Re: odd cholesterol patterns and hyperaldosteronism?

[Guest guest]

In my case, htn medications disturbed my CHOL, LDL, HDL, TRIG and I had to take Lipitor=10 for 2-3 years until it was known that the cause of my shoulder pain was muscle damage due to Lipitor. For a while I was on Fenofibrate but was not strong enough so Pravastatin=20 and then 40 mg/d now controls all my lipids. Here is my records of LDL/HDL ratio without Lipitor, with Pravastatin=20, 40:

Your LDL/HDL= 2.1 and mine is getting below 2. Each +1 unit increase in this ratio is equal to 75% increase in MI risk (ref.)

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}

|First off, my info:|45, female, aldosterone 42.3, renin 0.5, potassium <2.9 when|not taking supplements. Suspected primary aldosteronism, still|in process of diagnosis.||I have a really strange cholesterol pattern that has persisted|for probably around 20 years. Triglycerides are always low,|HDL is always really high, and my LDL has gone from being|really low to really high.||Every doctor I've seen has commented that my HDL is the|highest they have ever seen.||Since I don't have any other known risk factors, none of the|internists I've had have pursued the cause of my odd|cholesterol patterns.||My HDL came down a bit while I was taking CCBs and/or ARBS,|and at the same time my triglycerides and LDL started to rise.||I'm wondering if anybody else here has this pattern, or if you|have seen it in other hyperaldosteronism patients, Dr. Grim?||My last cholesterol labs were:|Triglycerides 51|HDL 104|LDL 219||Additional data points: not overweight (5'3", 120 lbs),|exercise regularly and practice yoga, eat low sodium/no|processed junk, avoid all sugars and grains because they cause|gastrointestinal symptoms.||

[Guest guest]

When the topic of statins has come up, my response has always been to refuse

them as my mother had muscle damage due to one of them. I'm far too young to

have anything that debilitating happen to me, especially since I know that every

antihypertensive I've ever taken has disturbed my cholesterol.

Currently I am off all anyhypertensives while undergoing testing, and I feel

better than I've felt in 9 years. I really hope that " feeling better " is

reflected in my labs soon! Prior to taking antihypertensives, my cholesterol

profile was still odd but the high HDL skewed things so that my ratio was a

negative risk factor for MI, and I want that " negative " back

This brings up another question, now that I think of it - for those of us who

took the " wrong " antihypertensives for years, I wonder if this will cause

problems for us down the line. Having come off of all meds recently, in my case

I learned that ARBs and CCBs actually *elevate* my blood pressure.

>

> In my case, htn medications disturbed my CHOL, LDL, HDL, TRIG and I had to

> take Lipitor=10 for 2-3 years until it was known that the cause of my

> shoulder pain was muscle damage due to Lipitor. For a while I was on

> Fenofibrate but was not strong enough so Pravastatin=20 and then 40 mg/d now

> controls all my lipids. Here is my records of LDL/HDL ratio without Lipitor,

> with Pravastatin=20, 40:

>

> Your LDL/HDL= 2.1 and mine is getting below 2. Each +1 unit increase in this

> ratio is equal to 75% increase in MI risk (ref.)

>

> http://members.shaw.ca/studycircle/images/LDL_HDL_Ratio.png

>

> 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}

>

>

>

>

> |First off, my info:

> |45, female, aldosterone 42.3, renin 0.5, potassium <2.9 when

> |not taking supplements. Suspected primary aldosteronism, still

> |in process of diagnosis.

> |

> |I have a really strange cholesterol pattern that has persisted

> |for probably around 20 years. Triglycerides are always low,

> |HDL is always really high, and my LDL has gone from being

> |really low to really high.

> |

> |Every doctor I've seen has commented that my HDL is the

> |highest they have ever seen.

> |

> |Since I don't have any other known risk factors, none of the

> |internists I've had have pursued the cause of my odd

> |cholesterol patterns.

> |

> |My HDL came down a bit while I was taking CCBs and/or ARBS,

> |and at the same time my triglycerides and LDL started to rise.

