://www.amazon.com/DASH-Diet-Hypertension--/dp/0743202953) read it and use it: ~$8 in paperback at your local bookstore or online. If they don’t have it ask them to order it for you. You can also get the hardback larger print version as well at Amazon. Learning to eat the DASH way will play a major role in your road to good BP and K control and, in many of our folks here, will revolutionize your life. See http://en.wikipedia.org/wiki/DASH_diet for an overview and more details. In the book go to chapter 9 and do the 14 day challenge. Tell your Dr you are doing this as your BP may plummet if you are on other meds. Measure your BP every day and post to us. or go to http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf download this 64 page booklet free and do the Week on the DASH Diet for 2 weeks. If you are on BP meds be prepared for a large fall in BP (20/10 mm Hg or more) and let your Dr. know you are doing this. And/Or go to (but costs money monthly) DASH Diet for Health Program (http://www.dashforhealth.com/pages/public/tour.php)The DASH Diet for Health Program is designed to help you improve your eating and exercise habits. Twice each week they will provide you with information on our website about food, food preparation, eating out, losing weight, getting fit and much more. In addition to providing new information each week on the website, they create a web page specially for you where you can track progress in areas such as your weight, blood pressure, and exercise. I strongly recommend you get this book and read it. 4. Measure your BP: Measure your BP daily so you can see if it is getting better. If you are taking meds be sure to tell your health care team you are doing this as your BP may plummet to normal quickly. We recommend you use a device you listen to and will help you learn how to do this. If this is not something you want to do we can teach a significant other how to do it. See sharedcareinc.com or email to sharedcare@... to order a video on how to do this. If you already have one we will teach you how to teach your health care team how to validate your device. Your life and health depends on accurate BP measurements. Go to the amricanheart.org and download the Guidelines for Human Blood Pressure Measurement. Insist the your health care team do BP the AHA way. Never trust your life to an automatic BP machine unless you know it is accurate on YOU. 5. Genetics and your BP: Go to familyhistory.hhs.gov and do your detailed family medical history so we can review with you to help Dx familial causes of high blood pressure and heart disease. If BP runs in your family you may save lives in your family by checking their BP yourself. 6. How to DX and treat PA: Go to our file/Conn's Articles of Note/Medications/Bravo spir 1973.pdf and read this article and take to your health care team. It is old but still one of the best in the medical management of PA. Also see our file from the Endocrine Society Guidelines on PA. Dr. Grim's Perfect Primary Aldosteronism Blood and Urine Testing to diagnose PA in one day. 1. Eat a regular to high salt diet for 2 weeks.2. No BP meds in last 4-12 weeks depending on meds.3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do not lose a drop of this liquid gold. It is impossible to interpret the renin and aldo without this.4. The morning you finish the 24 hr urine have fasting blood drawn for renin, aldo and K using our guidelines to get an accurate K. Try to get this done about 4 hours after you have been out of bed.5. Send us the results with the normal values for your lab.6. If you ever have a salt (saline) infusion test for PA be certain to ask them to measure how much you pee during the 4 hours of the infusion. If it is 1-1.5 liter of urine it strongly suggests that you may have PA. If more tha 1.5 L you almost certainly have PA. 8. Become a participant in our PA Registry and contribute to our large database on PA: If you have been Dxed with PA already and are on Rx or have had surgery please go to http://www.kwiksurveys.com/online-survey.php?surveyID=HIJIO_f2685379 and complete our survey with as much information as you know. If there is some information you don't know ask us and we will help. If you need to update this as you journey thru the diagnostic/treatment process you can add another entry but label it as Nameyymmdd. For example today 6/12/09 for me would be Grim090612. This ever increasing number will allow us and you to sort your multiple entries into a dated order. 9. Learn the language: If you are new to medical lingo then download the acroyms from http://health.groups.yahoo.com/group/bloodpressureline/message/2918610. Salt and high blood pressure: To learn the state of the science of salt and blood pressure please spend some time looking at http://www.worldactiononsalt.com/evidence/treatment_trials.htm11. Become a HBP expert consumer: Expect that it will take at least several weeks to get all this digested and to learn the new language of high blood pressure health care. As most doctors and nurses in practice have had very little training in high blood pressure you must become an expert yourself. For example most have never had anyone listen with them with a double stethoscope to verify that they can hear BP sounds. We cannot make you a doctor but we will make you a pretty good BP doctor.12. How High Blood Pressure should be managed: Go to nih.gov and download and read the Joint National Commission (JNC) Report 7 to get an overview on current guidelines. I ask all my secretaries to read this so they can communicate the importance of high blood pressure to my patients. JNC 8 will be out soon.Then: get (and study) the Hypertension Primer from americanheart.org. This is the most up-to-date compendium of what is known about high blood pressure and what every Dr. should know when they graduate from Medical School. Every chapter is only 2-3 pages. Read one chapter every week-night and you will finish it in about a year. I am working on a reading guide for lay people for the Primer. Stay tuned.13. Ask us questions: Ask any questions about high blood pressure you want answered. That is what we are here for. We have had this site for 10 years and over 30,000 emails are searchable. This is the largest collection of communications about Conn's Syndrome in the World. 14. One-on-one Consulting: I can provide individual consulting if you do not want to go public. If you want individual one-on-one consulting for you and your Doctor contract me directly at lowerbp2@....May your pressure be low!Clarence E. Grim BS, MS, MD, FACP, FACC, FAHABoard Certified in Internal Medicine, Geriatrics, and High Blood Pressure Retired Faculty/Professor of Medicine (U of MO, Indiana, UCLA/DREW, Medical College of Wisconsin and Cardiology, Endocrinology, Nephrology, and Epidemiology. Specializing in Primary Aldosteronism and Difficult to Control High Blood Pressure. I'm going in on Thursday for the following test: basic panel and serum aldosterone.Shouldn't there be a urine test? Are these test a waste of my time if I want real answers to why I have high aldosterone.What would be the ideal test? Please help I am feeling pressured for time! Thank youSent from my iPad Not that I know of or can make a connection to in my wildest Endocrine/Heme thoughs. But then another reason we need a good data base.Do you do data bases?CE Grim,MDIs there any connection between high aldosterone and low ferritin?Sent from my iPad If your BP and K is normal you may not need to DASH.Runners may have aldo if it was collected after a run.Drink when you are thirsty. A low Na suggests you are drinking too much.CE Grim MDCould I get some input on water intake? I tried searching the web-site about dashing but couldn't find what I was looking for.I know are bodies are constantly trying to keep things in balance so I feel like h2o consumption is just as important as sodium intake. However, I don't think I can assume the average 8 cups a day will be my norm.Here are a few things that I think might influence my sodium/h20 consumption: I have lowish serum sodium 138 (135-145), I have low blood pressure110/65, high aldosterone (24 hr urine 54.3 ( 17-44) and I am active ( runner)I feel it is reasonable that I keep my sodium intake at the higher end of the Dashing Diet , because of low sodium and low blood pressure and activity level, but I also want to try and lower aldosterone naturally ( if possible) and I'm hoping maybe it's a matter of the right amount of daily water and sodium consumption. Are there any right ratios for this? For example, if you consume 1,500 mg of sodium you should have 8 cups of h2o or maybe if you consume 2,300 mg of sodium you should shoot for 10 cups of h2o?Thanks so much! Really trying to get it right!Sent from my iPad Keep us posted. so you have high renin and high aldo and low K and low BP?CE Grim MDHi Dr. Grim, The following post grabbed my attention. I started following you and this site when I was thought to have primary hyperaldosteronism. I had all the expected abnormal lab results except for low to normal blood pressure. Eventually, labaratory results confirmed Bartters Syndrome and now I follow both yahoo groups. > > >>>>>>>>>> > > >>>>>>>>>>> > > >>>>>>>>>>> Hi everyone, just joined today. Thanks to all of you for this support!> > >>>>>>>>>>> > > >>>>>>>>>>> I tested high for aldosterone two years ago through a urine test. My ND at the time was not concerned, he thought it was due to the fact that I was a runner. I also thought that made since and was also following a low salt diet. So we ignored it.> > >>>>>>>>>>> > > >>>>>>>>>>> I am treAting a thyroid issue, thyroid hormone resistance, and through recent blood work tested high for aldosterone again. This time I decided not to ignore it! > > >>>>>>>>>>> > > >>>>>>>>>>> I do not have a high blood pressure. It runs pretty normal to low. I don't have issues with potassium. This is all Very confusing as to why I have high aldosterone.> > >>>>>>>>>>> > > >>>>>>>>>>> I am trying to get into a endocrinologist but will take about three months. I need some education and advise on where to start.> > >>>>>>>>>>> > > >>>>>>>>>>> I don't even know if this is primary or secondary.> > >>>>>>>>>>> > > >>>>>>>>>>> My only real "health" issue, that I know about, has been hair loss. This was one reason for exploring the thyroid but I am wondering if it has been the aldosterone all along. Maybe the aldosterone is what's causing my thyroid issues.> > >>>>>>>>>>> > > >>>>>>>>>>> Any comments or advice would be greatly appreciated.> > >>>>>>>>>>> > > >>>>>>>>>>> My labs:> > >>>>>>>>>>> > > >>>>>>>>>>> 9/26/2008> > >>>>>>>>>>> Aldosterone (urine)> > >>>>>>>>>>> High 54.3. (normal diet 6-25, low salt 17-44, high salt0-6)> > >>>>>>>>>>> > > >>>>>>>>>>> Other adrenal hormones were fine at that time. Cortisol was pretty middle of the road. *Progesterone however was really high too. I can post if necessary.> > >>>>>>>>>>> > > >>>>>>>>>>> Rbc potassium 7/14/2010> > >>>>>>>>>>> 97. (90-111)> > >>>>>>>>>>> > > >>>>>>>>>>> Blood aldosterone 7/18/2010> > >>>>>>>>>>> 52.0. (1-16)> > >>>>>>>>>>> > > >>>>>>>>>>> Blood aldosterone/renin 6/30/2010> > >>>>>>>>>>> Aldosterone 49. (1-16)> > >>>>>>>>>>> Renin. 3.3. (random ambulatory 0.8-2.5, non ambulatory 1.5-5.2)> > >>>>>>>>>>> I was sitting, fasting, taking two hours after waking before/around 8am> > >>>>>>>>>>> > > >>>>>>>>>>> Aldosterone renin ratio = 15> > >>>>>>>>>>> > > >>>>>>>>>>> Sodium. 138. (135-145)> > >>>>>>>>>>> Potassium. 4.5. (3.5-5.3)> > >>>>>>>>>>> Chloride. 106. (98-109)> > >>>>>>>>>>> Co2. 23. (22-31)> > >>>>>>>>>>> Anion gap. 9. (5-16)> > >>>>>>>>>>> > > >>>>>>>>>>> Saliva cortisol 5/23/2010> > >>>>>>>>>>> 7am. 3.7. (3.7-9.5)> > >>>>>>>>>>> 11am. 1.6. (1.2-3.0)> > >>>>>>>>>>> 5pm. 1.3. (0.6-1.9)> > >>>>>>>>>>> 9pm. 0.5. (0.4-1.0)> > >>>>>>>>>>> > > >>>>>>>>>>> Rbc magnesium 5/26/2010> > >>>>>>>>>>> 4.2. (4.0-6.4)> > >>>>>>>>>>> > > >>>>>>>>>>> Lot of test!!!!> > >>>>>>>>>>> > > >>>>>>>>>>> Thanks again for your kind support! Suzanne> > >>>>>>>>>>> > > >>>>>>>>>>> > > >>>>>>>>>> > > >>>>>>>>> > > >>>>>>>>> > > >>>>>>>> > > >>>>>>>> > > >>>>>>> > > >>>>>>> > > >>>>>> > > >>>>>> > > >>>>> > > >>>>> > > >>>> > > >>>> > > >>> > > >>> > > >> > > > > > >> >> > > Reply to sender |>

