Guest guest Posted April 19, 2010 Report Share Posted April 19, 2010 Do u have renin results. Agree if spiro works then stay in it and DASH to the Max. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension Well, I'm home now, finally!! Ended up being in the hospital 2-1/2 days down in Rochester. My aldo tested 7 (normal <21), couldn't believe it was that low!! Asked the endo why it was so low after being high every time it was tested in the past. Said most likely due to meds I was on. Told her I was off all BP meds for 6 weeks when tested high in 2006, didn't have an answer for me. But totally disinterested in persuing anything at this point, I have to agree with her. So, back on Spiro....I was on Inspra for a year but when my insurance balked, I thought I'd go ahead and try the Spiro and it seems to work just as well as the Inspra. I have had a complete hysterectomy, so no female trouble to worry about. I will mention your suggestion re/the Nipride when I see my local doc next month. > > > My story is in the files, I have been diagnosed with inappropriate > > aldosterone at the Mayo in the past. i am here getting evaluated > > again, for more than the PA, I also have hyperadrenergic autonomic > > dysfunction, cyclic vomiting syndrome and daily chronic headache/ > > migraines. Was in Monday AM to have an endoscopy and ended up riding > > the ambulance to the St 's ER for hypertensive crisis (was > > 230/144). They kept me in ICU over night and had a heck of a time > > getting pressure down (used a drip of labetalol after the nitro > > given in ER). I am still in hospital, but down on the general floor > > and get out in the am. Will meet with my endo tomorrow afternoon > > (ater the egd)and see what she said. However, I tested much lower on > > the aldo, will post numbers when I get a copy tomorrow, but renin > > still non-existent. K was borderline low (3.6 and the range starts > > at 3.6). Pretty sure will recommend continued management with > > spironolactone and others, will have to see what the team says in am. > > > > Kim > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 29, 2010 Report Share Posted April 29, 2010 This is my problem with the ratio. If all you look at is the ratio you can't say if it is early or late PA. Would have to know all meds one is taking. How much salt they were eating. What there K was. I think to many Dr only look at ratio and if it isn't over 20 then you don't have PA even if you have the tumor. > > > > > > > > > > > My story is in the files, I have been diagnosed with > > inappropriate > > > > > > aldosterone at the Mayo in the past. i am here getting > > evaluated > > > > > > again, for more than the PA, I also have hyperadrenergic > > autonomic > > > > > > dysfunction, cyclic vomiting syndrome and daily chronic > > headache/ > > > > > > migraines. Was in Monday AM to have an endoscopy and ended up > > > > riding > > > > > > the ambulance to the St 's ER for hypertensive crisis (was > > > > > > 230/144). They kept me in ICU over night and had a heck of a > > time > > > > > > getting pressure down (used a drip of labetalol after the > > nitro > > > > > > given in ER). I am still in hospital, but down on the general > > > > floor > > > > > > and get out in the am. Will meet with my endo tomorrow > > afternoon > > > > > > (ater the egd)and see what she said. However, I tested much > > > > lower on > > > > > > the aldo, will post numbers when I get a copy tomorrow, but > > renin > > > > > > still non-existent. K was borderline low (3.6 and the range > > starts > > > > > > at 3.6). Pretty sure will recommend continued management with > > > > > > spironolactone and others, will have to see what the team says > > > > in am. > > > > > > > > > > > > Kim > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 29, 2010 Report Share Posted April 29, 2010 Since I have two ratios the first one being 8.1 RENIN: 1.8 range (upright/sitting) 0.65-5.0 ng/mL/hr. ALDOS: 16 range Upright 8:00-10:00 am < or = 28 ng/dL Upright 4:00-6:00 pm < or = 21 ng/dL. The time of blood draw was 2:14PM. AT the VA RENIN 0.8 range (-) ALDOS 5.5 range (<=21-) time of blood draw 3pm At Dartmouth Mecical Center. There report Mr. Bill is a 61 years y.o. Mwith symptoms of daily lightheadednass and exartional SOB with an incidentally discovered 2.1cm left adrenal mass whom we saw in our Endocrinology Clinic at DHMC on 03/03/2009 for evaluation of the adrenal mass. We felt at the time the pt's symptoms were likely unrelated to this adrenal incidentaloma especially since he has had an extensive negative work-up in the past. However, since most of his previous testing results were not available to us, and the patient would like to be retested, we rechecked levels of: midnight salivary cortisol renin and aldosterone DHEA-S serum metanephrine and normetanephrine to rule this lesion out as a functioning adenoma. The results above show that there is no evidence that this adenoma is producing any excess adrenal hormones. Past Medical History: HTN diagnosed about 5 yrs ago Chronic Fatigue Syndrome Chronic dyspnea Chronic dizziness sip appendectomy in Dec 2008 Multiple granulomas in the Lungs Exophytic cyst Lt kidney History of Present I11ness: Mr Bill presents today for a second opinion regarding whether he might have Conns Syndrome. In 2006, he underwent w/u for SOB. He had a CT scan of the chest which showed a 2.1 cm soft tisuue mass in the Lt adrenal gland. Subsequent tests showed that the adenoma was non secretory. He has since undergone several chest CT and the adrenal mass has not grown is size. In March 2009, he was seen by endocrinology at DHMC. He again underwent testing including cortisol, PRA, aldosterone, metanephrines etc, all of which were within normal limits. Patient was reassured that this likely represents an incidentaloma. Over the past 3-4 yrs, he has had chronic SOB and dizziness . He has undergone extensive testing for both including EKG, stress tests, echocardiograms, Holter montior, MRI brain (to rio acoustic neuroma), sleep studies, PFTs etc all of which have not identified an abnormality. In Dec 2008, he presented with abd pain and was found to have appendicitis on CT scan. It also showed an exophytic mass in the L kidney for which he unerwent an ultrasound. He was told by his PCP that he needs CT scan for the lesion. I do not have records relating to this issue today. He has normal renal fucntion ( Cr from VA records has ranged from 0.8-1.1 in the past 3 yrs) . Was tested on these Meds Furosemide 20 mg Tablet 60 MG = 3 Tablet(s) / Once daily Oral Potassium Chloride 10 mEq 20 MEQ = 2 Capsule(s) / Once daily Capsule, Sustained Oral Release Atenolol 25 mg Tablet 25 MG = 1 Tablet(s) / Once daily He has undergone testing multiple times and there is no evidence that this is a fucntional adenoma. It most likely represents an incidentaloma that has not increased in size over the past 3 yrs based on CT scanning. His symptoms are also probably unrelated to the incidentaloma. He also does not have any evidence to support a diagnosis of Conns Syndrome. HTN - Not at goal. Discussed occasional home BP checks to help adjust medication regimen. If needed, would add ACEI /ARB or CCB for better control. Discussed wt loss and dietary salt restiriction. Lt renal mass - I do not have records available today regarding this issue but would recommed urology evaluation. He does not routine flu with nephrology unless a new issue arises. Seen and examined with Dr. Rangan. additions: I agree with her above note with the following Renin/aldo levels are normal; no evidence of hyperaldosteronism. H/o hypokalemia on furosemide is not unusual. BP is mildly elevated but likely essential hypertension. If