> |

> |I'm wondering if anybody else here has this pattern, or if you

> |have seen it in other hyperaldosteronism patients, Dr. Grim?

> |

> |My last cholesterol labs were:

> |Triglycerides 51

> |HDL 104

> |LDL 219

> |

> |Additional data points: not overweight (5'3 " , 120 lbs),

> |exercise regularly and practice yoga, eat low sodium/no

> |processed junk, avoid all sugars and grains because they cause

> |gastrointestinal symptoms.

> |

> |

>

[Guest guest]

Need to know your FHx of heart disease before age 55 men and 65 women. Did you do number 5 below. When done post it in your story file in our Conn's story files. Call it Mss story You can't change you FHx but you don't have to repeat it. This is a bit out of the hyperaldo area and I can help you if you want to engage my services individually, but then again I think you may have already done this. If so add to your intro on each email: 45, female, aldosterone 42.3, renin 0.5, potassium <2.9 when not taking supplements. Suspected primary aldosteronism, still in process of diagnosis-consulting with Dr. Grim. BTW based on your numbers so far you have PA. The next question, if you want to answer it, is which type do I have.CE Grim MD Welcome to the exciting world of Hyperaldosteronism! You are in the right place! I am Dr. CE Grim a retired Professor of Medicine and Endocrinology. I have a long standing interest is Primary Aldosteronism since medical school days when I saw my first patient with Primary Aldosteronism in 1963. I trained with Dr. Jerome W. Conn in Endocrinology and Metabolism 1969-70 and have published over 240 papers and book chapters in most areas of the broad discipline of High Blood Pressure. My CV is in our files for details. The goal of our group is to teach you and your health care team about the ins and outs of the causes, diagnosis and control of the many forms of hyperaldosteronism. The steps below will introduce you into the fascinating world of high blood pressure, salt (sodium(Na) chloride (Cl) or NaCL) and potassium (K) and the role of the adrenal hormone aldosterone in health and disease. Doing these in sequence will save you time and effort in getting up to speed in taking control of you health and educating your own health care team. While we can’t make you into a doctor we will make you into a pretty good BP doctor-a skill that you will have for life and you can transfer to the rest of your family who will likely have high blood pressure eventually-if they live long enough. 1. A brief history of Primary Aldosteronsim and why it is so common today in drug resistant high blood pressure. Read my article in our files on the evolution of PA (Evolution_of_PA-Grim.pdf ) and take to all members of health care team. Tell us what stage you believe you are in. This is a brief review of most causes of hyperaldosteronism, high blood pressure, low potassium (K). READING THIS HOW WILL SAVE YOU TIME AND MONEY. By taking it to your health care team they will not treat their other patients as badly as they may have treated you. 2. Read about other patients with hyperaldosteronism (Conn’s syndrome). Read our Conn's stories in our files and then give us your own in as much detail as you can. Dr. Conn was the first to describe this disease process and the syndrome is named after him. The first patient is described in my review article.To see others' stories, on the Hyperaldosteronism home page, go to Files/Conn’s Stories. You'll find instructions in "A - How to put your story here.doc " First send us your story in an email and they we may have questions and suggestions before you upload it to our files. 3. DASH to lower your BP. Your and my tax dollars funded the most important series of studies on how to improve blood pressure, blood sugar, blood lipids and make your heart smaller: The DASH Eating Plan to control high blood pressure due to hyperaldosteronism and most others with high blood pressure. This will reduce your need for medications and in many will get your BP and K to goal without meds.. Get the DASH diet book by T. et al, (http://www.amazon.com/DASH-Diet-Hypertension--/dp/0743202953) read it and use it: ~$8 in paperback at your local bookstore or online. If they don’t have it ask them to order it for you. You can also get the hardback larger print version as well at Amazon. Learning to eat the DASH way will play a major role in your road to good BP and K control and, in many of our folks here, will revolutionize your life. See http://en.wikipedia.org/wiki/DASH_diet for an overview and more details. In the book go to chapter 9 and do the 14 day challenge. Tell your Dr you are doing this as your BP may plummet if you are on other meds. Measure your BP every day and post to us. or go to http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf download this 64 page booklet free and do the Week on the DASH Diet for 2 weeks. If you are on BP meds be prepared for a large fall in BP (20/10 mm Hg or more) and let your Dr. know you are doing this. And/Or go to (but costs money monthly) DASH Diet for Health Program (http://www.dashforhealth.com/pages/public/tour.php)The DASH Diet for Health Program is designed to help you improve your eating and exercise habits. Twice each week they will provide you with information on our website about food, food preparation, eating out, losing weight, getting fit and much more. In addition to providing new information each week on the website, they create a web page specially for you where you can track progress in areas such as your weight, blood pressure, and exercise. I strongly recommend you get this book by .... and read it. 4. Measure your BP: Measure your BP daily so you can see if it is getting better. If you are taking meds be sure to tell your health care team you are doing this as your BP may plummet to normal quickly. We recommend you use a device you listen to and will help you learn how to do this. If this is not something you want to do we can teach a significant other how to do it. See sharedcareinc.com or email to sharedcare@... to order a video on how to do this. If you already have one we will teach you how to teach your health care team how to validate your device. Your life and health depends on accurate BP measurements. Go to the amricanheart.org and download the Guidelines for Human Blood Pressure Measurement. Insist that your health care team do BP the AHA way. Never trust your life to an automatic BP machine unless you know it is accurate on YOU. 5. Genetics and your BP: Go to familyhistory.hhs.gov and do your detailed family medical history (FHx or FH) so we can review with you to help diagnosis (Dx) and treat (Rx) familial causes of high blood pressure and heart disease. If BP runs in your family you may save lives in your family by checking their BP yourself. 