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

[Guest guest]

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]

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]

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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This 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 iPadOn Nov 3, 2010, at 7:49 PM, Clarence Grim

wrote: 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]

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]

Ok, 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 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 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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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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Good pubmeding out there. Is there any connection between high aldosterone and low ferritin?Authors:Kakigi, AkinobuOkada, TeruhikoTakeda, TaizoTaguchi, DaizoNishioka, RieSource: Acta Oto-Laryngologica; Mar2008, Vol. 128 Issue 3, p233-238, 6p, 1 Black and White Photograph, 1 Diagram, 1 ChartDocument Type: ArticleSubject Terms: SODIUM channelsENDOCYTOSISFERRITINPEROXIDASEENDOSOMESAMILORIDEAbstract:Conclusion. This study indicates that epithelial Na+-selective channels (ENaC) recycle Na+ via clathrin-mediated endocytosis in the marginal cells of the stria vascularis and that clathrin-independent endocytosis appeared to be modulated by the amount of Na+ transported. These results suggest the presence of ENaC in the luminal membrane of marginal cells and that ENaC are an efficient pathway for the uptake of Na+ from the endolymph. Objective. The ENaC found in many transporting epithelia play a key role in the regulation of salts and water homeostasis, cellular pH, cell volume, and cell function. Both biochemical and physiological approaches have been used to identify, characterize, and quantify this important channel, but its location in the marginal cells of the stria vascularis has not been fully clarified. The aim of this study was to determine the localization and regulation of ENaC. Materials and methods. Forty healthy female guinea pigs were used: 20 for the control experiment, 10 for the amiloride experiment, and 10 for the aldosterone experiment. We perfused cationized ferritin (CF) and microperoxidase (MPO) as tracers for clathrin-mediated and clathrin-independent endocytosis, respectively, into the cochlear duct. After 30 min of endolymphatic perfusion, the tissues were fixed and CF- and MPO-loaded endosomes within the marginal cell were observed by transmission electron microscopy. The numbers of CF- and MPO-loaded endosomes were compared between the three groups.Results. In the amiloride group, the numbers of CF- and MPO-loaded endosomes decreased in comparison with the control. In the aldosterone group, the numbers of CF- and MPO-loaded endosomes decreased and increased, respectively. Recently, it has been reported that ENaC are endocytosed via clathrin-mediated endosomes and aldosterone decreases the rate of endocytosis of ENaC. In this study, the results of the aldosterone experiment were consistent with those of recent studies. [ABSTRACT FROM AUTHOR] Copyright of Acta Oto-Laryngologica is the property of & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)ISSN:0001-6489DOI:10.1080/00016480701413821Accession Number:29435121Database:Psychology and Behavioral Sciences Collection

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Hi Dr. Grim,

I wanted to ask if high aldosterone levels will block progesterone, testosterone, and estrogen receptors?

Thanks, Suzanne

To: 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 MD

Ok, 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 MD

This 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.

Abstract

Background: 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, Suzanne

To: 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 MD

What 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 MD

Hi 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 MD

Send 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 MD

Thanks 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 GrimMD

Welcome 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/29186

10. 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.htm

11. 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, FAHA

Board 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,MD

Is 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 MD

Could 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 MD

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]

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]

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,MDOn

Nov 1, 2010, at 7:59 PM, Suzanne Kann wrote:Is 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]

sorry have another question for you, what are the chances that high aldosterone, without high blood pressure, is caused by a progesterone deficiency?Thanks againSent from my iPad

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 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 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]

Suzanne, I don't have the answer to your question, but there is a diagram of some adrenal hormone synthesis pathways near the top of this article:

www.dshs.state.tx.us/newborn/prenatal.shtm

(I haven't read the article itself -- I just went looking for some form of this diagram.) You may be somewhat familiar with it already.

The message, I think, is not ONLY that different hormones affect each other. The message is also in those little numbers you see connecting the various hormones. Each digit represents an enzyme, mostly in the P450 group, that converts one hormone to another. With a smidgen more of one enzyme and a smidgen less of another, instead of aldosteronism many of us might have diabetes or some other hormonal disturbance. There is not a distinct and final fork after each product or hormone; rather, there are multiple possible pathways to several of the intermediate steps.

High cholesterol may increase levels of all of all these successor products, I'm not sure. A high level of one product may become a high level of a successor hormone -- or possibly, by creating bottlenecks or hogging raw material, reduce the level of yet another. I don't know how all of this relates to the circumstance that a nodule or an entire gland may go crazy specializing in aldosterone.

