Re: Re: 39 yr old WM with HTN slightly low K and no adrenal mass

[Guest guest]

Remember MIcardis has no effect alone on BP in PA. Dont worry about the badly taken BP in the Drs office what has your home BP been doing. This assumes that you home device is accurate in you. Some will be off by more than 20 mm Hg.Trust you team has validated your device in you.Can you tell us exactly how they tool your pressure? If it was not by a machine or an average they need to be taught that BP does not end in 5 if you are taking it correctly. Should end in an even number. Why did he recommend micradis as it does not work in PA.How sure are you that you have PA?CE Grim MDDid you try to play with spiro dosage? I am asking that because I have a strange effect. I was on Micardis 160 mg a day, when I started 50 mg a day of eplerenone and took it for three weeks. During my visit to my Doc my BP was 155/85 and he recommended to make eplerenone 100 mg (twice more) and Micardis 80 mg (50% off). I had it done and my BP became steadily higher. I got back to 160 Micardis and kept 100 of eplerenone. Still high BP. I got back to original dosage 50 + 80. My BP is much better, but I still got almost all symptoms of PA that I didn't have on 100 eplerenone. Is it possible that lower dosage works better for BP than higher?Many, many thanks.To: hyperaldosteronism Sent: Sat, February 5, 2011 11:16:34 AMSubject: RE: Re: 39 yr old WM with HTN slightly low K and no adrenal mass Mean values are average of sbp random readings during the period of dose combos...each combo period varies from few days to about 3.5 years. See other chart on my Spiro, K, Na,...for the period I started Spiro=100mg/d...until then no matter which medication combo I used my bp never was under control, i.e., steady during the day and during the combo period. So I wish to place emphasize on Spiro doses in my PA L adenoma condition. Max. 61M L adenoma NP59 Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67, K.cl=120 mEqThank you. Very helpful. Can you also give us those 75 combos with dosage. And how did you calculate mean -based on how many tests and for how long -one day, 100 days?To: hyperaldosteronism Sent: Fri, February 4, 2011 7:56:03 PMSubject: RE: Re: 39 yr old WM with HTN slightly low K and no adrenal mass And here is my Systolic BP since 1999 and 75 drug combos: This is excellent. Can we do an iPhone/Pad app using K, BP and meds as wellRecall there are 70 million with HTN. WE can only change $1. CE Grim MD

[Guest guest]

Eplerenone didn't do it for me. Natalia Kamneva 66 WF with adrenal adenoma, HTN and low renin and low aldesteron To: "hyperaldosteronism " <hyperaldosteronism >Sent: Sat, February 5, 2011 2:16:01 PMSubject:

Re: Re: 39 yr old WM with HTN slightly low K and no adrenal mass

Here is what I would do. 24 hr urine for Na and K and creat. If ENa is not less than EK THEN u are not dashing to the Max. But I recall you are taking a ton of K So if ENa is not less than 70 mM u are not maxed out. To minimize need for Spiro you could also try the rice diet which is 250 mg Na. I would also step down the other drugs that don't work in PA and see what Bp does. What is problem changing to eplerenone? It would likely get u off all other BP drugs AND K pills but what do I know. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

Yes, I am still on 8 drugs. I discussed with my doc your proposal to eliminate Amlo+Ram+Indap plus my breast pain and he decided to keep me as it is saying that if he eliminates the 3 drugs he has to increase Spiro from 100 to >100 and I get further breast pain. Switching to Inspra also seems super difficult for now. But my bp is so steady and controlled that I am considering to stay on them instead of adrenalectomy for now.

Max.

61M L adenoma NP59 Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67, K.cl=120 mEq

Max

Nice plots but are you still on all the meds you list in your thumbsketch? That is a ton of K and suspect you must be eating a lot of Na to require this much on spiro.

Again I think if we could put this in an iPhone app we might be able to retire.

CE Grim MD

[Guest guest]

How much. You need 2 x as much as spiro and you can out salt it.CE Grim MDEplerenone didn't do it for me. Natalia Kamneva 66 WF with adrenal adenoma, HTN and low renin and low aldesteron To: "hyperaldosteronism " <hyperaldosteronism >Sent: Sat, February 5, 2011 2:16:01 PMSubject: Re: Re: 39 yr old WM with HTN slightly low K and no adrenal mass Here is what I would do. 24 hr urine for Na and K and creat. If ENa is not less than EK THEN u are not dashing to the Max. But I recall you are taking a ton of K So if ENa is not less than 70 mM u are not maxed out. To minimize need for Spiro you could also try the rice diet which is 250 mg Na. I would also step down the other drugs that don't work in PA and see what Bp does. What is problem changing to eplerenone? It would likely get u off all other BP drugs AND K pills but what do I know. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension Yes, I am still on 8 drugs. I discussed with my doc your proposal to eliminate Amlo+Ram+Indap plus my breast pain and he decided to keep me as it is saying that if he eliminates the 3 drugs he has to increase Spiro from 100 to >100 and I get further breast pain. Switching to Inspra also seems super difficult for now. But my bp is so steady and controlled that I am considering to stay on them instead of adrenalectomy for now. Max.61M L adenoma NP59 Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67, K.cl=120 mEqMaxNice plots but are you still on all the meds you list in your thumbsketch? That is a ton of K and suspect you must be eating a lot of Na to require this much on spiro.Again I think if we could put this in an iPhone app we might be able to retire. CE Grim MD