6. How to DX and treat PA: Go to our file/Conn's Articles of Note/Medications/Bravo spir 1973.pdf and read this article and take to your health care team. It is old but still one of the best in the medical management of PA. DX: Also see our file from the Endocrine Society Guidelines on PA. 7. Dr. Grim's Perfect Primary Aldosteronism Blood and Urine Testing to diagnose PA in one day. 1. Eat a regular to high salt diet for 2 weeks.2. No BP meds in last 4-12 weeks depending on meds.3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do not lose a drop of this liquid gold. It is impossible to interpret the renin and aldo without this.4. The morning you finish the 24 hr urine have fasting blood drawn for renin, aldo and K using our guidelines to get an accurate K. Try to get this done about 4 hours after you have been out of bed.5. Send us the results with the normal values for your lab.6. If you ever have a salt (saline) infusion test for PA be certain to ask them to measure how much you pee during the 4 hours of the infusion. If it is 1-1.5 liter of urine it strongly suggests that you may have PA. If more tha 1.5 L you almost certainly have PA. 8. Become a participant in our PA Registry and contribute to our large database on PA: If you have been Dxed with PA already and are on Rx or have had surgery please go to http://www.kwiksurveys.com/online-survey.php?surveyID=HIJIO_f2685379 and complete our survey with as much information as you know. If there is some information you don't know ask us and we will help. If you need to update this as you journey thru the diagnostic/treatment process you can add another entry but label it as Nameyymmdd. For example today 6/12/09 for me would be Grim090612. This ever increasing number will allow us and you to sort your multiple entries into a dated order. 9. Learn the language: If you are new to medical lingo then download the acroyms from http://health.groups.yahoo.com/group/bloodpressureline/message/2918610. Salt and high blood pressure: To learn the state of the science of salt and blood pressure please spend some time looking at http://www.worldactiononsalt.com/evidence/treatment_trials.htm11. Become a HBP expert consumer: Expect that it will take at least several weeks to get all this digested and to learn the new language of high blood pressure health care. As most doctors and nurses in practice have had very little training in high blood pressure you must become an expert yourself. For example most have never had anyone listen with them with a double stethoscope to verify that they can hear BP sounds. We cannot make you a doctor but we will make you a pretty good BP doctor.12. How High Blood Pressure should be managed: Go to nih.gov and download and read the Joint National Commission (JNC) Report 7 to get an overview on current guidelines. I ask all my secretaries to read this so they can communicate the importance of high blood pressure to my patients. JNC 8 will be out soon.Then: get (and study) the Hypertension Primer from americanheart.org 4th addition. I coauthored the chapter on BP measurement. You can also get this for about $6 from Amazon.com. This is the most up-to-date compendium of what is known about high blood pressure and what every Dr. should know when they graduate from Medical School. Every chapter is only 2-3 pages. Read one chapter every week-night and you will finish it in about a year. I am working on a reading guide for lay people for the Primer. Stay tuned. If you don't like it take it to your health care team so they will know what every medical student today should know.13. Ask us questions: Ask any questions about high blood pressure you want answered. That is what we are here for. We have had this site for 10 years and over 30,000 emails are searchable. This is the largest collection of communications about Conn's Syndrome in the World. 14. One-on-one Consulting: I can provide individual consulting if you do not want to go public. If you want individual one-on-one consulting for you and your Doctor contract me directly at lowerbp2@....15: Abbreviations of common use in aldo speak include: AME apparent mineralocorticoid excess AVS adrenal vein sampling BB beta blockers CCB calcium channel blockers Dx diagnosis FHx family history GRE glucocorticoid remedial aldosteronism MCB mineralocorticoid blocker also called AB aldosterone blocker. MHx medical history Rx treatment SHx social history May your pressure be low!Clarence E. Grim BS, MS, MD, FACP, FACC, FAHA Council for High Blood Pressure Research. Board Certified in Internal Medicine, Geriatrics, and High Blood Pressure by the American Society of Hypertension. Retired Faculty/Professor of Medicine (U of MO, Indiana, UCLA/DREW, Medical College of Wisconsin in Nephrology, Endocrinology, Cardiology, and Epidemiology. Specializing in Primary Aldosteronism and Difficult to Control High Blood Pressure. First off, my info:45, female, aldosterone 42.3, renin 0.5, potassium <2.9 when not taking supplements. Suspected primary aldosteronism, still in process of diagnosis.I have a really strange cholesterol pattern that has persisted for probably around 20 years. Triglycerides are always low, HDL is always really high, and my LDL has gone from being really low to really high. Every doctor I've seen has commented that my HDL is the highest they have ever seen. Since I don't have any other known risk factors, none of the internists I've had have pursued the cause of my odd cholesterol patterns. My HDL came down a bit while I was taking CCBs and/or ARBS, and at the same time my triglycerides and LDL started to rise.I'm wondering if anybody else here has this pattern, or if you have seen it in other hyperaldosteronism patients, Dr. Grim?My last cholesterol labs were:Triglycerides 51HDL 104LDL 219Additional data points: not overweight (5'3", 120 lbs), exercise regularly and practice yoga, eat low sodium/no processed junk, avoid all sugars and grains because they cause gastrointestinal symptoms.