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On Dec 4, 2010, at 11:33 AM, Francis Bill SUSPECTED PA wrote:not much unless you eat all meat.but unless you have lots of previous urines say 10-14 previous 24 hr ones it is not possible to detect that.Your total urine 24 hr creat is related to your muscle mass.The concentration is driven by how much you drinkHow much you drink is driven by how your blood sodium concentrationThat is driven by the RAAS system.Or by supra-tentorial drives like the myth that 8 glasses of water a day is healthy. What goes in much go out. CE Grim MDDoesn't what you eat change creatinine as well?> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>> Hi everyone, > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> just joined today. Thanks to > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> all of you for this support!> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>> I tested > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> high for aldosterone two > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> years ago through a urine > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> test. My ND at the time was > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> not concerned, he thought it > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> was due to the fact that I > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> was a runner. I also thought > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> that made since and was also > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> following a low salt diet. > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> So we ignored it.> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>> I am > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> treAting a thyroid issue, > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> thyroid hormone resistance, > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> and through recent blood > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> work tested high for > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> aldosterone again. This time > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> I decided not to ignore it!> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>> I do not > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> have a high blood pressure. > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> It runs pretty normal to > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> low. I don't have issues > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> with potassium. This is all > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> Very confusing as to why I > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> have high aldosterone.> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>> I am trying > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> to get into a > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> endocrinologist but will > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> take about three months. I > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> need some education and > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> advise on where to start.> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>> I don't even > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> know if this is primary or > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> secondary.> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>> My only real > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> "health" issue, that I know > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> about, has been hair loss. > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> This was one reason for > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> exploring the thyroid but I > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> am wondering if it has been > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> the aldosterone all along. > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> Maybe the aldosterone is > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> what's causing my thyroid > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> issues.> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>> Any comments > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> or advice would be greatly > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> appreciated.> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>> My labs:> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>> 9/26/2008> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>> Aldosterone > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> (urine)> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>> High 54.3. > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> (normal diet 6-25, low salt > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> 17-44, high salt0-6)> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>> Other > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> adrenal hormones were fine > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> at that time. Cortisol was > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> pretty middle of the road. > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> *Progesterone however was > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> really high too. I can post > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> if necessary.> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>> Rbc > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> potassium 7/14/2010> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>> 97. (90-111)> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>> Blood > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> aldosterone 7/18/2010> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>> 52.0. (1-16)> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>> Blood > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> aldosterone/renin 6/30/2010> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>> Aldosterone > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> 49. (1-16)> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>> Renin. 3.3. > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> (random ambulatory 0.8-2.5, > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> non ambulatory 1.5-5.2)> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>> I was > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> sitting, fasting, taking two > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> hours after waking before/ > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> around 8am> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>> Aldosterone > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> renin ratio = 15> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>> Sodium. 138. > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> (135-145)> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>> Potassium. > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> 4.5. (3.5-5.3)> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>> Chloride. > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> 106. (98-109)> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>> Co2. 23. > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> (22-31)> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>> Anion gap. > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> 9. (5-16)> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>> Saliva > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> cortisol 5/23/2010> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>> 7am. 3.7. > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> (3.7-9.5)> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>> 11am. 1.6. > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> (1.2-3.0)> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>> 5pm. 1.3. > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> (0.6-1.9)> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>> 9pm. 0.5. > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> (0.4-1.0)> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>> Rbc > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> magnesium 5/26/2010> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>> 4.2. (4.0-6.4)> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>> Lot of > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> test!!!!> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>> Thanks again > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> for your kind support! Suzanne> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > Reply to sender |> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>> >>>>>>>>>>>>>>> >>>>>>>>>>>>>>> >>>>>>>>>>>>>> >>>>>>>>>>>>>> >>>>>>>>>>>>> >>>>>>>>>>>>> >>>>>>>>>>>> >>>>>>>>>>>> >>>>>>>>>>> >>>>>>>>>>> >>>>>>>>>> >>>>>>>>>> >>>>>>>>> >>>>>>>>> >>>>>>>> >>>>>>>> >>>>>>> >>>>>>> >>>>>> >>>>>> >>>>> >>>> >>>> >>> >>> >> >> >>

[Guest guest]

I just have to jump in here and add my 2 cents. Like you Suzanne, I have struggled with the difficulties of getting diagnosed and been to a lot of Dr. Dimwit's who treated my individual symptoms, but never looked for a causal relationship. Also, like you, I had to diagnose myself and demand the tests to prove my diagnosis. This has been a long and painful road with years of debilitating symptoms that have only begun to be addressed since joining this group and getting advice from Dr. Grim. Dr. Grim has been more than kind to me (and others) in giving of his time, advice and directions, but clearly, while he does that for humanitarian reasons, he should be paid for his hard won knowledge and time and effort spent on my behalf. Absolutely.Retaining his services for one year has been some of the best money I have

ever spent on doctors, and ultimately some of the least expensive. There is no way on earth that my doctors would have known to begin taking me off the 6 BP meds I was on, increase the Spiro to the dose it is and push me to DASH. They had no clue. Dr. Grim has consulted with my new Nephrologist and worked out that plan of action. Now that I'm thinking about it, he has more than earned his pay just by weaning me off all those expensive BP meds, which weren't working. His approach is working.Believe me, I do understand your frustration and anger over years of throwing good money after bad, and your mistrust of all medical professionals. It's a pretty lonely place to be when you are out there on your own with misdiagnoses and no hope of a resolution to your problem. All I can say is that if you are seeming to find some answers within the files of this group, then you are probably on the right track and Dr. Grim is probably

just the doctor you need as a guide and overseer. From my perspective his fee is an absolute bargain.DianneHi Dr. Grim, The following post grabbed my attention. I started following you and this site when I was thought to have primary hyperaldosteronism. I had all the expected abnormal lab results except for low to normal blood pressure. Eventually, labaratory results confirmed Bartters Syndrome and now I follow both yahoo groups. > > >>>>>>>>>> > > >>>>>>>>>>> > > >>>>>>>>>>> Hi everyone, just joined today.

Thanks to all of you for this support!> > >>>>>>>>>>> > > >>>>>>>>>>> I tested high for aldosterone two years ago through a urine test. My ND at the time was not concerned, he thought it was due to the fact that I was a runner. I also thought that made since and was also following a low salt diet. So we ignored it.> > >>>>>>>>>>> > > >>>>>>>>>>> I am treAting a thyroid issue, thyroid hormone resistance, and through recent blood work tested high for aldosterone again. This time I decided not to ignore it! > > >>>>>>>>>>> > >

>>>>>>>>>>> I do not have a high blood pressure. It runs pretty normal to low. I don't have issues with potassium. This is all Very confusing as to why I have high aldosterone.> > >>>>>>>>>>> > > >>>>>>>>>>> I am trying to get into a endocrinologist but will take about three months. I need some education and advise on where to start.> > >>>>>>>>>>> > > >>>>>>>>>>> I don't even know if this is primary or secondary.> > >>>>>>>>>>> > > >>>>>>>>>>> My only real "health" issue, that I know about,

has been hair loss. This was one

reason for exploring the thyroid but I am wondering if it has been the aldosterone all along. Maybe the aldosterone is what's causing my thyroid issues.> > >>>>>>>>>>> > > >>>>>>>>>>> Any comments or advice would be greatly appreciated.> > >>>>>>>>>>> > > >>>>>>>>>>> My labs:> > >>>>>>>>>>> > > >>>>>>>>>>> 9/26/2008> > >>>>>>>>>>> Aldosterone (urine)> > >>>>>>>>>>> High 54.3. (normal diet 6-25, low salt 17-44, high salt0-6)> >

>>>>>>>>>>> > > >>>>>>>>>>> Other adrenal hormones were fine at that time. Cortisol was pretty middle of the road. *Progesterone however was really high too. I can post if necessary.> > >>>>>>>>>>> > > >>>>>>>>>>> Rbc potassium 7/14/2010> > >>>>>>>>>>> 97. (90-111)> > >>>>>>>>>>> > > >>>>>>>>>>> Blood aldosterone 7/18/2010> > >>>>>>>>>>> 52.0. (1-16)> > >>>>>>>>>>> > >

>>>>>>>>>>> Blood aldosterone/renin 6/30/2010> > >>>>>>>>>>> Aldosterone 49. (1-16)> > >>>>>>>>>>> Renin. 3.3. (random ambulatory 0.8-2.5, non ambulatory 1.5-5.2)> > >>>>>>>>>>> I was sitting, fasting, taking two hours after waking before/around 8am> > >>>>>>>>>>> > > >>>>>>>>>>> Aldosterone renin ratio = 15> > >>>>>>>>>>> > > >>>>>>>>>>> Sodium. 138. (135-145)> > >>>>>>>>>>> Potassium. 4.5. (3.5-5.3)> > >>>>>>>>>>>