[Guest guest]

AS i note in my article MICARDIS (and ARB) WILL NOT WORK IN PA. read my lips.ACEs will not work. therefore ACES and ARBs together will not work, Indeed recent data suggests they may increase BP when renin is low.CE Grim MDI used to take 80 mg Micardis for several months but to no avail: My Systolic BP while on Micardis=80mg/d: My BP vs Spiro doses is posted earlier. Dr. Grim explained that using ACE or A2RB you try to block cortisol that PA patient already does not have and hence aldo/cortisol ratio goes up causing bp goes up. Lower Micardis=less cortisol blocking=lower aldo/cprtisol ratio= lover bp (my understanding).No. ACE and ARBs both block the RAAS system just in differenct places. They have no effect on cortisol that we know of. Remember that ACE+A2RB combo= heart attack! Max.61M L adenoma NP59 Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67, K.cl=120 mEqDid you try to play with spiro dosage? I am asking that because I have a strange effect. I was on Micardis 160 mg a day, when I started 50 mg a day of eplerenone and took it for three weeks. During my visit to my Doc my BP was 155/85 and he recommended to make eplerenone 100 mg (twice more) and Micardis 80 mg (50% off). I had it done and my BP became steadily higher. I got back to 160 Micardis and kept 100 of eplerenone. Still high BP. I got back to original dosage 50 + 80. My BP is much better, but I still got almost all symptoms of PA that I didn't have on 100 eplerenone. Is it possible that lower dosage works better for BP than higher?Many, many thanks.

[Guest guest]

>Dr. Grim explained that using ACE or A2RB you try to block cortisol that PA patient already does not have and hence aldo/cortisol ratio goes up causing bp goes up. I didn't read that and it's a point! My aldo is low and my cortisol is high. So, we are different!> Remember that ACE+A2RB combo= heart attack! ??????? I was on Micardis and Lisinopril !!!!! Thank you, very interesting and informative as usually from you.

Natalia Kamneva 66 Russian F with adrenal adenoma, HTN, low renin, low aldesteron and high cortisol.

To: hyperaldosteronism Sent: Sat, February 5, 2011 7:26:21 PMSubject: RE: Re: 39 yr old WM with HTN slightly low K and no adrenal mass

I used to take 80 mg Micardis for several months but to no avail:

My Systolic BP while on Micardis=80mg/d:

My BP vs Spiro doses is posted earlier.

Dr. Grim explained that using ACE or A2RB you try to block cortisol that PA patient already does not have and hence aldo/cortisol ratio goes up causing bp goes up. Lower Micardis=less cortisol blocking=lower aldo/cprtisol ratio= lover bp (my understanding).

Remember that ACE+A2RB combo= heart attack!

Max.

61M L adenoma NP59 Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67, K.cl=120 mEq

Did you try to play with spiro dosage? I am asking that because I have a strange effect. I was on Micardis 160 mg a day, when I started 50 mg a day of eplerenone and took it for three weeks. During my visit to my Doc my BP was 155/85 and he recommended to make eplerenone 100 mg (twice more) and Micardis 80 mg (50% off). I had it done and my BP became steadily higher. I got back to 160 Micardis and kept 100 of eplerenone. Still high BP. I got back to original dosage 50 + 80. My BP is much better, but I still got almost all symptoms of PA that I didn't have on 100 eplerenone. Is it possible that lower dosage works better for BP than higher?Many, many thanks.

[Guest guest]

They you have apparent cortisol excess.The you have Cushing's? Most studies don't show low renin in Cush.Give details on your cortisol. >Dr. Grim explained that using ACE or A2RB you try to block cortisol that PA patient already does not have and hence aldo/cortisol ratio goes up causing bp goes up. I didn't read that and it's a point! My aldo is low and my cortisol is high. So, we are different!> Remember that ACE+A2RB combo= heart attack! ??????? I was on Micardis and Lisinopril !!!!! Thank you, very interesting and informative as usually from you. Natalia Kamneva 66 Russian F with adrenal adenoma, HTN, low renin, low aldesteron and high cortisol. To: hyperaldosteronism Sent: Sat, February 5, 2011 7:26:21 PMSubject: RE: Re: 39 yr old WM with HTN slightly low K and no adrenal mass I used to take 80 mg Micardis for several months but to no avail: My Systolic BP while on Micardis=80mg/d: My BP vs Spiro doses is posted earlier. Dr. Grim explained that using ACE or A2RB you try to block cortisol that PA patient already does not have and hence aldo/cortisol ratio goes up causing bp goes up. Lower Micardis=less cortisol blocking=lower aldo/cprtisol ratio= lover bp (my understanding). Remember that ACE+A2RB combo= heart attack! Max.61M L adenoma NP59 Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67, K.cl=120 mEqDid you try to play with spiro dosage? I am asking that because I have a strange effect. I was on Micardis 160 mg a day, when I started 50 mg a day of eplerenone and took it for three weeks. During my visit to my Doc my BP was 155/85 and he recommended to make eplerenone 100 mg (twice more) and Micardis 80 mg (50% off). I had it done and my BP became steadily higher. I got back to 160 Micardis and kept 100 of eplerenone. Still high BP. I got back to original dosage 50 + 80. My BP is much better, but I still got almost all symptoms of PA that I didn't have on 100 eplerenone. Is it possible that lower dosage works better for BP than higher?Many, many thanks.