BP remains above 140/90 would consider addition of ACEI as these synergize well with diuretics and may also help mitigate hypokalemia. Reportedly has an exophytic mass on his kidney that does not meet criteria for a simple cyst, although I do not have the images to review personally. Recommend urology evalution for this. > > > > > > > > > > > > > My story is in the files, I have been diagnosed with > > > inappropriate > > > > > > > aldosterone at the Mayo in the past. i am here getting > > > evaluated > > > > > > > again, for more than the PA, I also have hyperadrenergic > > > autonomic > > > > > > > dysfunction, cyclic vomiting syndrome and daily chronic > > > headache/ > > > > > > > migraines. Was in Monday AM to have an endoscopy and ended up > > > > > riding > > > > > > > the ambulance to the St 's ER for hypertensive crisis (was > > > > > > > 230/144). They kept me in ICU over night and had a heck of a > > > time > > > > > > > getting pressure down (used a drip of labetalol after the > > > nitro > > > > > > > given in ER). I am still in hospital, but down on the general > > > > > floor > > > > > > > and get out in the am. Will meet with my endo tomorrow > > > afternoon > > > > > > > (ater the egd)and see what she said. However, I tested much > > > > > lower on > > > > > > > the aldo, will post numbers when I get a copy tomorrow, but > > > renin > > > > > > > still non-existent. K was borderline low (3.6 and the range > > > starts > > > > > > > at 3.6). Pretty sure will recommend continued management with > > > > > > > spironolactone and others, will have to see what the team says > > > > > in am. > > > > > > > > > > > > > > Kim > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 29, 2010 Report Share Posted April 29, 2010 the problem is that others dont recognize early PA. They think that you never have PA until you cross the magic line of 20. 19.999999 no PA. 20 = PA strange thinking IMHO.CE Grim MDOn Apr 29, 2010, at 6:13 PM, Francis Bill SUSPECTED PA wrote:This is my problem with the ratio. If all you look at is the ratio you can't say if it is early or late PA. Would have to know all meds one is taking. How much salt they were eating. What there K was. I think to many Dr only look at ratio and if it isn't over 20 then you don't have PA even if you have the tumor. > > > > >> > > > > > My story is in the files, I have been diagnosed with > > inappropriate> > > > > > aldosterone at the Mayo in the past. i am here getting > > evaluated> > > > > > again, for more than the PA, I also have hyperadrenergic > > autonomic> > > > > > dysfunction, cyclic vomiting syndrome and daily chronic > > headache/> > > > > > migraines. Was in Monday AM to have an endoscopy and ended up> > > > riding> > > > > > the ambulance to the St 's ER for hypertensive crisis (was> > > > > > 230/144). They kept me in ICU over night and had a heck of a > > time> > > > > > getting pressure down (used a drip of labetalol after the > > nitro> > > > > > given in ER). I am still in hospital, but down on the general> > > > floor> > > > > > and get out in the am. Will meet with my endo tomorrow > > afternoon> > > > > > (ater the egd)and see what she said. However, I tested much> > > > lower on> > > > > > the aldo, will post numbers when I get a copy tomorrow, but > > renin> > > > > > still non-existent. K was borderline low (3.6 and the range > > starts> > > > > > at 3.6). Pretty sure will recommend continued management with> > > > > > spironolactone and others, will have to see what the team says> > > > in am.> > > > > >> > > > > > Kim> > > > > >> > > > > >> > > > > >> > > > >> > > >> > > >> > >> >> >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 29, 2010 Report Share Posted April 29, 2010 What has your BP and K done on spiro? and DASH?CE Grim MD.On Apr 29, 2010, at 8:47 PM, Francis Bill SUSPECTED PA wrote:Since I have two ratios the first one being 8.1 RENIN: 1.8 range(upright/sitting) 0.65-5.0 ng/mL/hr. ALDOS: 16 range Upright 8:00-10:00 am < or = 28 ng/dL Upright 4:00-6:00 pm < or = 21 ng/dL. The time of blood draw was 2:14PM. AT the VARENIN 0.8 range (-) ALDOS 5.5 range (<=21-) time of blood draw 3pm At Dartmouth Mecical Center.There report Mr. Bill is a 61 years y.o. Mwith symptoms of daily lightheadednass and exartionalSOB with an incidentally discovered 2.1cm left adrenal mass whom we saw in ourEndocrinology Clinic at DHMC on 03/03/2009 for evaluation of the adrenal mass.We felt at the time the pt's symptoms were likely unrelated to this adrenalincidentaloma especially since he has had an extensive negative work-up in the past.However, since most of his previous testing results were not available to us, andthe patient would like to be retested, we rechecked levels of:midnight salivary cortisolrenin and aldosteroneDHEA-Sserum metanephrine and normetanephrineto rule this lesion out as a functioning adenoma.The results above show that there is no evidence that this adenoma is producing anyexcess adrenal hormones.Past Medical History:HTN diagnosed about 5 yrs agoChronic Fatigue SyndromeChronic dyspneaChronic dizzinesssip appendectomy in Dec 2008Multiple granulomas in the LungsExophytic cyst Lt kidneyHistory of Present I11ness:Mr Bill presents today for a second opinion regarding whether he might have ConnsSyndrome. In 2006, he underwent w/u for SOB. He had a CT scan of the chest whichshowed a 2.1 cm soft tisuue mass in the Lt adrenal gland. Subsequent tests showedthat the adenoma was non secretory. He has since undergone several chest CT and theadrenal mass has not grown is size. In March 2009, he was seen by endocrinology atDHMC. He again underwent testing including cortisol, PRA, aldosterone, metanephrinesetc, all of which were within normal limits. Patient was reassured that this likelyrepresents an incidentaloma.Over the past 3-4 yrs, he has had chronic SOB and dizziness . He has undergoneextensive testing for both including EKG, stress tests, echocardiograms, Holtermontior, MRI brain (to rio acoustic neuroma), sleep studies, PFTs etc all of whichhave not identified an abnormality.In Dec 2008, he presented with abd pain and was found to have appendicitis on CTscan. It also showed an exophytic mass in the L kidney for which he unerwent anultrasound. He was told by his PCP that he needs CT scan for the lesion. I donot have records relating to this issue today.He has normal renal fucntion ( Cr from VA records has ranged from 0.8-1.1 in thepast 3 yrs) .Was tested on these MedsFurosemide 20 mg Tablet 60 MG = 3 Tablet(s) / Once dailyOralPotassium Chloride 10 mEq 20 MEQ = 2 Capsule(s) / Once dailyCapsule, Sustained OralReleaseAtenolol 25 mg Tablet 25 MG = 1 Tablet(s) / Once dailyHe has undergone testing multiple times and there is no evidence that this is afucntional adenoma. It most likely represents an incidentaloma that has notincreased in size over the past 3 yrs based on CT scanning. His symptoms are alsoprobably unrelated to the incidentaloma. He also does not have any evidence tosupport a diagnosis of Conns Syndrome.HTN - Not at goal. Discussed occasional home BP checks to help adjust medicationregimen. If needed, would add ACEI /ARB or CCB for better control. Discussed wt lossand dietary salt restiriction.Lt renal mass - I do not have records available today regarding this issue but wouldrecommed urology evaluation.He does not routine flu with nephrology unless a new issue arises.Seen and examined with Dr. Rangan.additions:I agree with her above note with the followingRenin/aldo levels are normal; no evidence of hyperaldosteronism. H/o hypokalemia onfurosemide is not unusual. BP is mildly elevated but likely essential hypertension.If BP remains above 140/90 would consider addition of ACEI as these synergize wellwith diuretics and may also help mitigate hypokalemia. Reportedly has an exophyticmass on his kidney that does not meet criteria for a simple cyst, although I do nothave the images to review personally. Recommend urology evalution for this.