[Guest guest]

Have you added DASH diet in there?CE Grim MDIn my case, htn medications disturbed my CHOL, LDL, HDL, TRIG and I had to take Lipitor=10 for 2-3 years until it was known that the cause of my shoulder pain was muscle damage due to Lipitor. For a while I was on Fenofibrate but was not strong enough so Pravastatin=20 and then 40 mg/d now controls all my lipids. Here is my records of LDL/HDL ratio without Lipitor, with Pravastatin=20, 40:Your LDL/HDL= 2.1 and mine is getting below 2. Each +1 unit increase in this ratio is equal to 75% increase in MI risk (ref.)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} |First off, my info:|45, female, aldosterone 42.3, renin 0.5, potassium <2.9 when|not taking supplements. Suspected primary aldosteronism, still|in process of diagnosis.||I have a really strange cholesterol pattern that has persisted|for probably around 20 years. Triglycerides are always low,|HDL is always really high, and my LDL has gone from being|really low to really high.||Every doctor I've seen has commented that my HDL is the|highest they have ever seen.||Since I don't have any other known risk factors, none of the|internists I've had have pursued the cause of my odd|cholesterol patterns.||My HDL came down a bit while I was taking CCBs and/or ARBS,|and at the same time my triglycerides and LDL started to rise.||I'm wondering if anybody else here has this pattern, or if you|have seen it in other hyperaldosteronism patients, Dr. Grim?||My last cholesterol labs were:|Triglycerides 51|HDL 104|LDL 219||Additional data points: not overweight (5'3", 120 lbs),|exercise regularly and practice yoga, eat low sodium/no|processed junk, avoid all sugars and grains because they cause|gastrointestinal symptoms.||