Chloride. 106. (98-109)>

> >>>>>>>>>>> Co2. 23. (22-31)> > >>>>>>>>>>> Anion gap. 9. (5-16)> > >>>>>>>>>>> > > >>>>>>>>>>> Saliva cortisol 5/23/2010> > >>>>>>>>>>> 7am. 3.7. (3.7-9.5)> > >>>>>>>>>>> 11am. 1.6. (1.2-3.0)> > >>>>>>>>>>> 5pm. 1.3. (0.6-1.9)> > >>>>>>>>>>> 9pm. 0.5. (0.4-1.0)> > >>>>>>>>>>> > > >>>>>>>>>>> Rbc magnesium 5/26/2010> > >>>>>>>>>>> 4.2. (4.0-6.4)> >

>>>>>>>>>>> > > >>>>>>>>>>> Lot of test!!!!> > >>>>>>>>>>> > > >>>>>>>>>>> Thanks again for your kind support! Suzanne> > >>>>>>>>>>> > > >>>>>>>>>>> > > >>>>>>>>>> > > >>>>>>>>> > > >>>>>>>>> > > >>>>>>>> > > >>>>>>>> > > >>>>>>> > > >>>>>>> > > >>>>>> > > >>>>>> > > >>>>> > > >>>>> > > >>>> > >

>>>> > > >>> > > >>> > > >> > > > > > >> >> > > Reply to sender |>

[Guest guest]

Thanks for the feed back. Ah I forgot the cost of drugs as a benefit.CE Grim MDI just have to jump in here and add my 2 cents. Like you Suzanne, I have struggled with the difficulties of getting diagnosed and been to a lot of Dr. Dimwit's who treated my individual symptoms, but never looked for a causal relationship. Also, like you, I had to diagnose myself and demand the tests to prove my diagnosis. This has been a long and painful road with years of debilitating symptoms that have only begun to be addressed since joining this group and getting advice from Dr. Grim. Dr. Grim has been more than kind to me (and others) in giving of his time, advice and directions, but clearly, while he does that for humanitarian reasons, he should be paid for his hard won knowledge and time and effort spent on my behalf. Absolutely.Retaining his services for one year has been some of the best money I have ever spent on doctors, and ultimately some of the least expensive. There is no way on earth that my doctors would have known to begin taking me off the 6 BP meds I was on, increase the Spiro to the dose it is and push me to DASH. They had no clue. Dr. Grim has consulted with my new Nephrologist and worked out that plan of action. Now that I'm thinking about it, he has more than earned his pay just by weaning me off all those expensive BP meds, which weren't working. His approach is working.Believe me, I do understand your frustration and anger over years of throwing good money after bad, and your mistrust of all medical professionals. It's a pretty lonely place to be when you are out there on your own with misdiagnoses and no hope of a resolution to your problem. All I can say is that if you are seeming to find some answers within the files of this group, then you are probably on the right track and Dr. Grim is probably just the doctor you need as a guide and overseer. From my perspective his fee is an absolute bargain.DianneHi Dr. Grim, The following post grabbed my attention. I started following you and this site when I was thought to have primary hyperaldosteronism. I had all the expected abnormal lab results except for low to normal blood pressure. Eventually, labaratory results confirmed Bartters Syndrome and now I follow both yahoo groups. > > >>>>>>>>>> > > >>>>>>>>>>> > > >>>>>>>>>>> Hi everyone, just joined today. Thanks to all of you for this support!> > >>>>>>>>>>> > > >>>>>>>>>>> I tested high for aldosterone two years ago through a urine test. My ND at the time was not concerned, he thought it was due to the fact that I was a runner. I also thought that made since and was also following a low salt diet. So we ignored it.> > >>>>>>>>>>> > > >>>>>>>>>>> I am treAting a thyroid issue, thyroid hormone resistance, and through recent blood work tested high for aldosterone again. This time I decided not to ignore it! > > >>>>>>>>>>> > > >>>>>>>>>>> I do not have a high blood pressure. It runs pretty normal to low. I don't have issues with potassium. This is all Very confusing as to why I have high aldosterone.> > >>>>>>>>>>> > > >>>>>>>>>>> I am trying to get into a endocrinologist but will take about three months. I need some education and advise on where to start.> > >>>>>>>>>>> > > >>>>>>>>>>> I don't even know if this is primary or secondary.> > >>>>>>>>>>> > > >>>>>>>>>>> My only real "health" issue, that I know about, has been hair loss. This was one reason for exploring the thyroid but I am wondering if it has been the aldosterone all along. Maybe the aldosterone is what's causing my thyroid issues.> > >>>>>>>>>>> > > >>>>>>>>>>> Any comments or advice would be greatly appreciated.> > >>>>>>>>>>> > > >>>>>>>>>>> My labs:> > >>>>>>>>>>> > > >>>>>>>>>>> 9/26/2008> > >>>>>>>>>>> Aldosterone (urine)> > >>>>>>>>>>> High 54.3. (normal diet 6-25, low salt 17-44, high salt0-6)> > >>>>>>>>>>> > > >>>>>>>>>>> Other adrenal hormones were fine at that time. Cortisol was pretty middle of the road. *Progesterone however was really high too. I can post if necessary.> > >>>>>>>>>>> > > >>>>>>>>>>> Rbc potassium 7/14/2010> > >>>>>>>>>>> 97. (90-111)> > >>>>>>>>>>> > > >>>>>>>>>>> Blood aldosterone 7/18/2010> > >>>>>>>>>>> 52.0. (1-16)> > >>>>>>>>>>> > > >>>>>>>>>>> Blood aldosterone/renin 6/30/2010> > >>>>>>>>>>> Aldosterone 49. (1-16)> > >>>>>>>>>>> Renin. 3.3. (random ambulatory 0.8-2.5, non ambulatory 1.5-5.2)> > >>>>>>>>>>> I was sitting, fasting, taking two hours after waking before/around 8am> > >>>>>>>>>>> > > >>>>>>>>>>> Aldosterone renin ratio = 15> > >>>>>>>>>>> > > >>>>>>>>>>> Sodium. 138. (135-145)> > >>>>>>>>>>> Potassium. 4.5. (3.5-5.3)> > >>>>>>>>>>> Chloride. 106. (98-109)> > >>>>>>>>>>> Co2. 23. (22-31)> > >>>>>>>>>>> Anion gap. 9. (5-16)> > >>>>>>>>>>> > > >>>>>>>>>>> Saliva cortisol 5/23/2010> > >>>>>>>>>>> 7am. 3.7. (3.7-9.5)> > >>>>>>>>>>> 11am. 1.6. (1.2-3.0)> > >>>>>>>>>>> 5pm. 1.3. (0.6-1.9)> > >>>>>>>>>>> 9pm. 0.5. (0.4-1.0)> > >>>>>>>>>>> > > >>>>>>>>>>> Rbc magnesium 5/26/2010> > >>>>>>>>>>> 4.2. (4.0-6.4)> > >>>>>>>>>>> > > >>>>>>>>>>> Lot of test!!!!> > >>>>>>>>>>> > > >>>>>>>>>>> Thanks again for your kind support! Suzanne> > >>>>>>>>>>> > > >>>>>>>>>>> > > >>>>>>>>>> > > >>>>>>>>> > > >>>>>>>>> > > >>>>>>>> > > >>>>>>>> > > >>>>>>> > > >>>>>>> > > >>>>>> > > >>>>>> > > >>>>> > > >>>>> > > >>>> > > >>>> > > >>> > > >>> > > >> > > > > > >> >> > > Reply to sender |>

[Guest guest]

Thanks more layer todayTiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

so what's the support group for?Sent from my iPad

Once again this is what I get paid for. Contact me at lowerbp2@... for details of accessing my expertise for a year for only $500.CE Grim MDThanks!!Would

you mind explaining the difference between the creatinine random urine and the creatinine quantitative urine? I am concerned that my creat. rand is low meaning kidney trouble.I have been sitting here "researching" this for an hour or so and can't find an explanation.I won't been able to see my doctor until the end of this month and even then I don't think she is well educated in this area.I really wanted to rule out any kidney issues before December 28th.Thanks for your time and input! SuzanneSent from my iPad I assume

your Dr. gets paid for doing this sort of interpretation.I can do it one on one for a fee. They all look good to me.CE Grim MDI have some test results back that are worrying me. I don't have all the results so I will post them as I get them. Right now I am

concerned with what my creatinine levels mean. Please help!!!Blood creatinineCREAT 0.77 (0.44-1.00)BUN 14 (6-20)urine creatinine (there were two results for this)CREAT,RAND UR 40.86 L (80.00-170 mg./dl)CREAT, UR QUANT 1.0 (0.6-1.8 gm./dy)Should I be worried about the low CREAT, RAND UR?????THANKS, SUZANNESent from my iPadOn Dec 3, 2010, at 7:21 AM, Clarence Grim

wrote: It varies. Do a pubmed.CE Grim MDWhat significance does our menstrual cycle play in blood pressure?During my luteal phase my blood pressure ranges from

115/65 to 120/75 but then once menses begins i run a lot lower 90/60.I am in the process of doing the 24 hour urine. should have those numbers in a few days.thanks,suzanneSent from my iPad Yea but you usually are an alcoholic who does not each much or cancer pt who cannot eat and is starving. CE Grim MDI have read that a magnesium deficiency can cause low K.Sent from my iPad Better to DASH I would think.If you can get it in food why take a pill?CE Grim MDare you

serious? I am asking if I should take a b vitamin supplement?Sent from my iPad Still no question?CE Grim MD Was there a question here?Hi Dr. Grim,Is it recommended to take a b-complex vitamin?I have been holding off from taking mine (complete b-complex from life extension) because i am afraid it might encourage more aldosterone production! Am I crazy for worrying about this? I know the adrenals love b vitamins and I don't need anything that will cause me to produce more aldosterone. However, I know for a woman of my age and activity level that the b's are very important and could really benefit my body!!Thanks,