[Guest guest]

OOPS! sorry, Dr Grim said rennin, I confused rennin with cortisol: about ACE & A2RB not working.

Max.

61M L adenoma NP59 Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67, K.cl=120 mEq

>Dr. Grim explained that using ACE or A2RB you try to block cortisol that PA patient already does not have and hence aldo/cortisol ratio goes up causing bp goes up. I didn't read that and it's a point! My aldo is low and my cortisol is high. So, we are different!

[Guest guest]

rennin digests milk in the stomach. pronounced with a short e like in rent.renin comes from the kidney and raises BP. Pronounced with a long e like in release.OOPS! sorry, Dr Grim said rennin, I confused rennin with cortisol: about ACE & A2RB not working. Max.61M L adenoma NP59 Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67, K.cl=120 mEq>Dr. Grim explained that using ACE or A2RB you try to block cortisol that PA patient already does not have and hence aldo/cortisol ratio goes up causing bp goes up. I didn't read that and it's a point! My aldo is low and my cortisol is high. So, we are different!

[Guest guest]

I typed renin but then my dumb auto corrector changed it to rennin!

Max.

61M L adenoma NP59 Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67, K.cl=120 mEq

rennin digests milk in the stomach. pronounced with a short e like in rent.

renin comes from the kidney and raises BP. Pronounced with a long e like in release.

[Guest guest]

CORTISOL, 24 URINARY FREECORTISOL,F,UR 22CORTISOL,F, 24U 46PLASMA RENIN ACTIVITY 0.36ALDOSTERONE 1.9 From: Clarence Grim

To: hyperaldosteronism Cc: Clarence Grim Sent: Sat, February 5, 2011 8:17:43 PMSubject: Re: Re: 39 yr old WM with HTN slightly low K and no adrenal mass

They you have apparent cortisol excess.The you have Cushing's? Most studies don't show low renin in Cush.Give details on your cortisol. >Dr. Grim explained that using ACE or A2RB you try to block cortisol that PA patient already does not have and hence aldo/cortisol ratio goes up causing bp goes up. I didn't read that and it's a point! My aldo is low and my cortisol is high. So, we are different!> Remember that ACE+A2RB combo= heart attack! ??????? I was on Micardis and Lisinopril !!!!! Thank you, very interesting and informative as usually from you. Natalia Kamneva 66 Russian F with adrenal adenoma, HTN, low renin, low aldesteron and high cortisol. To: hyperaldosteronism Sent: Sat, February 5, 2011 7:26:21 PMSubject: RE: Re: 39 yr old WM with HTN slightly low K and no adrenal mass I used to take 80 mg Micardis for several months but to no avail: My Systolic BP while on Micardis=80mg/d: My BP vs Spiro doses is posted earlier. Dr. Grim explained that using ACE or A2RB you try to block cortisol that PA patient already does not have and hence aldo/cortisol ratio goes up causing bp goes up. Lower Micardis=less

cortisol blocking=lower aldo/cprtisol ratio= lover bp (my understanding). Remember that ACE+A2RB combo= heart attack! Max.61M L adenoma NP59 Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67, K.cl=120 mEqDid you try to play with

spiro dosage? I am asking that because I have a strange effect. I was on Micardis 160 mg a day, when I started 50 mg a day of eplerenone and took it for three weeks. During my visit to my Doc my BP was 155/85 and he recommended to make eplerenone 100 mg (twice more) and Micardis 80 mg (50% off). I had it done and my BP became steadily higher. I got back to 160 Micardis and kept 100 of eplerenone. Still high BP. I got back to original dosage 50 + 80. My BP is much better, but I still got almost all symptoms of PA that I didn't have on 100 eplerenone. Is it possible that lower dosage works better for BP than higher?Many, many thanks.

[Guest guest]

Then it's strange, since both this groups seem working for me. My renin plasma activity is 0.36.To: hyperaldosteronism Sent: Sat, February 5, 2011 8:33:33 PMSubject: RE: Re: 39 yr

old WM with HTN slightly low K and no adrenal mass

OOPS! sorry, Dr Grim said rennin, I confused rennin with cortisol: about ACE & A2RB not working.