One way of explaining a progesterone deficiency might be that there is too much of the enzyme represented by 5 in the diagram, sucking up too much of your progesterone and sending it down the line to become aldosterone. Or some slightly different but analogous mechanism.

I've read very little science in this area, but I did come across a book by Marcia Ruth Roper called " Type 2 Diabetes: The Adrenal Gland Disease " that attracted my attention. Roper works with a special population of diabetics, the southwestern native Americans, who have an exceptionally high propensity for the type 2 diabetes. I suspect her book is not very mainstream. (Then again, perhaps it is.) Whether it is cutting-edge I am not qualified to say. But she has found that in that population, the caffeine/xanthine family of stimulants can often tip the balance between type 2 diabetes and normality. (Of course she recommends other measures as well, but in her experience this one is one of the most critical for that population. Imagine -- a population that not only has exceptional trouble metabolizing alcohol but also caffeine.) Her evidence is completely empirical but she does explain the phenomenon by citing a particular enzyme that is inhibited from synthesis by caffeine-like stimulants. I gather that in her view, we with PA are just one tiny little enzyme apart from those in her population with high cortisol and resulting type 2 diabetes. Where she really raises my hackles of skepticism is with the claim that caffeine is genetically mutagenic because of its structural similarity to one of the proteins in DNA. I don't know enough to judge the similarity from the diagrams she adduces, since I can't say what really constitutes a small or large structural difference.

In any case, the caffeine angle rang a bell with me because I am several times more sensitive to caffeine than most people. Also my brother and father are obese although not diabetic, where I am merely somewhat overweight but have primary aldosteronism. They do not share my caffeine sensitivity at all. I spent my young adult years grossly overindulging in caffeine (a dozen or more diet sodas a day), followed by about 15 years consuming none, followed by the last 10 years consuming 1-2 sodas a day -- the equivalent of 1/4 to 1 cup of coffee, depending on how strongly the coffee is brewed. This has renewed my determination to get completely back off of caffeine. Roper claims that in susceptible people, overconsumption or even average consumption of caffeine can cause adrenal hypertrophy or eventually hyperplasia. Again I'm not vouching for this claim, just adding it to the mix of unvetted but potentially plausible information. I certainly don't expect getting back off caffeine to eliminate my aldosterone problem, but it will be interesting to see whether it influences it.

My real point isn't to villainize caffeine, though. It's to point out that hormone levels per se are merely the shadows cast by the REAL actors here, which are the enzymes (and enzyme-producing tissues) that convert among them. I wonder if we may some day see more refined medicines that, rather than simply blocking aldosterone or some other hormone, regulate an enzymatic pathway to attenuate or divert the conversion of one steroid to another. Medicine may also find dietary or environmental factors that up- and down-regulate the enzymes as well. Maybe the ultimate solution will not be a hormone blocker but an enzyme blocker.

AG

sorry have another question for you, what are the chances that high aldosterone, without high blood pressure, is caused by a progesterone deficiency?

Thanks again

Sent from my iPad

That's what this paper says. No one has looked at in anymore detail that I can find.

CE Grim MD

Ok, 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 MD

This 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. Thanks

Sent 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.

Abstract

Background: 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, Suzanne

To: hyperaldosteronism

Cc: Clarence Grim

Sent: Fri, November 5, 2010 7:04:29 AM

Subject: 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 MD

What 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 MD

Hi 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 MD

Send 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 MD

Thanks 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, Suzanne

Sent 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 GrimMD

Welcome 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/29186

10. 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.htm

11. 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, FAHA

Board 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 you

Sent 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,MD

Is 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 MD

Could 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 MD

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]

hey thanks for this info/link. it's a little over my head but i will keep reading until i get it and i will also take copies to my endo next month.so, is there anything we can do about enzymes?Sent from my iPad

Suzanne, I don't have the answer to your question, but there is a diagram of some adrenal hormone synthesis pathways near the top of this article:

www.dshs.state.tx.us/newborn/prenatal.shtm

(I haven't read the article itself -- I just went looking for some form of this diagram.) You may be somewhat familiar with it already.

The message, I think, is not ONLY that different hormones affect each other. The message is also in those little numbers you see connecting the various hormones. Each digit represents an enzyme, mostly in the P450 group, that converts one hormone to another. With a smidgen more of one enzyme and a smidgen less of another, instead of aldosteronism many of us might have diabetes or some other hormonal disturbance. There is not a distinct and final fork after each product or hormone; rather, there are multiple possible pathways to several of the intermediate steps.

High cholesterol may increase levels of all of all these successor products, I'm not sure. A high level of one product may become a high level of a successor hormone -- or possibly, by creating bottlenecks or hogging raw material, reduce the level of yet another. I don't know how all of this relates to the circumstance that a nodule or an entire gland may go crazy specializing in aldosterone.