SuzanneSent from my iPad They are all competitors for the receptors but I

do not know the measures of association that permits one to quantitate the relative effect of aldo in occupying each of the receptors. Also they circulate in much greater quantities that aldo as I recall. So the effect would seem likely to be weak.CE Grim MD Hi Dr. Grim, I wanted to ask if high aldosterone levels will block progesterone, testosterone, and estrogen receptors? Thanks, SuzanneTo: hyperaldosteronism Cc: Clarence Grim Sent: Sun, November 7, 2010 7:36:01 PMSubject: Re:

Re: 42 yo woman runner who has had aldo 52 and renin 3.3 normal bp That's what this paper says. No one has looked at in anymore detail that I can find.CE Grim MDOk, by doing this it will be ok to test

any time of my cycle?Sent from my iPadOn Nov 7, 2010, at 6:02 PM, Clarence Grim

wrote: Ask your lab to use plasma renin activity not direct renin assay.CE Grim MDThis is the article I did read. I didn't feel like it gave a definitive

answer. I have read it is best to test aldosterone on the third day of the menstrual cycle but not sure how that will go seeing it is a urine test and not a simple blood draw. Any advice would be greatly appreciated. ThanksSent from my iPad Guess you did not search aldosterone renin ratio.Here is one.J Clin Endocrinol Metab. 2010 Oct 20. [Epub ahead of print]Are Women More at Risk of False-Positive Primary Aldosteronism Screening and Unnecessary Suppression Testing than Men?Ahmed AH, Gordon RD, PJ, Ward G, Pimenta E, Stowasser M.Endocrine Hypertension Research Centre (A.H.A., R.D.G., P.J.T., E.P., M.S.), University of Queensland School of Medicine, Greenslopes and Princess andra Hospitals, Brisbane, Queensland 4102, Australia; and Sullivan and Nicolaides Pathology (G.W.), Brisbane, 4068 Queensland, Australia.AbstractBackground: Because primary aldosteronism is not uncommon, specifically treatable and in some cases curable, and carries higher risks for cardiovascular morbidity and mortality than essential

hypertension, screening hypertensive patients for its presence by measuring aldosterone to renin ratio (ARR) is increasingly common. A significantly higher false-positive ARR rate for women than men, resulting in unnecessary suppression tests has previously been reported. Methods: Using a new, highly accurate aldosterone assay and both of the currently widely used renin assays, ARR was measured in 19 normal, ovulating women at three time points in the menstrual cycle and compared with single measurements in 21 normal males of similar age. Results: ARRs in males were possibly too well down in the current normal range. Although normotensive and normokalemic, two women had raised ARRs in the luteal phase but only when direct renin concentration (DRC) was used. Their DRC levels were low at all sampling times [despite midrange plasma renin activity levels], whereas their progesterone and aldosterone levels were highest for the group. Saline suppression

testing, performed in one of them, showed normal aldosterone suppressibility. Conclusion: False-positive ARRs in normal women during the luteal phase only when DRC is used may explain the higher incidence of false-positive ARRs in hypertensive women than men and suggest the following: 1) plasma renin activity is preferable to DRC in determination of ARR and 2) new reference ranges for ARR that take into account gender and sex hormone levels are required.Thanks, I did do some reading on pubmed like you suggested about testing and menses but never came up with an answer. Hoping you had the answer. I know aldosterone is naturally higher during the luteal phase but I only want to do this once and I want to get it exactly right . Sent from my iPad I think I sent an abstract recently on menses and testing. If you cant find it let me know.Dr. Grim's Perfect Primary

Aldosteronism Blood and Urine Testing to diagnose PA in one day. 1. Eat a regular to high salt diet for 2 weeks.2. No BP meds in last 4-12 weeks depending on meds.3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do not lose a drop of this liquid gold. It is impossible to interpret the renin and aldo without this.4. The morning you finish the 24 hr urine have fasting blood drawn for renin, aldo and K using our guidelines to get an accurate K. Try to get this done about 4 hours after you have been out of bed.5. Send us the results with the normal values for your lab.6. If you ever have a salt (saline) infusion test for PA be certain to ask them to measure how much

you pee during the 4 hours of the infusion. If it is 1-1.5 liter of urine it strongly suggests that you may have PA. If more tha 1.5 L you almost certainly have PA. Hi, I am calling my Natural Path tomorrow to have her order test to

see if we can figure out why I have high alodsterone. Here are the test I am requesting: (PLEASE LET ME KNOW IF I AM MISSING SOMETHING) -24 hour urine NA, K, Creatinine, Aldosterone -blood draw Renin, Aldosterone, and K Anything else????Also where can I get the info on how to collect K correctly?See our files on how to draw blood.One last question, when during my menstrual cycle is the best time to do these test?'see a recent email re this issue.Thanks so much for you time, SuzanneTo: hyperaldosteronism Cc: Clarence Grim Sent: Fri, November 5, 2010 7:04:29 AMSubject: Re: Re: 42 yo woman runner who has had aldo 52 and renin 3.3 normal bp your team is who you have decided you want to manage your health. Can a Natural Path write prescriptions and order blood tests?CE Grim MDWhat if I don't have a team? Or do you consider a Natural Path my team?Sent from my iPad yes I can work with your team for $500 per year.CE Grim MDHi Dr Grim , I agree I am afraid I am going to make this 400 mile trip and get nowhere! I don't have a dr other than a Natural Path. Can you be my dr and take care of all of this online?Sent from my iPad she does not seem to understand PA as she did not order a renin.CE Grim MDSend her my article on the evolution of PA and the Endo guidelines in our files---BEFORE you see her. You want to know how many PAs she has treated and followed for at least 10 years.CE Grim MDThanks for the info. I am so frustrated with dr's in my area. It seems NO one knows the correct test around here! My natural path is very willing to order the test but she's the first one to admit that she won't know what to do with the results.I live in Whitefish, Montana and Kalispell is about 15 minutes away. Missoula is about 200 miles but I would drive it if someone could make a recommendation ( preferably first hand experience). I am doing Dr. grimes ideal test in December and then at the end of December I am scheduled to see an endocrinologist in Missoula. I don't have faith that the

endo knows much about hyperaldosteronism but at this point she is my only hope. This endo's name is Dr. Eyler. She has ordered the following test ( which I don't believe are ideal): hypothyroid panel, comprehensive metabolic panel, vitamin d, hemogram, LH, FSH, 24 hr urine aldosterone.Any comments or feedback would be so appreciated! Thanks, SuzanneSent from my iPad See Dr Grim's ideal test.You cannot interpret the aldo/renin ratio without having a 24 hr urine Na. But maybe your health care team knows how to do this. If so they need to let us know.CE GrimMDWelcome to the exciting world of Hyperaldosteronism! You are in the right place! I am Dr. CE Grim a retired Professor of Medicine and Endocrinology. I have a long standing interest is Primary Aldosteronism since medical school days when I saw my first patient with Primary Aldosteronism in 1963. I trained with Dr. Conn in Endocrinology and Metabolism 1969-70 and have published over 240 papers and book chapters in most areas of the broad discipline of High Blood Pressure. My CV is in our files for

details. The goal of our group is to teach you and your health care team about the ins and outs of the causes, diagnosis and control of the many forms of hyperaldosteronism. The steps below will introduce you into the fascinating world of high blood pressure, salt and potassium and the role of the adrenal hormone aldosterone in health and disease. Doing these in sequence will save you time and effort in getting up to speed in taking control of you health and educating your own health care team. While we can’t make you a doctor we will make you into a pretty good BP doctor-a skill that you will have for life. 1. A brief history of Primary Aldosteronsim and why it is so common today in drug resistant high blood pressure. Read my article in our files on the

evolution of PA (Evolution_of_PA-Grim.pdf ) and take to all members of health care team. Tell us what stage you believe you are in. This is a brief review of most causes of hyperaldosteronism, high blood pressure, low potassium (K). 2. Read about other patients with hyperaldosteronism (Conn’s syndrome). Read our Conn's stories in our files and then give us your own in as much detail as you can. Dr. Conn was the first to describe this disease process and the syndrome is named after him.To see others' stories, on the Hyperaldosteronism home page, go to Files/Conn’s Stories. You'll find instructions in "A - How to put your story here.doc " First send us your story in an email and they we may have questions and suggestions before you upload it to our files. 3. DASH to lower your BP.

Your and my tax dollars funded the most important series of studies on how to improve blood pressure, blood sugar, blood lipids and make your heart smaller: The DASH Eating Plan to control high blood pressure due to hyperaldosteronism and most others with high blood pressure. This will reduce your need for medications and in many will get your BP and K to goal without meds.. Get the DASH diet book by T. et al, (http://www.amazon.com/DASH-Diet-Hypertension--/dp/0743202953) read it and use it: ~$8 in paperback at your local bookstore or online. If they don’t have it ask them to order it for you. You can also get the hardback larger print version as well at Amazon.

Learning to eat the DASH way will play a major role in your road to good BP and K control and, in many of our folks here, will revolutionize your life. See http://en.wikipedia.org/wiki/DASH_diet for an overview and more details. In the book go to chapter 9 and do the 14 day challenge.