Max.

61M L adenoma NP59 Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67, K.cl=120 mEq

>Dr. Grim explained that using ACE or A2RB you try to block cortisol that PA patient already does not have and hence aldo/cortisol ratio goes up causing bp goes up. I didn't read that and it's a point! My aldo is low and my cortisol is high. So, we are different!

[Guest guest]

Our PAs are opposite each other: Your cortisol/aldo ratio is high, my aldo/cortisol ratio is high.

Max.

61M L adenoma NP59 med combo #75={Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67, K.cl=120 mEq}

Then it's strange, since both this groups seem working for me. My renin plasma activity is 0.36.

[Guest guest]

what meds were you on when these were done and for the PRA and Aldo what was your sodium intake?One cannot interpret the renin and aldo without a urine Na and K and creatinine.CE Grim MDCORTISOL, 24 URINARY FREECORTISOL,F,UR 22CORTISOL,F, 24U 46PLASMA RENIN ACTIVITY 0.36ALDOSTERONE 1.9 To: hyperaldosteronism Cc: Clarence Grim Sent: Sat, February 5, 2011 8:17:43 PMSubject: Re: Re: 39 yr old WM with HTN slightly low K and no adrenal mass They you have apparent cortisol excess.The you have Cushing's? Most studies don't show low renin in Cush.Give details on your cortisol. >Dr. Grim explained that using ACE or A2RB you try to block cortisol that PA patient already does not have and hence aldo/cortisol ratio goes up causing bp goes up. I didn't read that and it's a point! My aldo is low and my cortisol is high. So, we are different!> Remember that ACE+A2RB combo= heart attack! ??????? I was on Micardis and Lisinopril !!!!! Thank you, very interesting and informative as usually from you. Natalia Kamneva 66 Russian F with adrenal adenoma, HTN, low renin, low aldesteron and high cortisol. To: hyperaldosteronism Sent: Sat, February 5, 2011 7:26:21 PMSubject: RE: Re: 39 yr old WM with HTN slightly low K and no adrenal mass I used to take 80 mg Micardis for several months but to no avail: My Systolic BP while on Micardis=80mg/d: My BP vs Spiro doses is posted earlier. Dr. Grim explained that using ACE or A2RB you try to block cortisol that PA patient already does not have and hence aldo/cortisol ratio goes up causing bp goes up. Lower Micardis=less cortisol blocking=lower aldo/cprtisol ratio= lover bp (my understanding). Remember that ACE+A2RB combo= heart attack! Max.61M L adenoma NP59 Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67, K.cl=120 mEqDid you try to play with spiro dosage? I am asking that because I have a strange effect. I was on Micardis 160 mg a day, when I started 50 mg a day of eplerenone and took it for three weeks. During my visit to my Doc my BP was 155/85 and he recommended to make eplerenone 100 mg (twice more) and Micardis 80 mg (50% off). I had it done and my BP became steadily higher. I got back to 160 Micardis and kept 100 of eplerenone. Still high BP. I got back to original dosage 50 + 80. My BP is much better, but I still got almost all symptoms of PA that I didn't have on 100 eplerenone. Is it possible that lower dosage works better for BP than higher?Many, many thanks.

[Guest guest]

And the normal values for each of your labs are?? for these ratios. I am not aware of published normals for these ratios.CE Grim MDOur PAs are opposite each other: Your cortisol/aldo ratio is high, my aldo/cortisol ratio is high. Max.61M L adenoma NP59 med combo #75={Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67, K.cl=120 mEq} Then it's strange, since both this groups seem working for me. My renin plasma activity is 0.36.

[Guest guest]

Aldo = 1065 H [28 - 860] pmol/L 2009-10-22

Aldo = 1516 H [28 - 860] pmol/L 2009-10-26

Aldo = 2056 H [28 - 860] pmol/L 2009-10-27

Renin = 6 [<30] ng/L 2009-10-22

Renin = 6 ng/L = 0.1422 pmol/L

Aldo/renin = 1065 or 2056/0.1422 = 7489 to 14458

Metanephrines: all normal

No cortisol values as no AVS but NP59.

Max.

61M L adenoma NP59 med combo #75={Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67, K.cl=120 mEq}

And the normal values for each of your labs are?? for these ratios. I am not aware of published normals for these ratios.