One way of explaining a progesterone deficiency might be that there is too much of the enzyme represented by 5 in the diagram, sucking up too much of your progesterone and sending it down the line to become aldosterone. Or some slightly different but analogous mechanism.

I've read very little science in this area, but I did come across a book by Marcia Ruth Roper called "Type 2 Diabetes: The Adrenal Gland Disease" that attracted my attention. Roper works with a special population of diabetics, the southwestern native Americans, who have an exceptionally high propensity for the type 2 diabetes. I suspect her book is not very mainstream. (Then again, perhaps it is.) Whether it is cutting-edge I am not qualified to say. But she has found that in that population, the caffeine/xanthine family of stimulants can often tip the balance between type 2 diabetes and normality. (Of course she recommends other measures as well, but in her experience this one is one of the most critical for that population. Imagine -- a population that not only has exceptional trouble metabolizing alcohol but also caffeine.) Her evidence is completely empirical but she does explain the phenomenon by

citing a particular enzyme that is inhibited from synthesis by caffeine-like stimulants. I gather that in her view, we with PA are just one tiny little enzyme apart from those in her population with high cortisol and resulting type 2 diabetes. Where she really raises my hackles of skepticism is with the claim that caffeine is genetically mutagenic because of its structural similarity to one of the proteins in DNA. I don't know enough to judge the similarity from the diagrams she adduces, since I can't say what really constitutes a small or large structural difference.

In any case, the caffeine angle rang a bell with me because I am several times more sensitive to caffeine than most people. Also my brother and father are obese although not diabetic, where I am merely somewhat overweight but have primary aldosteronism. They do not share my caffeine sensitivity at all. I spent my young adult years grossly overindulging in caffeine (a dozen or more diet sodas a day), followed by about 15 years consuming none, followed by the last 10 years consuming 1-2 sodas a day -- the equivalent of 1/4 to 1 cup of coffee, depending on how strongly the coffee is brewed. This has renewed my determination to get completely back off of caffeine. Roper claims that in susceptible people, overconsumption or even average consumption of caffeine can cause adrenal hypertrophy or eventually hyperplasia. Again I'm not vouching for this claim, just adding it to the mix of unvetted but potentially plausible

information. I certainly don't expect getting back off caffeine to eliminate my aldosterone problem, but it will be interesting to see whether it influences it.

My real point isn't to villainize caffeine, though. It's to point out that hormone levels per se are merely the shadows cast by the REAL actors here, which are the enzymes (and enzyme-producing tissues) that convert among them. I wonder if we may some day see more refined medicines that, rather than simply blocking aldosterone or some other hormone, regulate an enzymatic pathway to attenuate or divert the conversion of one steroid to another. Medicine may also find dietary or environmental factors that up- and down-regulate the enzymes as well. Maybe the ultimate solution will not be a hormone blocker but an enzyme blocker.

AG

sorry have another question for you, what are the chances that high aldosterone, without high blood pressure, is caused by a progesterone deficiency?

Thanks again

Sent from my iPad

That's what this paper says. No one has looked at in anymore detail that I can find.

CE Grim MD

Ok, 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 MD

This 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. Thanks

Sent 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.

Abstract

Background: 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, Suzanne

To: hyperaldosteronism

Cc: Clarence Grim

Sent: Fri, November 5, 2010 7:04:29 AM

Subject: 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 MD

What 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 MD

Hi 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 MD

Send 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 MD

Thanks 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, Suzanne

Sent 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 GrimMD

Welcome 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/29186

10. 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.htm

11. 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, FAHA

Board 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 you

Sent 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,MD

Is 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 MD

Could 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 MD

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

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

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

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

> > >>>>>>>>>

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> > >>>

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> > >>

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[Guest guest]