Tell your Dr you are doing this as your BP may plummet if you are on other meds. Measure your BP every day and post to us. or go to http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf download this 64 page booklet free and do the Week on the DASH Diet for 2 weeks. If you are on BP meds be prepared for a large fall in BP (20/10 mm Hg or more) and let your Dr. know you are doing this. And/Or go to (but costs money monthly) DASH Diet for Health Program (http://www.dashforhealth.com/pages/public/tour.php)The DASH Diet for Health Program is designed to help you improve your eating and exercise habits. Twice each week they will provide you with information on our website about food, food preparation, eating out, losing weight, getting fit and much more. In addition to providing new information each week on the website, they create a web page

specially for you where you can track progress in areas such as your weight, blood pressure, and exercise. I strongly recommend you get this book and read it. 4. Measure your BP: Measure your BP daily so you can see if it is getting better. If you are taking meds be sure to tell your health care team you are doing this as your BP may plummet to normal quickly. We recommend you use a device you listen to and will help you learn how to do this. If this is not something you want to do we can teach a significant other how to do it. See sharedcareinc.com or email to sharedcare@... to order a video on how to do this. If you already have one we will teach you how to teach your health care team how to validate your device. Your life and health depends on accurate BP measurements. Go to the amricanheart.org and download the Guidelines for Human Blood Pressure Measurement. Insist the your health care team do BP the AHA way. Never trust your life to an automatic BP machine unless you know it is accurate on YOU. 5. Genetics and your BP: Go to familyhistory.hhs.gov and do your detailed family medical history so we can review with you to help Dx familial causes of high blood pressure and heart disease. If BP runs in your family you may save lives in your family by checking their BP yourself. 6. How to DX and treat PA: Go to our file/Conn's Articles of Note/Medications/Bravo spir 1973.pdf and read this

article and take to your health care team. It is old but still one of the best in the medical management of PA. Also see our file from the Endocrine Society Guidelines on PA. Dr. Grim's Perfect Primary Aldosteronism Blood and Urine Testing to diagnose PA in one day. 1. Eat a regular to high salt diet for 2 weeks.2. No BP meds in last 4-12 weeks depending on meds.3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do not lose a drop of this liquid gold. It is impossible to interpret the renin and aldo without this.4. The morning you finish the 24 hr urine have fasting blood drawn for renin, aldo and K using our guidelines to get an accurate K. Try to get this done about 4 hours after you have been out of bed.5. Send us the results with the normal values for your lab.6. If

you ever have a salt (saline) infusion test for PA be certain to ask them to measure how much you pee during the 4 hours of the infusion. If it is 1-1.5 liter of urine it strongly suggests that you may have PA. If more tha 1.5 L you almost certainly have PA. 8. Become a participant in our PA Registry and contribute to our large database on PA: If you have been Dxed with PA already and are on Rx or have had surgery please go to http://www.kwiksurveys.com/online-survey.php?surveyID=HIJIO_f2685379 and complete our survey with as much information as you know. If there is some information you don't know ask us and we will help. If you need to update this as you journey thru the

diagnostic/treatment process you can add another entry but label it as Nameyymmdd. For example today 6/12/09 for me would be Grim090612. This ever increasing number will allow us and you to sort your multiple entries into a dated order. 9. Learn the language: If you are new to medical lingo then download the acroyms from http://health.groups.yahoo.com/group/bloodpressureline/message/2918610. Salt and high blood pressure: To learn the state of the science of salt and blood pressure please spend some time looking at http://www.worldactiononsalt.com/evidence/treatment_trials.htm11. Become a HBP expert

consumer: Expect that it will take at least several weeks to get all this digested and to learn the new language of high blood pressure health care. As most doctors and nurses in practice have had very little training in high blood pressure you must become an expert yourself. For example most have never had anyone listen with them with a double stethoscope to verify that they can hear BP sounds. We cannot make you a doctor but we will make you a pretty good BP doctor.12. How High Blood Pressure should be managed: Go to nih.gov and download and read the Joint National Commission (JNC) Report 7 to get an

overview on current guidelines. I ask all my secretaries to read this so they can communicate the importance of high blood pressure to my patients. JNC 8 will be out soon.Then: get (and study) the Hypertension Primer from americanheart.org. This is the most up-to-date compendium of what is known about high blood pressure and what every Dr. should know when they graduate from Medical School. Every chapter is only 2-3 pages. Read one chapter every week-night and you will finish it in about a year. I am working on a reading guide for lay people for the Primer. Stay

tuned.13. Ask us questions: Ask any questions about high blood pressure you want answered. That is what we are here for. We have had this site for 10 years and over 30,000 emails are searchable. This is the largest collection of communications about Conn's Syndrome in the World. 14. One-on-one Consulting: I can provide individual consulting if you do not want to go public. If you want individual one-on-one consulting for you and your Doctor contract me directly at lowerbp2@....May your pressure be low!Clarence E. Grim BS, MS, MD, FACP, FACC, FAHABoard Certified in Internal Medicine, Geriatrics, and High Blood Pressure Retired Faculty/Professor of Medicine (U of MO, Indiana, UCLA/DREW, Medical College of Wisconsin and Cardiology, Endocrinology, Nephrology, and Epidemiology. Specializing in Primary Aldosteronism and Difficult to Control

High Blood Pressure. I'm going in on Thursday for the following test: basic panel and serum aldosterone.Shouldn't there be a urine test? Are these

test a waste of my time if I want real answers to why I have high aldosterone.What would be the ideal test? Please help I am feeling pressured for time! Thank youSent from my iPadOn Nov 1, 2010, at 8:02 PM, Clarence Grim

wrote: Not that I know of or can make a connection to in my wildest Endocrine/Heme thoughs. But then another reason we need a good data base.Do you do data bases?CE Grim,MDIs there any connection between high aldosterone and low ferritin?Sent from my iPad If your BP and K is normal you may not need to DASH.Runners may have aldo if it was collected after a run.Drink when you are thirsty. A low Na suggests you are drinking too much.CE Grim MDCould I get some input on water intake? I tried searching the web-site about dashing but couldn't find what I was looking for.I know are bodies are constantly trying to keep things in balance so I feel like h2o consumption is just as important as sodium intake. However, I don't think I can assume the average 8 cups a day will be my norm.Here are a few things that I think might influence my sodium/h20 consumption: I have lowish serum sodium 138 (135-145), I have low blood pressure110/65, high aldosterone (24 hr urine 54.3 ( 17-44) and I am active ( runner)I feel it is reasonable that I keep my sodium intake at the higher end of the Dashing Diet , because of low sodium and low blood pressure and activity level, but I also want

to try and lower aldosterone naturally ( if possible) and I'm hoping maybe it's a matter of the right amount of daily water and sodium consumption. Are there any right ratios for this? For example, if you consume 1,500 mg of sodium you should have 8 cups of h2o or maybe if you consume 2,300 mg of sodium you should shoot for 10 cups of h2o?Thanks so much! Really trying to get it right!Sent from my iPad Keep us posted. so you have high renin and high aldo and low K and low BP?CE Grim MDHi Dr. Grim, The following post grabbed my attention. I started following you and this site when I was thought to have primary hyperaldosteronism. I had all the expected abnormal lab results except for low to normal blood pressure. Eventually, labaratory results confirmed Bartters Syndrome and now I follow both yahoo groups. > > >>>>>>>>>> > > >>>>>>>>>>> > > >>>>>>>>>>> Hi everyone, just joined today.

Thanks to all of you for this support!> > >>>>>>>>>>> > > >>>>>>>>>>> I tested high for aldosterone two years ago through a urine test. My ND at the time was not concerned, he thought it was due to the fact that I was a runner. I also thought that made since and was also following a low salt diet. So we ignored it.> > >>>>>>>>>>> > > >>>>>>>>>>> I am treAting a thyroid issue, thyroid hormone resistance, and through recent blood work tested high for aldosterone again. This time I decided not to ignore it! > > >>>>>>>>>>> > >

>>>>>>>>>>> I do not have a high blood pressure. It runs pretty normal to low. I don't have issues with potassium. This is all Very confusing as to why I have high aldosterone.> > >>>>>>>>>>> > > >>>>>>>>>>> I am trying to get into a endocrinologist but will take about three months. I need some education and advise on where to start.> > >>>>>>>>>>> > > >>>>>>>>>>> I don't even know if this is primary or secondary.> > >>>>>>>>>>> > > >>>>>>>>>>> My only real "health" issue, that I know about, has been hair loss. This was one

reason for exploring the thyroid but I am wondering if it has been the aldosterone all along. Maybe the aldosterone is what's causing my thyroid issues.> > >>>>>>>>>>> > > >>>>>>>>>>> Any comments or advice would be greatly appreciated.> > >>>>>>>>>>> > > >>>>>>>>>>> My labs:> > >>>>>>>>>>> > > >>>>>>>>>>> 9/26/2008> > >>>>>>>>>>> Aldosterone (urine)> > >>>>>>>>>>> High 54.3. (normal diet 6-25, low salt 17-44, high salt0-6)> >

>>>>>>>>>>> > > >>>>>>>>>>> Other adrenal hormones were fine at that time. Cortisol was pretty middle of the road. *Progesterone however was really high too. I can post if necessary.> > >>>>>>>>>>> > > >>>>>>>>>>> Rbc potassium 7/14/2010> > >>>>>>>>>>> 97. (90-111)> > >>>>>>>>>>> > > >>>>>>>>>>> Blood aldosterone 7/18/2010> > >>>>>>>>>>> 52.0. (1-16)> > >>>>>>>>>>> > >

>>>>>>>>>>> Blood aldosterone/renin 6/30/2010> > >>>>>>>>>>> Aldosterone 49. (1-16)> > >>>>>>>>>>> Renin. 3.3. (random ambulatory 0.8-2.5, non ambulatory 1.5-5.2)> > >>>>>>>>>>> I was sitting, fasting, taking two hours after waking before/around 8am> > >>>>>>>>>>> > > >>>>>>>>>>> Aldosterone renin ratio = 15> > >>>>>>>>>>> > > >>>>>>>>>>> Sodium. 138. (135-145)> > >>>>>>>>>>> Potassium. 4.5. (3.5-5.3)> > >>>>>>>>>>> Chloride. 106. (98-109)>

> >>>>>>>>>>> Co2. 23. (22-31)> > >>>>>>>>>>> Anion gap. 9. (5-16)> > >>>>>>>>>>> > > >>>>>>>>>>> Saliva cortisol 5/23/2010> > >>>>>>>>>>> 7am. 3.7. (3.7-9.5)> > >>>>>>>>>>> 11am. 1.6. (1.2-3.0)> > >>>>>>>>>>> 5pm. 1.3. (0.6-1.9)> > >>>>>>>>>>> 9pm. 0.5. (0.4-1.0)> > >>>>>>>>>>> > > >>>>>>>>>>> Rbc magnesium 5/26/2010> > >>>>>>>>>>> 4.2. (4.0-6.4)> >

>>>>>>>>>>> > > >>>>>>>>>>> Lot of test!!!!> > >>>>>>>>>>> > > >>>>>>>>>>> Thanks again for your kind support! Suzanne> > >>>>>>>>>>> > > >>>>>>>>>>> > > >>>>>>>>>> > > >>>>>>>>> > > >>>>>>>>> > > >>>>>>>> > > >>>>>>>> > > >>>>>>> > > >>>>>>> > > >>>>>> > > >>>>>> > > >>>>> > > >>>>> > > >>>> > > >>>> > > >>> > > >>> > > >> > > > > > >> >> > > Reply to sender |>

[Guest guest]

Hi Meredith,Thank you for your support and kind words of encouragement!I have been doing this for four years now and haven't given up yet, but it is getting harder to pick myself back up when I take a hit!Anyway, I wanted to ask how your situation turned out? Are you know feeling good and back to running?SuzanneSent from my iPad

I am adding my two cents as well! I am so sorry for what you have been thru. Your story especially touched me because I was a 42 y/o runner when I became ill as well. I also happen to be a podiatric surgeon and have great health insurance. However, I have still spent upwards of $6000.00 out of pocket in the past 2 years searching for answers.