CE Grim MD

[Guest guest]

61M L adenoma by NP59 scan. High aldo not low renin. med combo #75={Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67, K.cl=120 mEq}Do you know the definition of low renin in your lab <30 is not adequate I don't think. What was urine Na and K in the urine when renin and aldo were tested.CEGAldo = 1065 H [28 - 860] pmol/L 2009-10-22Aldo = 1516 H [28 - 860] pmol/L 2009-10-26Aldo = 2056 H [28 - 860] pmol/L 2009-10-27Renin = 6 [<30] ng/L 2009-10-22 Renin = 6 ng/L = 0.1422 pmol/L Aldo/renin = 1065 or 2056/0.1422 = 7489 to 14458 Metanephrines: all normal No cortisol values as no AVS but NP59. Max.61M L adenoma NP59 med combo #75={Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67, K.cl=120 mEq}And the normal values for each of your labs are?? for these ratios. I am not aware of published normals for these ratios.CE Grim MD

[Guest guest]

There is no single 24-hr uNa or uK test in my 10 years med tests. I asked doc last time he said they do not indicate anything because they depend on how much water you drink in 24 hrs. hehehehe what a doc!

Max.

61M L adenoma by NP59 scan. High aldo not low renin. med combo #75={Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67, K.cl=120 mEq}

61M L adenoma by NP59 scan. High aldo not low renin. med combo #75={Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67, K.cl=120 mEq}

Do you know the definition of low renin in your lab <30 is not adequate I don't think. What was urine Na and K in the urine when renin and aldo were tested.

CEG

Aldo = 1065 H [28 - 860] pmol/L 2009-10-22

Aldo = 1516 H [28 - 860] pmol/L 2009-10-26

Aldo = 2056 H [28 - 860] pmol/L 2009-10-27

Renin = 6 [<30] ng/L 2009-10-22

Renin = 6 ng/L = 0.1422 pmol/L

Aldo/renin = 1065 or 2056/0.1422 = 7489 to 14458

Metanephrines: all normal

No cortisol values as no AVS but NP59.

Max.

61M L adenoma NP59 med combo #75={Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67, K.cl=120 mEq}

And the normal values for each of your labs are?? for these ratios. I am not aware of published normals for these ratios.

CE Grim MD

[Guest guest]

You might ask him to get the Hypertension Primer and review basic renal physiology and how the kidney handles sodium and water. What kind of a Dr. is he?How does he then know how interpret the renin and aldosterone numbers?There is no single 24-hr uNa or uK test in my 10 years med tests. I asked doc last time he said they do not indicate anything because they depend on how much water you drink in 24 hrs. hehehehe what a doc! Max.61M L adenoma by NP59 scan. High aldo not low renin. med combo #75={Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67, K.cl=120 mEq} 61M L adenoma by NP59 scan. High aldo not low renin. med combo #75={Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67, K.cl=120 mEq}Do you know the definition of low renin in your lab <30 is not adequate I don't think. What was urine Na and K in the urine when renin and aldo were tested.CEGAldo = 1065 H [28 - 860] pmol/L 2009-10-22Aldo = 1516 H [28 - 860] pmol/L 2009-10-26Aldo = 2056 H [28 - 860] pmol/L 2009-10-27Renin = 6 [<30] ng/L 2009-10-22 Renin = 6 ng/L = 0.1422 pmol/L Aldo/renin = 1065 or 2056/0.1422 = 7489 to 14458 Metanephrines: all normal No cortisol values as no AVS but NP59. Max.61M L adenoma NP59 med combo #75={Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67, K.cl=120 mEq}And the normal values for each of your labs are?? for these ratios. I am not aware of published normals for these ratios.CE Grim MD

[Guest guest]

Actually, my doc did not even ordered the aldo & renin tests...but the spepcialist Prof. of UH ordered and based on those results she followed with 24 hr urine sample for neph tests and then CT and finally NP59. My family doc only writes med refills!

Max.

61M L adenoma by NP59 scan. High aldo not low renin. med combo #75={Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67, K.cl=120 mEq}

You might ask him to get the Hypertension Primer and review basic renal physiology and how the kidney handles sodium and water. What kind of a Dr. is he?

How does he then know how interpret the renin and aldosterone numbers?

There is no single 24-hr uNa or uK test in my 10 years med tests. I asked doc last time he said they do not indicate anything because they depend on how much water you drink in 24 hrs. hehehehe what a doc!

Max.

61M L adenoma by NP59 scan. High aldo not low renin. med combo #75={Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67, K.cl=120 mEq}

61M L adenoma by NP59 scan. High aldo not low renin. med combo #75={Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67, K.cl=120 mEq}

Do you know the definition of low renin in your lab <30 is not adequate I don't think. What was urine Na and K in the urine when renin and aldo were tested.

CEG

Aldo = 1065 H [28 - 860] pmol/L 2009-10-22

Aldo = 1516 H [28 - 860] pmol/L 2009-10-26

Aldo = 2056 H [28 - 860] pmol/L 2009-10-27

Renin = 6 [<30] ng/L 2009-10-22

Renin = 6 ng/L = 0.1422 pmol/L

Aldo/renin = 1065 or 2056/0.1422 = 7489 to 14458

Metanephrines: all normal

No cortisol values as no AVS but NP59.

Max.

61M L adenoma NP59 med combo #75={Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67, K.cl=120 mEq}

And the normal values for each of your labs are?? for these ratios. I am not aware of published normals for these ratios.