Studies are underway with aldo synthetase inhibitors. Of course in GRA we can use dexamethasone to reverse the HTN but it has other side effects. Suzanne, I don't have the answer to your question, but there is a diagram of some adrenal hormone synthesis pathways near the top of this article: www.dshs.state.tx.us/newborn/prenatal.shtm (I haven't read the article itself -- I just went looking for some form of this diagram.) You may be somewhat familiar with it already. The message, I think, is not ONLY that different hormones affect each other. The message is also in those little numbers you see connecting the various hormones. Each digit represents an enzyme, mostly in the P450 group, that converts one hormone to another. With a smidgen more of one enzyme and a smidgen less of another, instead of aldosteronism many of us might have diabetes or some other hormonal disturbance. There is not a distinct and final fork after each product or hormone; rather, there are multiple possible pathways to several of the intermediate steps. High cholesterol may increase levels of all of all these successor products, I'm not sure. A high level of one product may become a high level of a successor hormone -- or possibly, by creating bottlenecks or hogging raw material, reduce the level of yet another. I don't know how all of this relates to the circumstance that a nodule or an entire gland may go crazy specializing in aldosterone. One way of explaining a progesterone deficiency might be that there is too much of the enzyme represented by 5 in the diagram, sucking up too much of your progesterone and sending it down the line to become aldosterone. Or some slightly different but analogous mechanism. I've read very little science in this area, but I did come across a book by Marcia Ruth Roper called "Type 2 Diabetes: The Adrenal Gland Disease" that attracted my attention. Roper works with a special population of diabetics, the southwestern native Americans, who have an exceptionally high propensity for the type 2 diabetes. I suspect her book is not very mainstream. (Then again, perhaps it is.) Whether it is cutting-edge I am not qualified to say. But she has found that in that population, the caffeine/xanthine family of stimulants can often tip the balance between type 2 diabetes and normality. (Of course she recommends other measures as well, but in her experience this one is one of the most critical for that population. Imagine -- a population that not only has exceptional trouble metabolizing alcohol but also caffeine.) Her evidence is completely empirical but she does explain the phenomenon by citing a particular enzyme that is inhibited from synthesis by caffeine-like stimulants. I gather that in her view, we with PA are just one tiny little enzyme apart from those in her population with high cortisol and resulting type 2 diabetes. Where she really raises my hackles of skepticism is with the claim that caffeine is genetically mutagenic because of its structural similarity to one of the proteins in DNA. I don't know enough to judge the similarity from the diagrams she adduces, since I can't say what really constitutes a small or large structural difference. In any case, the caffeine angle rang a bell with me because I am several times more sensitive to caffeine than most people. Also my brother and father are obese although not diabetic, where I am merely somewhat overweight but have primary aldosteronism. They do not share my caffeine sensitivity at all. I spent my young adult years grossly overindulging in caffeine (a dozen or more diet sodas a day), followed by about 15 years consuming none, followed by the last 10 years consuming 1-2 sodas a day -- the equivalent of 1/4 to 1 cup of coffee, depending on how strongly the coffee is brewed. This has renewed my determination to get completely back off of caffeine. Roper claims that in susceptible people, overconsumption or even average consumption of caffeine can cause adrenal hypertrophy or eventually hyperplasia. Again I'm not vouching for this claim, just adding it to the mix of unvetted but potentially plausible information. I certainly don't expect getting back off caffeine to eliminate my aldosterone problem, but it will be interesting to see whether it influences it. My real point isn't to villainize caffeine, though. It's to point out that hormone levels per se are merely the shadows cast by the REAL actors here, which are the enzymes (and enzyme-producing tissues) that convert among them. I wonder if we may some day see more refined medicines that, rather than simply blocking aldosterone or some other hormone, regulate an enzymatic pathway to attenuate or divert the conversion of one steroid to another. Medicine may also find dietary or environmental factors that up- and down-regulate the enzymes as well. Maybe the ultimate solution will not be a hormone blocker but an enzyme blocker. AG sorry have another question for you, what are the chances that high aldosterone, without high blood pressure, is caused by a progesterone deficiency?Thanks againSent from my iPad 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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Choose different grand parents is the main thing at this point. But many drugs we take for various things can affect enzymes. Such as salt and sugar.We are all basically a bowl full of chemicals and enzymes in a salty fluid.CE Grimhey thanks for this info/link. it's a little over my head but i will keep reading until i get it and i will also take copies to my endo next month.so, is there anything we can do about enzymes?Sent from my iPad Suzanne, I don't have the answer to your question, but there is a diagram of some adrenal hormone synthesis pathways near the top of this article: www.dshs.state.tx.us/newborn/prenatal.shtm (I haven't read the article itself -- I just went looking for some form of this diagram.) You may be somewhat familiar with it already. The message, I think, is not ONLY that different hormones affect each other. The message is also in those little numbers you see connecting the various hormones. Each digit represents an enzyme, mostly in the P450 group, that converts one hormone to another. With a smidgen more of one enzyme and a smidgen less of another, instead of aldosteronism many of us might have diabetes or some other hormonal disturbance. There is not a distinct and final fork after each product or hormone; rather, there are multiple possible pathways to several of the intermediate steps. High cholesterol may increase levels of all of all these successor products, I'm not sure. A high level of one product may become a high level of a successor hormone -- or possibly, by creating bottlenecks or hogging raw material, reduce the level of yet another. I don't know how all of this relates to the circumstance that a nodule or an entire gland may go crazy specializing in aldosterone. One way of explaining a progesterone deficiency might be that there is too much of the enzyme represented by 5 in the diagram, sucking up too much of your progesterone and sending it down the line to become aldosterone. Or some slightly different but analogous mechanism. I've read very little science in this area, but I did come across a book by Marcia Ruth Roper called "Type 2 Diabetes: The Adrenal Gland Disease" that attracted my attention. Roper works with a special population of diabetics, the southwestern native Americans, who have an exceptionally high propensity for the type 2 diabetes. I suspect her book is not very mainstream. (Then again, perhaps it is.) Whether it is cutting-edge I am not qualified to say. But she has found that in that population, the caffeine/xanthine family of stimulants can often tip the balance between type 2 diabetes and normality. (Of course she recommends other measures as well, but in her experience this one is one of the most critical for that population. Imagine -- a population that not only has exceptional trouble metabolizing alcohol but also caffeine.) Her evidence is completely empirical but she does explain the phenomenon by citing a particular enzyme that is inhibited from synthesis by caffeine-like stimulants. I gather that in her view, we with PA are just one tiny little enzyme apart from those in her population with high cortisol and resulting type 2 diabetes. Where she really raises my hackles of skepticism is with the claim that caffeine is genetically mutagenic because of its structural similarity to one of the proteins in DNA. I don't know enough to judge the similarity from the diagrams she adduces, since I can't say what really constitutes a small or large structural difference. In any case, the caffeine angle rang a bell with me because I am several times more sensitive to caffeine than most people. Also my brother and father are obese although not diabetic, where I am merely somewhat overweight but have primary aldosteronism. They do not share my caffeine sensitivity at all. I spent my young adult years grossly overindulging in caffeine (a dozen or more diet sodas a day), followed by about 15 years consuming none, followed by the last 10 years consuming 1-2 sodas a day -- the equivalent of 1/4 to 1 cup of coffee, depending on how strongly the coffee is brewed. This has renewed my determination to get completely back off of caffeine. Roper claims that in susceptible people, overconsumption or even average consumption of caffeine can cause adrenal hypertrophy or eventually hyperplasia. Again I'm not vouching for this claim, just adding it to the mix of unvetted but potentially plausible information. I certainly don't expect getting back off caffeine to eliminate my aldosterone problem, but it will be interesting to see whether it influences it. My real point isn't to villainize caffeine, though. It's to point out that hormone levels per se are merely the shadows cast by the REAL actors here, which are the enzymes (and enzyme-producing tissues) that convert among them. I wonder if we may some day see more refined medicines that, rather than simply blocking aldosterone or some other hormone, regulate an enzymatic pathway to attenuate or divert the conversion of one steroid to another. Medicine may also find dietary or environmental factors that up- and down-regulate the enzymes as well. Maybe the ultimate solution will not be a hormone blocker but an enzyme blocker. AG sorry have another question for you, what are the chances that high aldosterone, without high blood pressure, is caused by a progesterone deficiency?Thanks againSent from my iPad 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]