> > > > > >> > > > > > > My story is in the files, I have been diagnosed with > > > inappropriate> > > > > > > aldosterone at the Mayo in the past. i am here getting > > > evaluated> > > > > > > again, for more than the PA, I also have hyperadrenergic > > > autonomic> > > > > > > dysfunction, cyclic vomiting syndrome and daily chronic > > > headache/> > > > > > > migraines. Was in Monday AM to have an endoscopy and ended up> > > > > riding> > > > > > > the ambulance to the St 's ER for hypertensive crisis (was> > > > > > > 230/144). They kept me in ICU over night and had a heck of a > > > time> > > > > > > getting pressure down (used a drip of labetalol after the > > > nitro> > > > > > > given in ER). I am still in hospital, but down on the general> > > > > floor> > > > > > > and get out in the am. Will meet with my endo tomorrow > > > afternoon> > > > > > > (ater the egd)and see what she said. However, I tested much> > > > > lower on> > > > > > > the aldo, will post numbers when I get a copy tomorrow, but > > > renin> > > > > > > still non-existent. K was borderline low (3.6 and the range > > > starts> > > > > > > at 3.6). Pretty sure will recommend continued management with> > > > > > > spironolactone and others, will have to see what the team says> > > > > in am.> > > > > > >> > > > > > > Kim> > > > > > >> > > > > > >> > > > > > >> > > > > >> > > > >> > > > >> > > >> > >> > >> > >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 29, 2010 Report Share Posted April 29, 2010 Since my doctor seems to think it doesn't matter if I have PA he thinks the Meds I am on will treat it. So no Spiro. Also since he isn't on board with DASH and doing blood test to see if I would need te cut out meds. I have some concern about DASHING and being on Furosemide and Triamterene. They had left Triamterene off there list of meds. .. > > > > > > > > > > > > > > > > > My story is in the files, I have been diagnosed with > > > > > inappropriate > > > > > > > > > aldosterone at the Mayo in the past. i am here getting > > > > > evaluated > > > > > > > > > again, for more than the PA, I also have hyperadrenergic > > > > > autonomic > > > > > > > > > dysfunction, cyclic vomiting syndrome and daily chronic > > > > > headache/ > > > > > > > > > migraines. Was in Monday AM to have an endoscopy and > > ended up > > > > > > > riding > > > > > > > > > the ambulance to the St 's ER for hypertensive > > crisis (was > > > > > > > > > 230/144). They kept me in ICU over night and had a > > heck of a > > > > > time > > > > > > > > > getting pressure down (used a drip of labetalol after > > the > > > > > nitro > > > > > > > > > given in ER). I am still in hospital, but down on the > > general > > > > > > > floor > > > > > > > > > and get out in the am. Will meet with my endo tomorrow > > > > > afternoon > > > > > > > > > (ater the egd)and see what she said. However, I tested > > much > > > > > > > lower on > > > > > > > > > the aldo, will post numbers when I get a copy > > tomorrow, but > > > > > renin > > > > > > > > > still non-existent. K was borderline low (3.6 and the > > range > > > > > starts > > > > > > > > > at 3.6). Pretty sure will recommend continued > > management with > > > > > > > > > spironolactone and others, will have to see what the > > team says > > > > > > > in am. > > > > > > > > > > > > > > > > > > Kim > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 30, 2010 Report Share Posted April 30, 2010 This is my VA Dr note on ratio. Reviewed Aldosterone, renin level results. His PAC/PRA ratio is 8.1. Normal is 4-10. Patients with primary hyperaldo typically have ratios in 30 to 50 range . > > > > > > > > > > > > > > > My story is in the files, I have been diagnosed with > > > > inappropriate > > > > > > > > aldosterone at the Mayo in the past. i am here getting > > > > evaluated > > > > > > > > again, for more than the PA, I also have hyperadrenergic > > > > autonomic > > > > > > > > dysfunction, cyclic vomiting syndrome and daily chronic > > > > headache/ > > > > > > > > migraines. Was in Monday AM to have an endoscopy and > > ended up > > > > > > riding > > > > > > > > the ambulance to the St 's ER for hypertensive > > crisis (was > > > > > > > > 230/144). They kept me in ICU over night and had a heck > > of a > > > > time > > > > > > > > getting pressure down (used a drip of labetalol after the > > > > nitro > > > > > > > > given in ER). I am still in hospital, but down on the > > general > > > > > > floor > > > > > > > > and get out in the am. Will meet with my endo tomorrow > > > > afternoon > > > > > > > > (ater the egd)and see what she said. However, I tested > > much > > > > > > lower on > > > > > > > > the aldo, will post numbers when I get a copy tomorrow, > > but > > > > renin > > > > > > > > still non-existent. K was borderline low (3.6 and the > > range > > > > starts > > > > > > > > at 3.6). Pretty sure will recommend continued management > > with > > > > > > > > spironolactone and others, will have to see what the > > team says > > > > > > in am. > > > > > > > > > > > > > > > > Kim > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 30, 2010 Report Share Posted April 30, 2010 Spiro is one of the recommended treatments for all HTN. ESP IF RENIN IS LOW. ACE ARBS DONT WORK WELL WHEN RENIN IS LOW. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension Since my doctor seems to think it doesn't matter if I have PA he thinks the Meds I am on will treat it. So no Spiro. Also since he isn't on board with DASH and doing blood test to see if I would need te cut out meds. I have some concern about DASHING and being on Furosemide and Triamterene. They had left Triamterene off there list of meds. .. > > > > > > > > > > > > > > > > > My story is in the files, I have been diagnosed with > > > > > inappropriate > > > > > > > > > aldosterone at the Mayo in the past. i am here getting > > > > > evaluated > > > > > > > > > again, for more than the PA, I also have hyperadrenergic > > > > > autonomic > > > > > > > > > dysfunction, cyclic vomiting syndrome and daily chronic > > > > > headache/ > > > > > > > > > migraines. Was in Monday AM to have an endoscopy and > > ended up > > > > > > > riding > > > > > > > > > the ambulance to the St 's ER for hypertensive > > crisis (was > > > > > > > > > 230/144). They kept me in ICU over night and had a > > heck of a > > > > > time > > > > > > > > > getting pressure down (used a drip of labetalol after > > the > > > > > nitro > > > > > > > > > given in ER). I am still in hospital, but down on the > > general > > > > > > > floor > > > > > > > > > and get out in the am. Will meet with my endo tomorrow > > > > > afternoon > > > > > > > > > (ater the egd)and see what she said. However, I tested > > much > > > > > > > lower on > > > > > > > > > the aldo, will post numbers when I get a copy > > tomorrow, but > > > > > renin > > > > > > > > > still non-existent. K was borderline low (3.6 and the > > range > > > > > starts > > > > > > > > > at 3.6). Pretty sure will recommend continued > > management with > > > > > > > > > spironolactone and others, will have to see what the > > team says > > > > > > > in am. > > > > > > > > > > > > > > > > > > Kim > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 30, 2010 Report Share Posted April 30, 2010 My Dr is trying very hard to have me take Diltiazem with the Atenolol. It seem every time I try to take it my SX get worse. I read that taking these meds together