CE Grim MD

[Guest guest]

That's what I found

CREATININE, URINE QUANT.

CREATININE URINE VOLUME 3045 ml

CREATININE EXCRETION 0.76 [0.80 - 1.80] g/24hr

PLASMA RENIN ACTIVITY 0.36

Unit: ng/mL/hr

(NOTE)

Adult Normal Salt Intake:

Upright 1.31 - 3.95

Supine 0.15- 2.33

Salt Excretion:

(Na mEq/24 hr):

Na= 0 - 30 8.82 - 23.86

Na= 30 - 75 4.09 - 7.73

Na= 75 - 150 1.44 - 2.80

Na= >150 0.39 -1.31

In the time I was on 160 Micardis and 20 lisinopril.

Natalia Kamneva 66 Russian F with left adrenal adenoma, HTN, low renin, low aldesteron and high cortisol.

To: hyperaldosteronism Cc: Clarence Grim Sent: Sun, February 6, 2011 11:22:06 PMSubject: Re: Re: 39 yr old WM with HTN slightly low K and no adrenal mass

what meds were you on when these were done and for the PRA and Aldo what was your sodium intake?

One cannot interpret the renin and aldo without a urine Na and K and creatinine.

CE Grim MD

CORTISOL, 24 URINARY FREECORTISOL,F,UR 22CORTISOL,F, 24U 46PLASMA RENIN ACTIVITY 0.36ALDOSTERONE 1.9

To: hyperaldosteronism Cc: Clarence Grim Sent: Sat, February 5, 2011 8:17:43

PMSubject: Re: Re: 39 yr old WM with HTN slightly low K and no adrenal mass

They you have apparent cortisol excess.

The you have Cushing's? Most studies don't show low renin in Cush.

Give details on your cortisol.

>Dr. Grim explained that using ACE or A2RB you try to block cortisol that PA patient already does not have and hence aldo/cortisol ratio goes up causing bp goes up. I didn't read that and it's a point! My aldo is low and my cortisol is high. So, we are different!> Remember that ACE+A2RB combo= heart attack! ??????? I was on Micardis and Lisinopril !!!!! Thank you, very interesting and informative as usually from you.

Natalia Kamneva 66 Russian F with adrenal adenoma, HTN, low renin, low aldesteron and high cortisol.

To: hyperaldosteronism Sent: Sat, February 5, 2011 7:26:21 PMSubject: RE: Re: 39 yr old WM with HTN slightly low K and no adrenal mass

I used to take 80 mg Micardis for several months but to no avail:

My Systolic BP while on Micardis=80mg/d:

My BP vs Spiro doses is posted earlier.

Dr. Grim explained that using ACE or A2RB you try to block cortisol that PA patient already does not have and hence aldo/cortisol ratio goes up causing bp goes up. Lower Micardis=less cortisol blocking=lower aldo/cprtisol ratio= lover bp (my understanding).

Remember that ACE+A2RB combo= heart attack!

Max.

61M L adenoma NP59 Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67, K.cl=120 mEq

Did you try to play with spiro dosage? I am asking that because I have a strange effect. I was on Micardis 160 mg a day, when I started 50 mg a day of eplerenone and took it for three weeks. During my visit to my Doc my BP was 155/85 and he recommended to make eplerenone 100 mg (twice more) and Micardis 80 mg (50% off). I had it done and my BP became steadily higher. I got back to 160 Micardis and kept 100 of eplerenone. Still high BP. I got back to original dosage 50 + 80. My BP is much better, but I still got almost all symptoms of PA that I didn't have on 100 eplerenone. Is it possible that lower dosage works better for BP than higher?Many, many thanks.

[Guest guest]

Yes, it's true. I was there twice with blood sodium 126 and BP 240/120. They improved sodium by IV, but with BP said that I had to find a good blood pressure doctor. I found you. All others cannot be called good doctors ar all.

Natalia Kamneva 66 Russian F with adrenal adenoma, HTN and low renin , low aldosteron and high cortisol, K=3.4.

To: hyperaldosteronism Sent: Mon, February 7, 2011 9:16:26 AMSubject: Re: 39 yr old WM with HTN slightly low K and no adrenal mass

I believe She has been in hospital for low blood NA> >> >>> >> >Dr. Grim explained that using ACE or A2RB you try to block > >> cortisol that PA patient already does not have and hence aldo/ > >> cortisol ratio goes up

causing bp goes up.> >>> >> I didn't read that and it's a point! My aldo is low and my cortisol > >> is high. So, we are different!> >>> >> > Remember that ACE+A2RB combo= heart attack!> >>> >> ??????? I was on Micardis and Lisinopril !!!!!> >>> >> Thank you, very interesting and informative as usually from you.> >>> >> Natalia Kamneva 66 Russian F with adrenal adenoma, HTN, low renin, > >> low aldesteron and high cortisol.> >>> >>> >>> >> > >> To: hyperaldosteronism > >> Sent: Sat, February 5, 2011 7:26:21 PM> >>