Furthermore, I might add that I have full access to all kinds of doctors all day long!! I went to the NIH, Dartmouth, the Beth Israel, Maine Medical Center, Mercy Hospital, Cleveland Clinic, and most recently, Case Western Reserve University (from which I graduated). What I have learned has mostly been self taught. This is a very complicated and "uncommon" disease. I had lots of great caring doctors who simply didn't have the experience to help me. What has helped, is letting go of the frustration (as much as possible) and following Dr. Grim's advice on DASHing and lab tests. Also, you must never ever ever give up.

I absolutely agree with paying him to get more information! The only reason I haven't retained his services is because, now that he has led me to the correct diagnosis, I can get help up here in the Northeast. I also had help from a member named Larry who referred me to a specialist at the Brigham and Womens.

So KEEP THE FAITH!! Yes, you DO have to advocate for yourself! And, I am a firm believer, you do get what you pay for and the universe reflects back onto us what we are putting out there. So let's all put this in the positive - it's the greatest thing that ever happened!

God Bless and good luck - keep going until you find the right doctor for you.

[Guest guest]

Hi everybody,I have some recent labs I would like to post. The results are very different from what they had been in the past. My past labs were always done salt fasting for at least a day. The labs I will post today were done following Dr. Grim/support group guidelines.I would love to hear any input. BLOOD ( my sodium intake the day before was around 2100mg) I was sitting upright for the blood draw)-aldosterone 22 (*standing reference range 4-31) (* recumbent 1-16)-renin 1.4 (random ambulatory 0.8-2.5) (random non ambulatory

1.5-5.2)aldost/renin ratio= 16-creat. 0.77 (0.44-1.00)-NA 138 (135-145)-K 4.2 (3.5-5.0)24 HOUR URINE RESULTS -done the day before blood drawsodium, timed 102 (40-220)NA,random ur 40(k) no ref.creat. random 40.86 L (80.-170)creat. ur quant 1.0 (0.6-1.8)POT. ur per day 45.9 (25.0-150)K+, rand ur 18(k) no ref.aldosterone 15.8 (normal sodium intake 6-25)creat,ur 24hr 1096 (700-1600)Thank you! Dr Grim I would be happy to pay you for your time

reviewing these! Suzanne Sent from my iPad

Hi Dr. Grim,I have been giving all of this some thought and have come up with a proposal for you.Would you considered looking over my labs for a fee smaller than $500.00 and after reviewing them if it looks as if I will need your help for a year then I will pay the full $500.00?The reason I ask to do it this way is because I have not been diagnosed with Hyperaldosteronism and question whether this is really even an issue for me. I don't have most of the issues most have here like high blood pressure, I am not on any meds other than thyroid, and from what I can tell from my labs I am not low on potassium. I do however always come up high on aldosterone. My situation just doesn't make sense. I do have a thyroid issue and I have learned that a lot of people with my thyroid condition have adrenal fatigue. Is this something you

treat?I do respect your knowledge in this area and trust that if I do have hyperaldosteronism you will pick it up on my labs and hopefully put the missing piece of this puzzle together for me.Thanks, SuzanneSent from my iPad

Thanks more layer todayTiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

so what's the support group for?Sent from my iPad

Once again this is what I get paid for. Contact me at lowerbp2@... for details of accessing my expertise for a year for only $500.CE Grim MDThanks!!Would

you mind explaining the difference between the creatinine random urine and the creatinine quantitative urine? I am concerned that my creat. rand is low meaning kidney trouble.I have been sitting here "researching" this for an hour or so and can't find an explanation.I won't been able to see my doctor until the end of this month and even then I don't think she is well educated in this area.I really wanted to rule out any kidney issues before December 28th.Thanks for your time and input! SuzanneSent from my iPadOn Dec 3, 2010, at 6:22 PM, Clarence Grim

wrote: I assume

your Dr. gets paid for doing this sort of interpretation.I can do it one on one for a fee. They all look good to me.CE Grim MDI have some test results back that are worrying me. I don't have all the results so I will post them as I get them. Right now I am

concerned with what my creatinine levels mean. Please help!!!Blood creatinineCREAT 0.77 (0.44-1.00)BUN 14 (6-20)urine creatinine (there were two results for this)CREAT,RAND UR 40.86 L (80.00-170 mg./dl)CREAT, UR QUANT 1.0 (0.6-1.8 gm./dy)Should I be worried about the low CREAT, RAND UR?????THANKS, SUZANNESent from my iPadOn Dec 3, 2010, at 7:21 AM, Clarence Grim

wrote: It varies. Do a pubmed.CE Grim MDWhat significance does our menstrual cycle play in blood pressure?During my luteal phase my blood pressure ranges from

115/65 to 120/75 but then once menses begins i run a lot lower 90/60.I am in the process of doing the 24 hour urine. should have those numbers in a few days.thanks,suzanneSent from my iPad Yea but you usually are an alcoholic who does not each much or cancer pt who cannot eat and is starving. CE Grim

MDOn Nov 22, 2010, at 10:04 PM,

Suzanne Kann wrote:I have read that a magnesium deficiency can cause low K.Sent from my iPad Better to DASH I would think.If you can get it in food why take a pill?CE Grim MDare you

serious? I am asking if I should take a b vitamin supplement?Sent from my iPad Still no question?CE Grim MD Was there a question here?Hi Dr. Grim,Is it recommended to take a b-complex vitamin?I have been holding off from taking mine (complete b-complex from life extension) because i am afraid it might encourage more aldosterone production! Am I crazy for worrying about this? I know the adrenals love b vitamins and I don't need anything that will cause me to produce more aldosterone. However, I know for a woman of my age and activity level that the b's are very important and could really benefit my body!!Thanks,

SuzanneSent from my iPad They are all competitors for the receptors but I

do not know the measures of association that permits one to quantitate the relative effect of aldo in occupying each of the receptors. Also they circulate in much greater quantities that aldo as I recall. So the effect would seem likely to be weak.CE Grim MD Hi Dr. Grim, I wanted to ask if high aldosterone levels will block progesterone, testosterone, and estrogen receptors? Thanks, SuzanneTo: hyperaldosteronism Cc: Clarence Grim Sent: Sun, November 7, 2010 7:36:01 PMSubject: Re:

Re: 42 yo woman runner who has had aldo 52 and renin 3.3 normal bp That's what this paper says. No one has looked at in anymore detail that I can find.CE Grim MDOk, by doing this it will be ok to test

any time of my cycle?Sent from my iPadOn Nov 7, 2010, at 6:02 PM, Clarence Grim

wrote: Ask your lab to use plasma renin activity not direct renin assay.CE Grim MDThis is the article I did read. I didn't feel like it gave a definitive

answer. I have read it is best to test aldosterone on the third day of the menstrual cycle but not sure how that will go seeing it is a urine test and not a simple blood draw. Any advice would be greatly appreciated. ThanksSent from my iPad Guess you did not search aldosterone renin ratio.Here is one.J Clin Endocrinol Metab. 2010 Oct 20. [Epub ahead of print]Are Women More at Risk of False-Positive Primary Aldosteronism Screening and Unnecessary Suppression Testing than Men?Ahmed AH, Gordon RD, PJ, Ward G, Pimenta E, Stowasser M.Endocrine Hypertension Research Centre (A.H.A., R.D.G., P.J.T., E.P., M.S.), University of Queensland School of Medicine, Greenslopes and Princess andra Hospitals, Brisbane, Queensland 4102, Australia; and Sullivan and Nicolaides Pathology (G.W.), Brisbane, 4068 Queensland, Australia.AbstractBackground: Because primary aldosteronism is not uncommon, specifically treatable and in some cases curable, and carries higher risks for cardiovascular morbidity and mortality than essential

hypertension, screening hypertensive patients for its presence by measuring aldosterone to renin ratio (ARR) is increasingly common. A significantly higher false-positive ARR rate for women than men, resulting in unnecessary suppression tests has previously been reported. Methods: Using a new, highly accurate aldosterone assay and both of the currently widely used renin assays, ARR was measured in 19 normal, ovulating women at three time points in the menstrual cycle and compared with single measurements in 21 normal males of similar age. Results: ARRs in males were possibly too well down in the current normal range. Although normotensive and normokalemic, two women had raised ARRs in the luteal phase but only when direct renin concentration (DRC) was used. Their DRC levels were low at all sampling times [despite midrange plasma renin activity levels], whereas their progesterone and aldosterone levels were highest for the group. Saline suppression

testing, performed in one of them, showed normal aldosterone suppressibility. Conclusion: False-positive ARRs in normal women during the luteal phase only when DRC is used may explain the higher incidence of false-positive ARRs in hypertensive women than men and suggest the following: 1) plasma renin activity is preferable to DRC in determination of ARR and 2) new reference ranges for ARR that take into account gender and sex hormone levels are required.Thanks, I did do some reading on pubmed like you suggested about testing and menses but never came up with an answer. Hoping you had the answer. I know aldosterone is naturally higher during the luteal phase but I only want to do this once and I want to get it exactly right . Sent from my iPad I think I sent an abstract recently on menses and testing. If you cant

find it let me

know.Dr. Grim's Perfect Primary

Aldosteronism Blood and Urine Testing to diagnose PA in one day. 1. Eat a regular to high salt diet for 2 weeks.2. No BP meds in last 4-12 weeks depending on meds.3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do not lose a drop of this liquid gold. It is impossible to interpret the renin and aldo without this.4. The morning you finish the 24 hr urine have fasting blood drawn for renin, aldo and K using our guidelines to get an accurate K. Try to get this done about 4 hours after you have been out of bed.5. Send us the results with the normal values for your lab.6. If you ever have a salt (saline) infusion test for PA be certain to ask them to measure how much