isn't recommend. > > > > > > > > > > > > > > > > > > > > > My story is in the files, I have been diagnosed with > > > > > > > inappropriate > > > > > > > > > > > aldosterone at the Mayo in the past. i am here > > getting > > > > > > > evaluated > > > > > > > > > > > again, for more than the PA, I also have > > hyperadrenergic > > > > > > > autonomic > > > > > > > > > > > dysfunction, cyclic vomiting syndrome and daily > > chronic > > > > > > > headache/ > > > > > > > > > > > migraines. Was in Monday AM to have an endoscopy and > > > > ended up > > > > > > > > > riding > > > > > > > > > > > the ambulance to the St 's ER for hypertensive > > > > crisis (was > > > > > > > > > > > 230/144). They kept me in ICU over night and had a > > > > heck of a > > > > > > > time > > > > > > > > > > > getting pressure down (used a drip of labetalol > > after > > > > the > > > > > > > nitro > > > > > > > > > > > given in ER). I am still in hospital, but down on > > the > > > > general > > > > > > > > > floor > > > > > > > > > > > and get out in the am. Will meet with my endo > > tomorrow > > > > > > > afternoon > > > > > > > > > > > (ater the egd)and see what she said. However, I > > tested > > > > much > > > > > > > > > lower on > > > > > > > > > > > the aldo, will post numbers when I get a copy > > > > tomorrow, but > > > > > > > renin > > > > > > > > > > > still non-existent. K was borderline low (3.6 and > > the > > > > range > > > > > > > starts > > > > > > > > > > > at 3.6). Pretty sure will recommend continued > > > > management with > > > > > > > > > > > spironolactone and others, will have to see what the > > > > team says > > > > > > > > > in am. > > > > > > > > > > > > > > > > > > > > > > Kim > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 30, 2010 Report Share Posted April 30, 2010 If BP OK and you feel OK SIT tight. What about DASH and salt dies he not understand. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension Since my doctor seems to think it doesn't matter if I have PA he thinks the Meds I am on will treat it. So no Spiro. Also since he isn't on board with DASH and doing blood test to see if I would need te cut out meds. I have some concern about DASHING and being on Furosemide and Triamterene. They had left Triamterene off there list of meds. .. > > > > > > > > > > > > > > > > > My story is in the files, I have been diagnosed with > > > > > inappropriate > > > > > > > > > aldosterone at the Mayo in the past. i am here getting > > > > > evaluated > > > > > > > > > again, for more than the PA, I also have hyperadrenergic > > > > > autonomic > > > > > > > > > dysfunction, cyclic vomiting syndrome and daily chronic > > > > > headache/ > > > > > > > > > migraines. Was in Monday AM to have an endoscopy and > > ended up > > > > > > > riding > > > > > > > > > the ambulance to the St 's ER for hypertensive > > crisis (was > > > > > > > > > 230/144). They kept me in ICU over night and had a > > heck of a > > > > > time > > > > > > > > > getting pressure down (used a drip of labetalol after > > the > > > > > nitro > > > > > > > > > given in ER). I am still in hospital, but down on the > > general > > > > > > > floor > > > > > > > > > and get out in the am. Will meet with my endo tomorrow > > > > > afternoon > > > > > > > > > (ater the egd)and see what she said. However, I tested > > much > > > > > > > lower on > > > > > > > > > the aldo, will post numbers when I get a copy > > tomorrow, but > > > > > renin > > > > > > > > > still non-existent. K was borderline low (3.6 and the > > range > > > > > starts > > > > > > > > > at 3.6). Pretty sure will recommend continued > > management with > > > > > > > > > spironolactone and others, will have to see what the > > team says > > > > > > > in am. > > > > > > > > > > > > > > > > > > Kim > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 30, 2010 Report Share Posted April 30, 2010 I have a nephew who now is working at the VA. His job is answering the telephone advice line. From what he tells me VA isn't very good at finding answers to hard to DX cases. They treat Sx. Just like my DR told me others tell him there DR tell them to wait and see if they get new SX. > > > > > > > > > > > > > > > > > > > > > > > My story is in the files, I have been diagnosed with > > > > > > > > inappropriate > > > > > > > > > > > > aldosterone at the Mayo in the past. i am here > > > getting > > > > > > > > evaluated > > > > > > > > > > > > again, for more than the PA, I also have > > > hyperadrenergic > > > > > > > > autonomic > > > > > > > > > > > > dysfunction, cyclic vomiting syndrome and daily > > > chronic > > > > > > > > headache/ > > > > > > > > > > > > migraines. Was in Monday AM to have an endoscopy and > > > > > ended up > > > > > > > > > > riding > > > > > > > > > > > > the ambulance to the St 's ER for hypertensive > > > > > crisis (was > > > > > > > > > > > > 230/144). They kept me in ICU over night and had a > > > > > heck of a > > > > > > > > time > > > > > > > > > > > > getting pressure down (used a drip of labetalol > > > after > > > > > the > > > > > > > > nitro > > > > > > > > > > > > given in ER). I am still in hospital, but down on > > > the > > > > > general > > > > > > > > > > floor > > > > > > > > > > > > and get out in the am. Will meet with my endo > > > tomorrow > > > > > > > > afternoon > > > > > > > > > > > > (ater the egd)and see what she said. However, I > > > tested > > > > > much > > > > > > > > > > lower on > > > > > > > > > > > > the aldo, will post numbers when I get a copy > > > > > tomorrow, but > > > > > > > > renin > > > > > > > > > > > > still non-existent. K was borderline low (3.6 and > > > the > > > > > range > > > > > > > > starts > > > > > > > > > > > > at 3.6). Pretty sure will recommend continued > > > > > management with > > > > > > > > > > > > spironolactone and others, will have to see what the > > > > > team says > > > > > > > > > > in am. > > > > > > > > > > > > > > > > > > > > > > > > Kim > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 30, 2010 Report Share Posted April 30, 2010 But notice at low levels of renin (measured) the ratio can vary widely with small errors. So a 0.6 has to be very accurately measured. A 0.3 gets it to 23. My range was 0.65 to 5. Regards Re: Update This is my problem with the ratio. If all you look at is the ratio you can't say if it is early or late PA. Would have to know all meds one is taking. How much salt they were eating. What there K was. I think to many Dr only look at ratio and if it isn't over 20 then you don't have PA even if you have the tumor. > > > > >> > > > > > My story is in the files, I have been diagnosed with > > inappropriate> > > > > > aldosterone at the Mayo in the past. i am here getting > > evaluated> > > > > > again, for more than the PA, I also have hyperadrenergic > > autonomic> > > > > > dysfunction, cyclic vomiting syndrome and daily chronic > > headache/> > > > > > migraines. Was in Monday AM to have an endoscopy and ended up> > > > riding> > > > > > the ambulance to the St 's ER for hypertensive crisis (was> > > > > > 230/144). They kept me in ICU over night and had a heck of a > > time> > > > > > getting pressure down (used a drip of labetalol after the > > nitro> > > > > > given in ER). I am still in hospital, but down on the general> > > > floor> > > > > > and get out in the am. Will meet with my endo tomorrow > > afternoon> > > > > > (ater the egd)and see what she said. However, I tested much> > > > lower on> > > > > > the aldo, will post numbers when I get a copy tomorrow, but > > renin> > > > > > still non-existent. K was borderline low (3.6 and the range > > starts> > > > > > at 3.6). Pretty sure will recommend continued management with> > > > > > spironolactone and others, will have to see what the team says> > > > in am.