Subject: RE: Re: 39 yr old WM with HTN > >> slightly low K and no adrenal mass> >>> >>> >>> >> I used to take 80 mg Micardis for several months but to no avail:> >>> >> My Systolic BP while on Micardis=80mg/d:> >>> >>> >> My BP vs Spiro doses is posted earlier.> >>> >> Dr. Grim explained that using ACE or A2RB you try to block cortisol > >> that PA patient already does not have and hence aldo/cortisol ratio > >> goes up causing bp goes up. Lower Micardis=less cortisol > >> blocking=lower aldo/cprtisol ratio= lover bp (my understanding).> >>> >> Remember that ACE+A2RB combo= heart attack!> >>> >> Max.> >> 61M L adenoma NP59 Spiro=100, Amlo=10, Indap=2.5, Ramip=5, >

>> Metf=1000, Prav=40, Feno=67, K.cl=120 mEq> >>> >> Did you try to play with spiro dosage? I am asking that because I > >> have a strange effect. I was on Micardis 160 mg a day, when I > >> started 50 mg a day of eplerenone and took it for three weeks. > >> During my visit to my Doc my BP was 155/85 and he recommended to > >> make eplerenone 100 mg (twice more) and Micardis 80 mg (50% off). I > >> had it done and my BP became steadily higher. I got back to 160 > >> Micardis and kept 100 of eplerenone. Still high BP. I got back to > >> original dosage 50 + 80. My BP is much better, but I still got > >> almost all symptoms of PA that I didn't have on 100 eplerenone.> >> Is it possible that lower dosage works better for BP than higher?> >>> >> Many, many thanks.>

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

[Guest guest]

U need to be sure they are drawing the blood correctly as it is easy to do this wrong and miss a low blood K. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

I recently learned that when my K drops below 4, my trapezius muscle goes into spasm as a result of low K. So even though 3.5-5.5 is considered "normal", I feel that the low end of normal for me is actually 4. Palpitations start for me when it dips to 3.1.

Re: palpitations - do you take vitamin D, or a multivitamin by any chance? I've found that supplementing with vitamin D triggers palpitations for me. I have no idea why, and my doctor is puzzled by it too.

>

>

> Hello everyone,

>

> I think this question may have been asked before so I apologize in

> advance if it has. What is a good target potassium level? Mine is

> usually around 3.8 (3.5-5.5 normal range). Right now I am just taking

> 50 mg of spiro 2X/day. I just recently was able to stop taking clonidine

> and atenolol over the past month. My blood pressure remains very good at

> around 120/80. I still have some occasional heart palpitations, but

> otherwise I actually feel great for the first time in I don't know how

> long.

>

> I am watching my sodium intake, but not doing a strict dash diet. Is

> there any danger in having a potassium level in the low normal range?

> Before I was diagnosed with PA my potassium was 3.4 ( with no potassium

> supplementation). Are the palpitaions due to a lower potassium level?

>

> polymac

>

[Guest guest]

One cup of low Na V8 gets u 25 mM how much are u taking?Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

I do know that I have PA based upon the past testing I have had. I just

don't have any visible adenomas. The spiro working so well to lower my

blood pressure further supports my diagnosis. I have been watching how

my blood samples have been taken to measure potassium. I make sure they

don't have me pump my fist. They do tie the rubber tubing to my arm. I

have asked if they can do sample without this and they won't. It does

make since ot me that I may also need to take potassium supplements. I

don't think I could dash enough to get my potassium up to 4.6. It woudl

be interesting to see if my palpitations stop after increasing my

potassiunm levels.

polymac

>

> I learned that low K (<4.0) causes multitude of problems...not sure if

> palpitation is one but when Spiro is lowering your bp it means you

have PA

> and PA means you have one or two adenoma producing aldosterone and

> aldosterone lowers your K and low K causes many problems...so it seems

> rational to take enough dose of Spiro to control bp keeping it

=<120/80 and

> then if needed take enough K supplements to elevate K to about 4.6

either as

> Dr Grim says by DASH or in my case by K.Cl supplements of 120

mEq/daily.

>

> Max.

> 61M L adenoma by NP59 scan. High aldos not low renin. med combo

> #75={Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40,

Feno=67,

> K.cl=120 mEq}

>

> |

> |I have had my CHOL, LDL,HDL, and TRIG tested within the past

> |year and everything was fine. I have never had problems with

> |my cholesterol. I had very frequent palpitations when I was

> |pregnant. The docs think this was due to the expansion of

> |blood volume. I don't think my palpitations are due to

> |exercise or lack of exercise. I have them either way. Right

> |now I am doing moderate exercise 5-7 times/week. I am

> |wondering if I need my potassium levels to be higher to

> |eliminate the palpitations?

> |

> |I do not want to take any more blood pressure meds than

> |necessary. I seem to be prone to their side effects. I am

> |wondering if I should somehow supplement with extra potassium

> |or change dosage of spiro? (50 mg spiro 2X/day). Right now I

> |am only taking spiro to control my blood pressure and it seems

> |to be working very well for me except for the palpitations.