you pee during the 4 hours of the infusion. If it is 1-1.5 liter of urine it strongly suggests that you may have PA. If more tha 1.5 L you almost certainly have PA. Hi, I am calling my Natural Path tomorrow to have her order test to

see if we can figure out why I have high alodsterone. Here are the test I am requesting: (PLEASE LET ME KNOW IF I AM MISSING SOMETHING) -24 hour urine NA, K, Creatinine, Aldosterone -blood draw Renin, Aldosterone, and K Anything else????Also where can I get the info on how to collect K correctly?See our files on how to draw blood.One last question, when during my menstrual cycle is the best time to do these test?'see a recent email re this issue.Thanks so much for you time, SuzanneTo: hyperaldosteronism Cc: Clarence Grim Sent: Fri, November 5, 2010 7:04:29 AMSubject: Re: Re: 42 yo woman runner who has had aldo 52 and renin 3.3 normal bp your team is who you have decided you want to manage your health. Can a Natural Path write prescriptions and order blood tests?CE Grim MDWhat if I don't have a team? Or do you consider a Natural Path my team?Sent from my iPadOn Nov 4, 2010, at 8:06 PM, Clarence Grim

wrote: yes I can work with your team for $500 per year.CE Grim MDHi Dr Grim , I agree I am afraid I am going to make this 400 mile trip and get nowhere! I don't have a dr other than a Natural Path. Can you be my dr and take care of all of this online?Sent from my iPad she does not seem to understand PA as she did not order a renin.CE Grim MDSend her my article on the evolution of PA and the Endo guidelines in our files---BEFORE you see her. You want to know how many PAs she has treated and followed for at least 10 years.CE Grim MDThanks for the info. I am so frustrated with dr's in my area. It seems NO one knows the correct test around here! My natural path is very willing to order the test but she's the first one to admit that she won't know what to do with the results.I live in Whitefish, Montana and Kalispell is about 15 minutes away. Missoula is about 200 miles but I would drive it if someone could make a recommendation ( preferably first hand experience). I am doing Dr. grimes ideal test in December and then at the end of December I am scheduled to see an endocrinologist in Missoula. I don't have faith that the

endo knows much about hyperaldosteronism but at this point she is my only hope. This endo's name is Dr. Eyler. She has ordered the following test ( which I don't believe are ideal): hypothyroid panel, comprehensive metabolic panel, vitamin d, hemogram, LH, FSH, 24 hr urine aldosterone.Any comments or feedback would be so appreciated! Thanks, SuzanneSent from my iPad See Dr Grim's ideal test.You cannot interpret the aldo/renin ratio without having a 24 hr urine Na. But maybe your health care team knows how to do this. If so they need to let us know.CE GrimMDWelcome to the exciting world of Hyperaldosteronism! You are in the right place! I am Dr. CE Grim a retired Professor of Medicine and Endocrinology. I have a long standing interest is Primary Aldosteronism since medical school days when I saw my first patient with Primary Aldosteronism in 1963. I trained with Dr. Conn in Endocrinology and Metabolism 1969-70 and have published over 240 papers and book chapters in most areas of the broad discipline of High Blood Pressure. My CV is in our files for

details. The goal of our group is to teach you and your health care team about the ins and outs of the causes, diagnosis and control of the many forms of hyperaldosteronism. The steps below will introduce you into the fascinating world of high blood pressure, salt and potassium and the role of the adrenal hormone aldosterone in health and disease. Doing these in sequence will save you time and effort in getting up to speed in taking control of you health and educating your own health care team. While we can’t make you a doctor we will make you into a pretty good BP doctor-a skill that you will have for life. 1. A brief history of Primary Aldosteronsim and why it is so common today in drug resistant high blood pressure. Read my article in our files on the

evolution of PA (Evolution_of_PA-Grim.pdf ) and take to all members of health care team. Tell us what stage you believe you are in. This is a brief review of most causes of hyperaldosteronism, high blood pressure, low potassium (K). 2. Read about other patients with hyperaldosteronism (Conn’s syndrome). Read our Conn's stories in our files and then give us your own in as much detail as you can. Dr. Conn was the first to describe this disease process and the syndrome is named after him.To see others' stories, on the Hyperaldosteronism home page, go to Files/Conn’s Stories. You'll find instructions in "A - How to put your story here.doc " First send us your story in an email and they we may have questions and suggestions before you upload it to our files. 3. DASH to lower your BP.

Your and my tax dollars funded the most important series of studies on how to improve blood pressure, blood sugar, blood lipids and make your heart smaller: The DASH Eating Plan to control high blood pressure due to hyperaldosteronism and most others with high blood pressure. This will reduce your need for medications and in many will get your BP and K to goal without meds.. Get the DASH diet book by T. et al, (http://www.amazon.com/DASH-Diet-Hypertension--/dp/0743202953) read it and use it: ~$8 in

paperback at your local bookstore or online. If they don’t have it ask them to order it for you. You can also get the hardback larger print version as well at Amazon.

Learning to eat the DASH way will play a major role in your road to good BP and K control and, in many of our folks here, will revolutionize your life. See http://en.wikipedia.org/wiki/DASH_diet for an overview and more

details. In the book go to chapter 9 and do the 14 day challenge.

Tell your Dr you are doing this as your BP may plummet if you are on other meds. Measure your BP every day and post to us. or go to http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf download this 64 page booklet free and do the Week on the DASH Diet for 2 weeks. If you are on BP meds be prepared for a large fall in BP (20/10 mm Hg or more) and let your Dr. know you are doing this. And/Or go to (but costs money monthly) DASH Diet for

Health Program (http://www.dashforhealth.com/pages/public/tour.php)The DASH

Diet for Health Program is designed to help you improve your

eating and exercise habits. Twice each week they will provide you with information on our website about food, food preparation, eating out, losing weight, getting fit and much more. In addition to providing new information each week on the website, they create a web page

specially for you where you can track progress in areas such as your weight, blood pressure, and exercise. I strongly recommend you get this book and read it. 4. Measure your BP: Measure your BP daily so you can see if it is getting better. If you are taking meds be sure to tell your health care team you are doing this as your BP may plummet to normal quickly. We recommend you use a device you listen to and will help you learn how to do this. If this is not something you want to do we can teach a significant other how to do it. See sharedcareinc.com or email to sharedcare@... to order a video on how to do this. If you already have one we will teach you how to teach your health care team how to validate your device. Your life and health depends on accurate BP measurements. Go to the amricanheart.org and download the Guidelines for Human Blood Pressure Measurement. Insist the your health care team do BP the AHA way. Never trust your life

to an automatic BP machine unless you know it is accurate on YOU. 5. Genetics and your BP: Go to familyhistory.hhs.gov and do your detailed family medical history so we can review with you to help Dx familial causes of high blood pressure and heart disease. If BP runs in your family you may save lives in your family by checking their BP yourself. 6. How to DX and treat PA: Go to our

file/Conn's Articles of Note/Medications/Bravo spir 1973.pdf and read this

article and take to your health care team. It is old but still one of the best in the medical management of PA. Also see our file from the Endocrine Society Guidelines on PA. Dr. Grim's Perfect Primary Aldosteronism Blood and Urine Testing to diagnose PA in one day. 1. Eat a regular to high salt diet for 2 weeks.2. No BP meds in last 4-12 weeks depending on meds.3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do not lose a drop of this liquid gold. It is impossible to interpret the renin and aldo without this.4. The morning you finish the 24 hr urine have fasting blood drawn for renin, aldo and K using our guidelines to get an accurate K. Try to get this done about 4 hours after you have been out of bed.5. Send us the results with the normal values for your lab.6. If

you ever have a salt (saline) infusion test for PA be certain to ask them to measure how much you pee during the 4 hours of the infusion. If it is 1-1.5 liter of urine it strongly suggests that you may have PA. If more tha 1.5 L you almost certainly have PA. 8. Become a participant in our PA Registry and contribute to our large database on PA: If you have been Dxed with PA already and are on Rx or have had surgery please go to http://www.kwiksurveys.com/online-survey.php?surveyID=HIJIO_f2685379 and complete our survey with as

much information as you know. If there is some information you don't know ask us and we will help. If you need to update this as you journey thru the

diagnostic/treatment process you can add another entry but label it as Nameyymmdd. For example today 6/12/09 for me would be Grim090612. This ever increasing number will allow us and you to sort your multiple entries into a dated order. 9. Learn the language: If you are new to medical lingo then download the acroyms from http://health.groups.yahoo.com/group/bloodpressureline/message/2918610. Salt and high blood pressure: To learn the state of the science of salt and blood

pressure please spend some time looking at http://www.worldactiononsalt.com/evidence/treatment_trials.htm11. Become a HBP expert

consumer: Expect that it will take at least several weeks to get all this digested and to learn the new language of high blood pressure health care. As most doctors and nurses in practice have had very little training in high blood pressure you must become an expert yourself. For example most have never had anyone listen with them with a double stethoscope to verify that they can hear BP sounds. We cannot make you a doctor but we will make you a pretty good BP doctor.12. How High Blood Pressure should be managed: Go to nih.gov and download and read

the Joint National Commission (JNC) Report 7 to get an

overview on current guidelines. I ask all my secretaries to read this so they can communicate the importance of high blood pressure to my patients. JNC 8 will be out soon.Then: get (and study) the Hypertension Primer from americanheart.org. This is the most up-to-date compendium of what is known about high blood pressure and what every Dr. should know when they graduate from Medical School. Every chapter is only 2-3 pages. Read one chapter every week-night and you will finish

it in about a year. I am working

on a reading guide for lay people for the Primer. Stay

tuned.13. Ask us questions: Ask any questions about high blood pressure you want answered. That is what we are here for. We have had this site for 10 years and over 30,000 emails are searchable. This is the largest collection of communications about Conn's Syndrome in the World. 14. One-on-one Consulting: I can provide individual consulting if you do not want to go public. If you want individual one-on-one consulting for you and your Doctor contract me directly at lowerbp2@....May your pressure be low!Clarence E. Grim BS, MS, MD, FACP, FACC, FAHABoard Certified in Internal Medicine, Geriatrics, and High Blood Pressure Retired Faculty/Professor of Medicine (U of MO, Indiana, UCLA/DREW, Medical College of Wisconsin and Cardiology, Endocrinology,