> > > > > >> > > > > > Kim> > > > > >> > > > > >> > > > > >> > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 30, 2010 Report Share Posted April 30, 2010 Kim, I just wanted to mention one more thing. I have read that spinal fluid is not a good way to test for Lyme. I know several people who have been to Mayo, myself included, and Mayo misses Lyme. You have to see a Lyme literate physician and have tests through a Lab that is specifically devoted to Lyme testing. I think Mayo might be quite behind on this one. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Kim Renin was .6, no range given. > > > > Well, I'm home now, finally!! Ended up being in the hospital 2-1/2 > > days down in Rochester. My aldo tested 7 (normal <21), couldn't > > believe it was that low!! Asked the endo why it was so low after > > being high every time it was tested in the past. Said most likely > > due to meds I was on. Told her I was off all BP meds for 6 weeks > > when tested high in 2006, didn't have an answer for me. But totally > > disinterested in persuing anything at this point, I have to agree > > with her. So, back on Spiro....I was on Inspra for a year but when > > my insurance balked, I thought I'd go ahead and try the Spiro and it > > seems to work just as well as the Inspra. I have had a complete > > hysterectomy, so no female trouble to worry about. I will mention > > your suggestion re/the Nipride when I see my local doc next month. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 30, 2010 Report Share Posted April 30, 2010 Francis, I was tested, retested and detested. Given that they can’t find anything else wrong with you, you need to consider Lyme testing from a Lyme literate MD, especially given where you live. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Francis Bill SUSPECTED PA Since I have two ratios the first one being 8.1 RENIN: 1.8 range (upright/sitting) 0.65-5.0 ng/mL/hr. ALDOS: 16 range Upright 8:00-10:00 am < or = 28 ng/dL Upright 4:00-6:00 pm < or = 21 ng/dL. The time of blood draw was 2:14PM. AT the VA RENIN 0.8 range (-) ALDOS 5.5 range (<=21-) time of blood draw 3pm At Dartmouth Mecical Center. There report Mr. Bill is a 61 years y.o. Mwith symptoms of daily lightheadednass and exartional SOB with an incidentally discovered 2.1cm left adrenal mass whom we saw in our Endocrinology Clinic at DHMC on 03/03/2009 for evaluation of the adrenal mass. We felt at the time the pt's symptoms were likely unrelated to this adrenal incidentaloma especially since he has had an extensive negative work-up in the past. However, since most of his previous testing results were not available to us, and the patient would like to be retested, we rechecked levels of: midnight salivary cortisol renin and aldosterone DHEA-S serum metanephrine and normetanephrine to rule this lesion out as a functioning adenoma. The results above show that there is no evidence that this adenoma is producing any excess adrenal hormones. Past Medical History: HTN diagnosed about 5 yrs ago Chronic Fatigue Syndrome Chronic dyspnea Chronic dizziness sip appendectomy in Dec 2008 Multiple granulomas in the Lungs Exophytic cyst Lt kidney History of Present I11ness: Mr Bill presents today for a second opinion regarding whether he might have Conns Syndrome. In 2006, he underwent w/u for SOB. He had a CT scan of the chest which showed a 2.1 cm soft tisuue mass in the Lt adrenal gland. Subsequent tests showed that the adenoma was non secretory. He has since undergone several chest CT and the adrenal mass has not grown is size. In March 2009, he was seen by endocrinology at DHMC. He again underwent testing including cortisol, PRA, aldosterone, metanephrines etc, all of which were within normal limits. Patient was reassured that this likely represents an incidentaloma. Over the past 3-4 yrs, he has had chronic SOB and dizziness . He has undergone extensive testing for both including EKG, stress tests, echocardiograms, Holter montior, MRI brain (to rio acoustic neuroma), sleep studies, PFTs etc all of which have not identified an abnormality. In Dec 2008, he presented with abd pain and was found to have appendicitis on CT scan. It also showed an exophytic mass in the L kidney for which he unerwent an ultrasound. He was told by his PCP that he needs CT scan for the lesion. I do not have records relating to this issue today. He has normal renal fucntion ( Cr from VA records has ranged from 0.8-1.1 in the past 3 yrs) . Was tested on these Meds Furosemide 20 mg Tablet 60 MG = 3 Tablet(s) / Once daily Oral Potassium Chloride 10 mEq 20 MEQ = 2 Capsule(s) / Once daily Capsule, Sustained Oral Release Atenolol 25 mg Tablet 25 MG = 1 Tablet(s) / Once daily He has undergone testing multiple times and there is no evidence that this is a fucntional adenoma. It most likely represents an incidentaloma that has not increased in size over the past 3 yrs based on CT scanning. His symptoms are also probably unrelated to the incidentaloma. He also does not have any evidence to support a diagnosis of Conns Syndrome. HTN - Not at goal. Discussed occasional home BP checks to help adjust medication regimen. If needed, would add ACEI /ARB or CCB for better control. Discussed wt loss and dietary salt restiriction. Lt renal mass - I do not have records available today regarding this issue but would recommed urology evaluation. He does not routine flu with nephrology unless a new issue arises. Seen and examined with Dr. Rangan. additions: I agree with her above note with the following Renin/aldo levels are normal; no evidence of hyperaldosteronism. H/o hypokalemia on furosemide is not unusual. BP is mildly elevated but likely essential hypertension. If BP remains above 140/90 would consider addition of ACEI as these synergize well with diuretics and may also help mitigate hypokalemia. Reportedly has an exophytic mass on his kidney that does not meet criteria for a simple cyst, although I do not have the images to review personally. Recommend urology evalution for this. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 30, 2010 Report Share Posted April 30, 2010 I gather that Francis does not feel well. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Clarence Grim If BP OK and you feel OK SIT tight. What about DASH and salt dies he not understand. Since my doctor seems to think it doesn't matter if I have PA he thinks the Meds I am on will treat it. So no Spiro. Also since he isn't on board with DASH and doing blood test to see if I would need te cut out meds. I have some concern about DASHING and being on Furosemide and Triamterene. They had left Triamterene off there list of meds. .. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 30, 2010 Report Share Posted April 30, 2010 Tell ur dr you want BP CONTROLLED AND FEEL GOOD and won't be satisified until that goal is met. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension My Dr is trying very hard to have me take Diltiazem with the Atenolol. It seem every time I try to take it my SX get worse. I read that taking these meds together isn't recommend. > > > > > > > > > > > > > > > > > > > > That would be my recommendation. Have you tried > > Inspra? > > > > > > > > > > > > > > > > > > > > CE Grim MD > > > > > > > > > > > > > > > > > > > > I have found Labetaol to be inferior to Nipride in BP > > > > control. > > > > > > > > > With N > > > > > > > > > > I can always get BP to where I want it in under an > > hour. > > > > > > > Usually 30 > > > > > > > > > > min. > > > > > > > > > > > > > > > > > > > > I have never had Nipride fail to lower BP. > > > > > > > > > > > > > > > > > > > > 1. Grim CE. Emergency treatment of severe or malignant > > > > > > > > > > hypertension. Geriatrics 1980;35:57-60. > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 30, 2010 Report Share Posted April 30, 2010 If I didn't have the tumor and the tumor being on the left side and being about 2 cm in size and if my K didn't drop from 4.2 to 3.2 when starting a diuretic. I would think more about getting tested for lyme. I would first like to be properly be tested for PA. Based on the above I think I have a better then 90% of having PA. But because so many Dr only use the ratio to DX PA. It seems that I need to find a PA literate MD to get DX. > > Francis, I was tested, retested and detested. Given that they can't find > anything else wrong with you, you need to consider Lyme testing from a Lyme > literate MD, especially given where you live. > > Val > > > From: hyperaldosteronism > [mailto:hyperaldosteronism ] On Behalf Of Francis Bill > SUSPECTED PA > > > Since I have two ratios the first one being 8.1 RENIN: 1.8 range > (upright/sitting) 0.65-5.0 ng/mL/hr. ALDOS: 16 range Upright 8:00-10:00 am < > or = 28 ng/dL Upright 4:00-6:00 > > pm < or = 21 ng/dL. > The time of blood draw was 2:14PM. AT the VA > > RENIN 0.8 range (-) ALDOS 5.5 range (<=21-) time of blood draw 3pm At > Dartmouth Mecical Center. > > There report > Mr. Bill is a 61 years y.o. Mwith symptoms of daily lightheadednass and > exartional > SOB with an incidentally discovered 2.1cm left adrenal mass whom we saw in > our > Endocrinology Clinic at DHMC on 03/03/2009 for evaluation of the adrenal > mass. > We felt at the time the pt's symptoms were likely unrelated to this adrenal > incidentaloma especially since he has had an extensive negative work-up in > the past. > However, since most of his previous testing results were not available to > us, and > the patient would like to be retested, we rechecked levels of: > midnight salivary cortisol > renin and aldosterone > DHEA-S > serum metanephrine and normetanephrine > to rule this lesion out as a functioning adenoma. > The results above show that there is no evidence that this adenoma is > producing any > excess adrenal hormones. > > Past Medical History: > HTN diagnosed about 5 yrs ago > Chronic Fatigue Syndrome > Chronic dyspnea > Chronic dizziness > sip appendectomy in Dec 2008 > Multiple granulomas in the Lungs > Exophytic cyst Lt kidney > > History of Present I11ness: > Mr Bill presents today for a second opinion regarding whether he might have > Conns > Syndrome. In 2006, he underwent w/u for SOB. He had a CT scan of the chest > which > showed a 2.1 cm soft tisuue mass in the Lt adrenal gland. Subsequent tests > showed > that the adenoma was non secretory. He has since undergone several chest CT > and the > adrenal mass has not grown is size. In March 2009, he was seen by > endocrinology at > DHMC. He again underwent testing including cortisol, PRA, aldosterone, > metanephrines > etc, all of which were within normal limits. Patient was reassured that this > likely > represents an incidentaloma. > Over the past 3-4 yrs, he has had chronic SOB and dizziness . He has > undergone > extensive testing for both including EKG, stress tests, echocardiograms, > Holter > montior, MRI brain (to rio acoustic neuroma), sleep studies, PFTs etc all of > which > have not identified an abnormality. > In Dec 2008, he presented with abd pain and was found to have appendicitis > on CT > scan. It also showed an exophytic mass in the L kidney for which he unerwent > an > ultrasound. He was told by his PCP that he needs CT scan for the lesion. I > do > not have records relating to this issue today. > He has normal renal fucntion ( Cr from VA records has ranged from 0.8-1.1 in > the > past 3 yrs) . > > Was tested on these Meds > > Furosemide 20 mg Tablet 60 MG = 3 Tablet(s) / Once daily > Oral > Potassium Chloride 10 mEq 20 MEQ = 2 Capsule(s) / Once daily > Capsule, Sustained Oral > Release > Atenolol 25 mg Tablet 25 MG = 1 Tablet(s) / Once daily > > He has undergone testing multiple times and there is no evidence that this > is a > fucntional adenoma. It most likely represents an incidentaloma that has not > increased in size over the past 3 yrs based on CT scanning. His symptoms are > also > probably unrelated to the incidentaloma. He also does not have any evidence > to > support a diagnosis of Conns Syndrome. > HTN - Not at goal. Discussed occasional home BP checks to help adjust > medication > regimen. If needed, would add ACEI /ARB or CCB for better control. Discussed > wt loss > and dietary salt restiriction. > Lt renal mass - I do not have records available today regarding this issue > but would > recommed urology evaluation. > He does not routine flu with nephrology unless a new issue arises. > > Seen and examined with Dr. Rangan. > additions: > I agree with her above note with the following > Renin/aldo levels are normal; no evidence of hyperaldosteronism. H/o > hypokalemia on > furosemide is not unusual. BP is mildly elevated but likely essential > hypertension. > If BP remains above 140/90 would consider addition of ACEI as these > synergize well > with diuretics and may also help mitigate hypokalemia. Reportedly has an > exophytic > mass on his kidney that does not meet criteria for a simple cyst, although I > do not > have the images to review personally. Recommend urology evalution for this. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 30, 2010 Report Share Posted April 30, 2010 I think that the Va is now getting up to speed on DASH. They are starting to talk about it on there web site. Blood pressure is in in the 145/80 range. Sometimes it is lower. Better then 175/90 before taking diuretics. > > > > > > > > > > > > > > > > > > > > > My story is in the files, I have been diagnosed with > > > > > > > inappropriate > > > > > > > > > > > aldosterone at the Mayo in the past. i am here > > getting > > > > > > > evaluated > > > > > > > > > > > again, for more than the PA, I also have > > hyperadrenergic > > > > > > > autonomic > > > > > > > > > > > dysfunction, cyclic vomiting syndrome and daily > > chronic > > > > > > > headache/ > > > > > > > > > > > migraines. Was in Monday AM to have an endoscopy and > > > > ended up > > > > > > > > > riding > > > > > > > > > > > the ambulance to the St 's ER for hypertensive > > > > crisis (was > > > > > > > > > > > 230/144). They kept me in ICU over night and had a > > > > heck of a > > > > > > > time > > > > > > > > > > > getting pressure down (used a drip of labetalol > > after > > > > the > > > > > > > nitro > > > > > > > > > > > given in ER). I am still in hospital, but down on > > the > > > > general > > > > > > > > > floor > > > > > > > > > > > and get out in the am. Will meet with my endo > > tomorrow > > > > > > > afternoon > > > > > > > > > > > (ater the egd)and see what she said. However, I > > tested > > > > much > > > > > > > > > lower on > > > > > > > > > > > the aldo, will post numbers when I get a copy > > > > tomorrow, but > > > > > > > renin > > > > > > > > > > > still non-existent. K was borderline low (3.6 and > > the > > > > range > > > > > > > starts > > > > > > > > > > > at 3.6). Pretty sure will recommend continued > > > > management with > > > > > > > > > > > spironolactone and others, will have to see what the > > > > team says > > > > > > > > > in am. > > > > > > > > > > > > > > > > > > > > > > Kim > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 30, 2010 Report Share Posted April 30, 2010 Until someone does the right testing to find out why I don't feel good I can not get the right treatment to feel good. I don't know how to make this happen. I live almost next door to what is one of the best