> |

> |polymac

> |

>

[Guest guest]

Palpitations are how I realized I has PA. My K was 1.3 and 4 doctors sent me home! After nearly a year of being fobed off I finally requested all my labs from every ER and Dr . I looked it all up online and guessed it might be PA. I had an appt w my cardiologist, who was telling me I needed a psych consult. I stood in the doorway of his patient room and begged him to look at my labs- K ranging from 1.3 to 2.9. I had critical levels. It said so right on the lab reports. Ignored by 3 hospitals and 4 Drs. The cardiologist only listened to me because I blocked the door. By the next week he did labs and confirmed PA. My main complaint was palps. They were frightening. The cardiologist said low K was the cause. I moved and haven't found a dr that will test my K now. Though Dr Grim gave me the name of a Dr so fingers crossed. I have very few palps since the adrenalectomy but I'd like to make sure the remaining adrenal is functioning properly since I have symptoms now. Though less severe.

I have had my CHOL, LDL,HDL, and TRIG tested within the past year and

everything was fine. I have never had problems with my cholesterol. I

had very frequent palpitations when I was pregnant. The docs think this

was due to the expansion of blood volume. I don't think my palpitations

are due to exercise or lack of exercise. I have them either way. Right

now I am doing moderate exercise 5-7 times/week. I am wondering if I

need my potassium levels to be higher to eliminate the palpitations?

I do not want to take any more blood pressure meds than necessary. I

seem to be prone to their side effects. I am wondering if I should

somehow supplement with extra potassium or change dosage of spiro? (50

mg spiro 2X/day). Right now I am only taking spiro to control my blood

pressure and it seems to be working very well for me except for the

palpitations.

polymac

>

> I keep my K=4.6 ...any K<3.9 has caused me some kind of muscle spasm

in the

> past.

>

> I experienced palpitation during the time I was on ACEi+A2RB combo

that

> medical authorities later declared causing MI and insteructed doctors

to

> abandon iit. With that combo I had severe palpitations at

wake-up...very

> scary indeed. So bad drug combo might be cause of palpitation...as

well as

> lack of regular moderate exercise...as far as I discovered.

>

> You might also need a diuretic (of course not HCTZ)! How are your

CHOL, LDL,

> HDL, TRIG?

>

> Max.

> 61M L adenoma by NP59 scan. High aldos not low renin. med combo

> #75={Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40,

Feno=67,

> K.cl=120 mEq}

>

> |Hello everyone,

> |

> |I think this question may have been asked before so I

> |apologize in advance if it has. What is a good target

> |potassium level? Mine is usually around 3.8 (3.5-5.5 normal

> |range). Right now I am just taking 50 mg of spiro 2X/day. I

> |just recently was able to stop taking clonidine and atenolol

> |over the past month. My blood pressure remains very good at

> |around 120/80. I still have some occasional heart

> |palpitations, but otherwise I actually feel great for the

> |first time in I don't know how long.

> |

> |I am watching my sodium intake, but not doing a strict dash

> |diet. Is there any danger in having a potassium level in the

> |low normal range? Before I was diagnosed with PA my potassium

> |was 3.4 ( with no potassium supplementation). Are the

> |palpitaions due to a lower potassium level?

> |

> |polymac

> |

>

[Guest guest]

120 mM K a day is a lot to get down. That is 4800 mg k + what u are aging. Must be pouring on the salt as well to require this much. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

I learned that low K (<4.0) causes multitude of problems...not sure if

palpitation is one but when Spiro is lowering your bp it means you have PA

and PA means you have one or two adenoma producing aldosterone and

aldosterone lowers your K and low K causes many problems...so it seems

rational to take enough dose of Spiro to control bp keeping it =<120/80 and

then if needed take enough K supplements to elevate K to about 4.6 either as

Dr Grim says by DASH or in my case by K.Cl supplements of 120 mEq/daily.

Max.

61M L adenoma by NP59 scan. High aldos not low renin. med combo

#75={Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67,

K.cl=120 mEq}

|

|I have had my CHOL, LDL,HDL, and TRIG tested within the past

|year and everything was fine. I have never had problems with

|my cholesterol. I had very frequent palpitations when I was

|pregnant. The docs think this was due to the expansion of

|blood volume. I don't think my palpitations are due to

|exercise or lack of exercise. I have them either way. Right

|now I am doing moderate exercise 5-7 times/week. I am

|wondering if I need my potassium levels to be higher to

|eliminate the palpitations?

|

|I do not want to take any more blood pressure meds than

|necessary. I seem to be prone to their side effects. I am

|wondering if I should somehow supplement with extra potassium

|or change dosage of spiro? (50 mg spiro 2X/day). Right now I

|am only taking spiro to control my blood pressure and it seems

|to be working very well for me except for the palpitations.

|

|polymac

|