Nephrology, and

Epidemiology. Specializing in Primary Aldosteronism and Difficult to Control

High Blood Pressure. I'm going in on Thursday for the following test: basic panel and serum aldosterone.Shouldn't there be a urine test? Are these

test a waste of my time if I want real answers to why I have high aldosterone.What would be the ideal test? Please help I am feeling pressured for time! Thank youSent from my iPadOn Nov 1, 2010, at 8:02 PM, Clarence Grim

wrote: Not that I know of or can make a connection to in my wildest Endocrine/Heme thoughs. But then another reason we need a good data base.Do you do data bases?CE Grim,MDIs there any connection between high aldosterone and low ferritin?Sent from my iPad If your BP and K is normal you may not need to DASH.Runners may have aldo if it was collected after a run.Drink when you are thirsty. A low Na suggests you are drinking too much.CE Grim MDCould I get some input on water intake? I tried searching the web-site about dashing but couldn't find what I was looking for.I know are bodies are constantly trying to keep things in balance so I feel like h2o consumption is just as important as sodium intake. However, I don't think I can assume the average 8 cups a day will be my norm.Here are a few things that I think might influence my sodium/h20 consumption: I have lowish serum sodium 138 (135-145), I have low blood pressure110/65, high aldosterone (24 hr urine 54.3 ( 17-44) and I am active ( runner)I feel it is reasonable that I keep my sodium intake at the higher end of the Dashing Diet , because of low sodium and low blood pressure and activity level, but I also want

to try and lower aldosterone naturally ( if possible) and I'm hoping maybe it's a matter of the right amount of daily water and sodium consumption. Are there any right ratios for this? For example, if you consume 1,500 mg of sodium you should have 8 cups of h2o or maybe if you consume 2,300 mg of sodium you should shoot for 10 cups of h2o?Thanks so much! Really trying to get it right!Sent from my iPad Keep us posted. so you have high renin and high aldo and low K and low BP?CE Grim MDOn Oct 28,

2010, at 4:13 PM, bou746 wrote:Hi Dr. Grim, The following post grabbed my attention. I started following you and this site when I was thought to have primary hyperaldosteronism. I had all the expected abnormal lab results except for low to normal blood pressure. Eventually, labaratory results confirmed Bartters Syndrome and now I follow both yahoo groups. > > >>>>>>>>>> > > >>>>>>>>>>> > > >>>>>>>>>>> Hi everyone, just joined today.

Thanks to all of you for this support!> > >>>>>>>>>>> > > >>>>>>>>>>> I tested high for aldosterone two years ago through a urine test. My ND at the time was not concerned, he thought it was due to the fact that I was a runner. I also thought that made since and was also following a low salt diet. So we ignored it.> > >>>>>>>>>>> > > >>>>>>>>>>> I am treAting a thyroid issue, thyroid hormone resistance, and through recent blood work tested high for aldosterone again. This time I decided not to ignore it! > > >>>>>>>>>>> > >

>>>>>>>>>>> I do not have a high blood pressure. It runs pretty normal to low. I don't have issues with potassium. This is all Very confusing as to why I have high aldosterone.> > >>>>>>>>>>> > > >>>>>>>>>>> I am trying to get into a endocrinologist but will take about three months. I need some education and advise on where to start.> > >>>>>>>>>>> > > >>>>>>>>>>> I don't even know if this is primary or secondary.> > >>>>>>>>>>> > > >>>>>>>>>>> My only real "health" issue, that I know about, has been hair loss. This was one

reason for exploring the thyroid but I am wondering if it has been the aldosterone all along. Maybe the aldosterone is what's causing my thyroid issues.> > >>>>>>>>>>> > > >>>>>>>>>>> Any comments or advice would be greatly appreciated.> > >>>>>>>>>>> > > >>>>>>>>>>> My labs:> > >>>>>>>>>>> > > >>>>>>>>>>> 9/26/2008> > >>>>>>>>>>> Aldosterone (urine)> > >>>>>>>>>>> High 54.3. (normal diet 6-25, low salt 17-44, high salt0-6)> >

>>>>>>>>>>> > > >>>>>>>>>>> Other adrenal hormones were fine at that time. Cortisol was pretty middle of the road. *Progesterone however was really high too. I can post if necessary.> > >>>>>>>>>>> > > >>>>>>>>>>> Rbc potassium 7/14/2010> > >>>>>>>>>>> 97. (90-111)> > >>>>>>>>>>> > > >>>>>>>>>>> Blood aldosterone 7/18/2010> > >>>>>>>>>>> 52.0. (1-16)> > >>>>>>>>>>> > >

>>>>>>>>>>> Blood aldosterone/renin 6/30/2010> > >>>>>>>>>>> Aldosterone 49. (1-16)> > >>>>>>>>>>> Renin. 3.3. (random ambulatory 0.8-2.5, non ambulatory 1.5-5.2)> > >>>>>>>>>>> I was sitting, fasting, taking two hours after waking before/around 8am> > >>>>>>>>>>> > > >>>>>>>>>>> Aldosterone renin ratio = 15> > >>>>>>>>>>> > > >>>>>>>>>>> Sodium. 138. (135-145)> > >>>>>>>>>>> Potassium. 4.5. (3.5-5.3)> > >>>>>>>>>>> Chloride. 106. (98-109)>

> >>>>>>>>>>> Co2. 23. (22-31)> > >>>>>>>>>>> Anion gap. 9. (5-16)> > >>>>>>>>>>> > > >>>>>>>>>>> Saliva cortisol 5/23/2010> > >>>>>>>>>>> 7am. 3.7. (3.7-9.5)> > >>>>>>>>>>> 11am. 1.6. (1.2-3.0)> > >>>>>>>>>>> 5pm. 1.3. (0.6-1.9)> > >>>>>>>>>>> 9pm. 0.5. (0.4-1.0)> > >>>>>>>>>>> > > >>>>>>>>>>> Rbc magnesium 5/26/2010> > >>>>>>>>>>> 4.2. (4.0-6.4)> >

>>>>>>>>>>> > > >>>>>>>>>>> Lot of test!!!!> > >>>>>>>>>>> > > >>>>>>>>>>> Thanks again for your kind support! Suzanne> > >>>>>>>>>>> > > >>>>>>>>>>> > > >>>>>>>>>> > > >>>>>>>>> > > >>>>>>>>> > > >>>>>>>> > > >>>>>>>> > > >>>>>>> > > >>>>>>> > > >>>>>> > > >>>>>> > > >>>>> > > >>>>> > > >>>> > > >>>> > > >>> > > >>> > > >> > > > > > >> >> > > Reply to sender |>

[Guest guest]

Suzanne, based on these numbers,

you do not have PA.  Are you ill or have

you just been concerned about your prior absolute value of aldosterone?  Your blood pressure is good, isn't it? 

When you post, it is important

to removed the mountains of messages that are below the current message.  When I get your messages, it locks my

computer up for a few minutes.  Same for

when Dr. Grim answers you. When I started this message in response to you, I

started removing all the old material and realized there were tons of messages

to remove.  It took several minutes to

remove it all.

Val

From:

hyperaldosteronism [mailto:hyperaldosteronism ] On

Behalf Of Suzanne Kann

Hi

everybody,

I

have some recent labs I would like to post. The results are very different from

what they had been in the past. My past labs were always done salt fasting for

at least a day. The labs I will post today were done following Dr. Grim/support

group guidelines.

I

would love to hear any input.

BLOOD

( my sodium intake the day before was around 2100mg) I was sitting upright for

the blood draw)

-aldosterone

22 (*standing reference range 4-31)

(* recumbent 1-16)

-renin

1.4 (random

ambulatory 0.8-2.5) (random non ambulatory 1.5-5.2)

aldost/renin

ratio= 16

-creat.

0.77 (0.44-1.00)

-NA

138 (135-145)

-K

4.2

(3.5-5.0)

24

HOUR URINE RESULTS -done the day before blood draw

sodium,

timed 102 (40-220)

NA,random

ur 40(k) no ref.

creat.

random 40.86 L (80.-170)

creat.

ur quant 1.0 (0.6-1.8)

POT.

ur per day 45.9 (25.0-150)

K+,

rand ur 18(k) no ref.

aldosterone

15.8 (normal sodium intake 6-25)

creat,ur

24hr 1096 (700-1600)

Thank

you! Dr Grim I would be happy to pay you for your time reviewing these! Suzanne

decided

[Guest guest]

Indeed it will be a godly act!

When you post, it is important to removed the mountains of messages that are below the current message. When I get your messages, it locks my computer up for a few minutes. Same for when Dr. Grim answers you. When I started this message in response to you, I started removing all the old material and realized there were tons of messages to remove. It took several minutes to remove it all.

[Guest guest]

Thanks Val. Sorry, I didn't know about clearing old messages. **** no, I haven't been ill. I have been dealing with a thyroid issue and while dealing with that I had a urine test come up with high aldosterone. So after that I ran blood aldosterone and it also came up high. That is when I found this support group.Yes, my blood pressure is ok, at

times on the low side.So you said based on these numbers I do not have PA, does that also mean I do not have Secondary Hyperaldosteronism?Thanks Val, I appreciate your time! Suzanne

BLOOD

( my sodium intake the day before was around 2100mg) I was sitting upright for

the blood draw)

-aldosterone

22 (*standing reference range 4-31)

(* recumbent 1-16)

-renin

1.4 (random

ambulatory 0.8-2.5) (random non ambulatory 1.5-5.2)

aldost/renin

ratio= 16

-creat.

0.77 (0.44-1.00)

-NA

138 (135-145)

-K

4.2

(3.5-5.0)

24

HOUR URINE RESULTS -done the day before blood draw

sodium,

timed 102 (40-220)

NA,random

ur 40(k) no ref.

creat.

random 40.86 L (80.-170)

creat.

ur quant 1.0 (0.6-1.8)

POT.

ur per day 45.9 (25.0-150)

K+,

rand ur 18(k) no ref.

aldosterone

15.8 (normal sodium intake 6-25)

creat,ur

24hr 1096 (700-1600)

Thank

you! Dr Grim I would be happy to pay you for your time reviewing these! Suzanne

decided