medical centers there are and the VA is part of this. It seems this 350 million dollar medical doesn't know what PA is. > > > > > > > > > > > > > > > > > > > > > > > > That would be my recommendation. Have you tried > > > > Inspra? > > > > > > > > > > > > > > > > > > > > > > > > CE Grim MD > > > > > > > > > > > > > > > > > > > > > > > > I have found Labetaol to be inferior to Nipride > > in BP > > > > > > control. > > > > > > > > > > > With N > > > > > > > > > > > > I can always get BP to where I want it in under an > > > > hour. > > > > > > > > > Usually 30 > > > > > > > > > > > > min. > > > > > > > > > > > > > > > > > > > > > > > > I have never had Nipride fail to lower BP. > > > > > > > > > > > > > > > > > > > > > > > > 1. Grim CE. Emergency treatment of severe or > > malignant > > > > > > > > > > > > hypertension. Geriatrics 1980;35:57-60. > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 30, 2010 Report Share Posted April 30, 2010 I found a new friend on Facebook. It seems people are attracted by different communities of interest. Interestingly, my new friend is also a member of this board. Her name is Shotzie. She had PA and an adrenalectomy in 2006. Her BP and K returned to normal but her health continued to deteriorate. She’s been diagnosed since 1989 with CFS. She is now formally diagnosed with Lyme. That’s three of us. Connections. Val Francis, you will likely never get a proper diagnosis where you are. From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Francis Bill SUSPECTED PA If I didn't have the tumor and the tumor being on the left side and being about 2 cm in size and if my K didn't drop from 4.2 to 3.2 when starting a diuretic. I would think more about getting tested for lyme. I would first like to be properly be tested for PA. Based on the above I think I have a better then 90% of having PA. But because so many Dr only use the ratio to DX PA. It seems that I need to find a PA literate MD to get DX. > > Francis, I was tested, retested and detested. Given that they can't find > anything else wrong with you, you need to consider Lyme testing from a Lyme > literate MD, especially given where you live. > > Val Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 1, 2010 Report Share Posted May 1, 2010 What is your concern about DASHing and fur and tram. This is a piss poor way to treat HTN. F must be taken 2 x a day to have good BP effect. My guess it is only being given once.CE Grim MDOn Apr 29, 2010, at 10:17 PM, Francis Bill SUSPECTED PA wrote:Since my doctor seems to think it doesn't matter if I have PA he thinks the Meds I am on will treat it. So no Spiro. Also since he isn't on board with DASH and doing blood test to see if I would need te cut out meds. I have some concern about DASHING and being on Furosemide and Triamterene.They had left Triamterene off there list of meds. .> > > > > > > >> > > > > > > > > My story is in the files, I have been diagnosed with> > > > > inappropriate> > > > > > > > > aldosterone at the Mayo in the past. i am here getting> > > > > evaluated> > > > > > > > > again, for more than the PA, I also have hyperadrenergic> > > > > autonomic> > > > > > > > > dysfunction, cyclic vomiting syndrome and daily chronic> > > > > headache/> > > > > > > > > migraines. Was in Monday AM to have an endoscopy and > > ended up> > > > > > > riding> > > > > > > > > the ambulance to the St 's ER for hypertensive > > crisis (was> > > > > > > > > 230/144). They kept me in ICU over night and had a > > heck of a> > > > > time> > > > > > > > > getting pressure down (used a drip of labetalol after > > the> > > > > nitro> > > > > > > > > given in ER). I am still in hospital, but down on the > > general> > > > > > > floor> > > > > > > > > and get out in the am. Will meet with my endo tomorrow> > > > > afternoon> > > > > > > > > (ater the egd)and see what she said. However, I tested > > much> > > > > > > lower on> > > > > > > > > the aldo, will post numbers when I get a copy > > tomorrow, but> > > > > renin> > > > > > > > > still non-existent. K was borderline low (3.6 and the > > range> > > > > starts> > > > > > > > > at 3.6). Pretty sure will recommend continued > > management with> > > > > > > > > spironolactone and others, will have to see what the > > team says> > > > > > > in am.> > > > > > > > >> > > > > > > > > Kim> > > > > > > > >> > > > > > > > >> > > > > > > > >> > > > > > > >> > > > > > >> > > > > > >> > > > > >> > > > >> > > > >> > > > >> > > >> > >> >> >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 1, 2010 Report Share Posted May 1, 2010 Need to start collecting data. Dont know if there is a standard Lyme questionnaire to use?Maybe a new Yahoo Group for those with both?I found a new friend on Facebook. It seems people are attracted by different communities of interest. Interestingly, my new friend is also a member of this board. Her name is Shotzie. She had PA and an adrenalectomy in 2006. Her BP and K returned to normal but her health continued to deteriorate. She’s been diagnosed since 1989 with CFS. She is now formally diagnosed with Lyme. That’s three of us. Connections. Val Francis, you will likely never get a proper diagnosis where you are. From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Francis Bill SUSPECTED PAIf I didn't have the tumor and the tumor being on the left side and being about 2 cm in size and if my K didn't drop from 4.2 to 3.2 when starting a diuretic. I would think more about getting tested for lyme. I would first like to be properly be tested for PA. Based on the above I think I have a better then 90% of having PA. But because so many Dr only use the ratio to DX PA. It seems that I need to find a PA literate MD to get DX. >> Francis, I was tested, retested and detested. Given that they can't find> anything else wrong with you, you need to consider Lyme testing from a Lyme> literate MD, especially given where you live.> > Val Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 1, 2010 Report Share Posted May 1, 2010 You most likely have early PA.What meds are you taking and what has not worked?CE Grim MDFrancis, I was tested, retested and detested. Given that they can’t find anything else wrong with you, you need to consider Lyme testing from a Lyme literate MD, especially given where you live. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Francis Bill SUSPECTED PASince I have two ratios the first one being 8.1 RENIN: 1.8 range(upright/sitting) 0.65-5.0 ng/mL/hr. ALDOS: 16 range Upright 8:00-10:00 am < or = 28 ng/dL Upright 4:00-6:00 pm < or = 21 ng/dL. The time of blood draw was 2:14PM. AT the VARENIN 0.8 range (-) ALDOS 5.5 range (<=21-) time of blood draw 3pm At Dartmouth Mecical Center.There report Mr. Bill is a 61 years y.o. Mwith symptoms of daily lightheadednass and exartionalSOB with an incidentally discovered 2.1cm left adrenal mass whom we saw in ourEndocrinology Clinic at DHMC on 03/03/2009 for evaluation of the adrenal mass.We felt at the time the pt's symptoms were likely unrelated to this adrenalincidentaloma especially since he has had an extensive negative work-up in the past.However, since most of his previous testing results were not available to us, andthe patient would like to be retested, we rechecked levels of:midnight salivary cortisolrenin and aldosteroneDHEA-Sserum metanephrine and normetanephrineto rule this lesion out as a functioning adenoma.The results above show that there is no evidence that this adenoma is producing anyexcess adrenal hormones.Past Medical History:HTN diagnosed about 5 yrs agoChronic Fatigue SyndromeChronic dyspneaChronic dizzinesssip appendectomy in Dec 2008Multiple granulomas in the LungsExophytic cyst Lt kidneyHistory of Present I11ness:Mr Bill