Was there a question here?Sent from my iPadBegin forwarded message:Date: November 16, 2010 11:33:12 AM MSTTo: "hyperaldosteronism " <hyperaldosteronism >Subject: Re: Re: 42 yo woman runner who has had aldo 52 and renin 3.3 normal bpReply-To: hyperaldosteronism 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]

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, Suzanne

To: 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 MD

Ok, 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 MD

This 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.

Abstract

Background: 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, Suzanne

To: 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 MD

What 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 MD

Hi 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 MD

Send 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 MD

Thanks 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 GrimMD

Welcome 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/29186

10. 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.htm

11. 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, FAHA

Board 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,MD

Is 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 MD

Could 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 MD

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]

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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are 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,MDOn

Nov 1, 2010, at 7:59 PM, Suzanne Kann wrote:Is 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> > >>>>>>>>>>> > > >>>>>>>>>>> > > >>>>>>>>>> > > >>>>>>>>> > >

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

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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 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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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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Really? I "hear" magnesium deficiency is VERY common due to our food/growing conditions. My magnesium levels tested low and I am not an alcoholic or cancer patient. I eat close to 2300 calories a day.Sent 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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Would repeat it again. unless you have PA many of whom may have low K esp if they have been on diuretics which can pee out Mg.Also high salt diet can do the same thing.Another reason to DASH lots of Mg. CE Grim MDReally? I "hear" magnesium deficiency is VERY common due to our food/growing conditions. My magnesium levels tested low and I am not an alcoholic or cancer patient. I eat close to 2300 calories a day.Sent 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 |>