presents today for a second opinion regarding whether he might have ConnsSyndrome. In 2006, he underwent w/u for SOB. He had a CT scan of the chest whichshowed a 2.1 cm soft tisuue mass in the Lt adrenal gland. Subsequent tests showedthat the adenoma was non secretory. He has since undergone several chest CT and theadrenal mass has not grown is size. In March 2009, he was seen by endocrinology atDHMC. He again underwent testing including cortisol, PRA, aldosterone, metanephrinesetc, all of which were within normal limits. Patient was reassured that this likelyrepresents an incidentaloma.Over the past 3-4 yrs, he has had chronic SOB and dizziness . He has undergoneextensive testing for both including EKG, stress tests, echocardiograms, Holtermontior, MRI brain (to rio acoustic neuroma), sleep studies, PFTs etc all of whichhave not identified an abnormality.In Dec 2008, he presented with abd pain and was found to have appendicitis on CTscan. It also showed an exophytic mass in the L kidney for which he unerwent anultrasound. He was told by his PCP that he needs CT scan for the lesion. I donot have records relating to this issue today.He has normal renal fucntion ( Cr from VA records has ranged from 0.8-1.1 in thepast 3 yrs) .Was tested on these MedsFurosemide 20 mg Tablet 60 MG = 3 Tablet(s) / Once dailyOralPotassium Chloride 10 mEq 20 MEQ = 2 Capsule(s) / Once dailyCapsule, Sustained OralReleaseAtenolol 25 mg Tablet 25 MG = 1 Tablet(s) / Once dailyHe has undergone testing multiple times and there is no evidence that this is afucntional adenoma. It most likely represents an incidentaloma that has notincreased in size over the past 3 yrs based on CT scanning. His symptoms are alsoprobably unrelated to the incidentaloma. He also does not have any evidence tosupport a diagnosis of Conns Syndrome.HTN - Not at goal. Discussed occasional home BP checks to help adjust medicationregimen. If needed, would add ACEI /ARB or CCB for better control. Discussed wt lossand dietary salt restiriction.Lt renal mass - I do not have records available today regarding this issue but wouldrecommed urology evaluation.He does not routine flu with nephrology unless a new issue arises.Seen and examined with Dr. Rangan.additions:I agree with her above note with the followingRenin/aldo levels are normal; no evidence of hyperaldosteronism. H/o hypokalemia onfurosemide is not unusual. BP is mildly elevated but likely essential hypertension.If BP remains above 140/90 would consider addition of ACEI as these synergize wellwith diuretics and may also help mitigate hypokalemia. Reportedly has an exophyticmass on his kidney that does not meet criteria for a simple cyst, although I do nothave the images to review personally. Recommend urology evalution for this. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 1, 2010 Report Share Posted May 1, 2010 And if you are DASHing that is also helping.You can do every thing with DASH you can with diuretics. Well with DASH you don't get low K, Gout, kidney stones, allergies (most skin) and all the other side effects you can get from Ds. But Ds have the fewest side effects if DASHing to the Max doesn't do it.Chlorthalidone is now preferred ti appears. Esp if over 60. Start 12.5 per day then 25 then add ateneolol was what was done with SHEP.CE Grim MDOn Apr 30, 2010, at 6:58 PM, Francis Bill SUSPECTED PA wrote:I think that the Va is now getting up to speed on DASH. They are starting to talk about it on there web site. Blood pressure is in in the 145/80 range. Sometimes it is lower. Better then 175/90 before taking diuretics. > > > > > > > > > >> > > > > > > > > > > My story is in the files, I have been diagnosed with> > > > > > > inappropriate> > > > > > > > > > > aldosterone at the Mayo in the past. i am here > > getting> > > > > > > evaluated> > > > > > > > > > > again, for more than the PA, I also have > > hyperadrenergic> > > > > > > autonomic> > > > > > > > > > > dysfunction, cyclic vomiting syndrome and daily > > chronic> > > > > > > headache/> > > > > > > > > > > migraines. Was in Monday AM to have an endoscopy and> > > > ended up> > > > > > > > > riding> > > > > > > > > > > the ambulance to the St 's ER for hypertensive> > > > crisis (was> > > > > > > > > > > 230/144). They kept me in ICU over night and had a> > > > heck of a> > > > > > > time> > > > > > > > > > > getting pressure down (used a drip of labetalol > > after> > > > the> > > > > > > nitro> > > > > > > > > > > given in ER). I am still in hospital, but down on > > the> > > > general> > > > > > > > > floor> > > > > > > > > > > and get out in the am. Will meet with my endo > > tomorrow> > > > > > > afternoon> > > > > > > > > > > (ater the egd)and see what she said. However, I > > tested> > > > much> > > > > > > > > lower on> > > > > > > > > > > the aldo, will post numbers when I get a copy> > > > tomorrow, but> > > > > > > renin> > > > > > > > > > > still non-existent. K was borderline low (3.6 and > > the> > > > range> > > > > > > starts> > > > > > > > > > > at 3.6). Pretty sure will recommend continued> > > > management with> > > > > > > > > > > spironolactone and others, will have to see what the> > > > team says> > > > > > > > > in am.> > > > > > > > > > >> > > > > > > > > > > Kim> > > > > > > > > > >> > > > > > > > > > >> > > > > > > > > > >> > > > > > > > > >> > > > > > > > >> > > > > > > > >> > > > > > > >> > > > > > >> > > > > > >> > > > > > >> > > > > >> > > > >> > > >> > > >> > > >> > >> >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 1, 2010 Report Share Posted May 1, 2010 If I don't have PA and Fur is removing sodium. I would think by reducing sodium I could deplete sodium to much. It happened to my mother. Of course she was 90 at the time. I take 60 mg of Fur once a day. There are warnings about eating to much K when taking Tram. I was put on Tram because of K droping so much. Didn't seem to help much. I take 50mg once a day. > > > > > > > > > > > > > > > > > > > > > My story is in the files, I have been diagnosed with > > > > > > > inappropriate > > > > > > > > > > > aldosterone at the Mayo in the past. i am here > > getting > > > > > > > evaluated > > > > > > > > > > > again, for more than the PA, I also have > > hyperadrenergic > > > > > > > autonomic > > > > > > > > > > > dysfunction, cyclic vomiting syndrome and daily > > chronic > > > > > > > headache/ > > > > > > > > > > > migraines. Was in Monday AM to have an endoscopy and > > > > ended up > > > > > > > > > riding > > > > > > > > > > > the ambulance to the St 's ER for hypertensive > > > > crisis (was > > > > > > > > > > > 230/144). They kept me in ICU over night and had a > > > > heck of a > > > > > > > time > > > > > > > > > > > getting pressure down (used a drip of labetalol > > after > > > > the > > > > > > > nitro > > > > > > > > > > > given in ER). I am still in hospital, but down on > > the > > > > general > > > > > > > > > floor > > > > > > > > > > > and get out in the am. Will meet with my endo > > tomorrow > > > > > > > afternoon > > > > > > > > > > > (ater the egd)and see what she said. However, I > > tested > > > > much > > > > > > > > > lower on > > > > > > > > > > > the aldo, will post numbers when I get a copy > > > > tomorrow, but > > > > > > > renin > > > > > > > > > > > still non-existent. K was borderline low (3.6 and > > the > > > > range > > > > > > > starts > > > > > > > > > > > at 3.6). Pretty sure will recommend continued > > > > management with > > > > > > > > > > > spironolactone and others, will have to see what the > > > > team says > > > > > > > > > in am. > > > > > > > > > > > > > > > > > > > > > > Kim > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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