[Guest guest]

The elevation is what Alderman et al reported recently in those with low renin. Many of whom have PA IMHO.CE Grim MDWhen the topic of statins has come up, my response has always been to refuse them as my mother had muscle damage due to one of them. I'm far too young to have anything that debilitating happen to me, especially since I know that every antihypertensive I've ever taken has disturbed my cholesterol.Currently I am off all anyhypertensives while undergoing testing, and I feel better than I've felt in 9 years. I really hope that "feeling better" is reflected in my labs soon! Prior to taking antihypertensives, my cholesterol profile was still odd but the high HDL skewed things so that my ratio was a negative risk factor for MI, and I want that "negative" back :)This brings up another question, now that I think of it - for those of us who took the "wrong" antihypertensives for years, I wonder if this will cause problems for us down the line. Having come off of all meds recently, in my case I learned that ARBs and CCBs actually *elevate* my blood pressure.>> In my case, htn medications disturbed my CHOL, LDL, HDL, TRIG and I had to> take Lipitor=10 for 2-3 years until it was known that the cause of my> shoulder pain was muscle damage due to Lipitor. For a while I was on> Fenofibrate but was not strong enough so Pravastatin=20 and then 40 mg/d now> controls all my lipids. Here is my records of LDL/HDL ratio without Lipitor,> with Pravastatin=20, 40:> > Your LDL/HDL= 2.1 and mine is getting below 2. Each +1 unit increase in this> ratio is equal to 75% increase in MI risk (ref.)> > http://members.shaw.ca/studycircle/images/LDL_HDL_Ratio.png> > 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}> > > > > |First off, my info:> |45, female, aldosterone 42.3, renin 0.5, potassium <2.9 when> |not taking supplements. Suspected primary aldosteronism, still> |in process of diagnosis.> |> |I have a really strange cholesterol pattern that has persisted> |for probably around 20 years. Triglycerides are always low,> |HDL is always really high, and my LDL has gone from being> |really low to really high.> |> |Every doctor I've seen has commented that my HDL is the> |highest they have ever seen.> |> |Since I don't have any other known risk factors, none of the> |internists I've had have pursued the cause of my odd> |cholesterol patterns.> |> |My HDL came down a bit while I was taking CCBs and/or ARBS,> |and at the same time my triglycerides and LDL started to rise.> |> |I'm wondering if anybody else here has this pattern, or if you> |have seen it in other hyperaldosteronism patients, Dr. Grim?> |> |My last cholesterol labs were:> |Triglycerides 51> |HDL 104> |LDL 219> |> |Additional data points: not overweight (5'3", 120 lbs),> |exercise regularly and practice yoga, eat low sodium/no> |processed junk, avoid all sugars and grains because they cause> |gastrointestinal symptoms.> |> |>

[Guest guest]

Excellent point. After specialist added Meftformin to my combo, I noticed my food reduced to about 60%-75%...and although I have not yet developed OCD about DASH, but I usually take <2000 mg salt daily without precise measurements. I suspect the precision DASHing that requires counting number of beans in food will cause anxiety disorder in me that worsens my HTN!!!

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}

Have you added DASH diet in there?

CE Grim MD

In my case, htn medications disturbed my CHOL, LDL, HDL, TRIG and I had to take Lipitor=10 for 2-3 years until it was known that the cause of my shoulder pain was muscle damage due to Lipitor. For a while I was on Fenofibrate but was not strong enough so Pravastatin=20 and then 40 mg/d now controls all my lipids. Here is my records of LDL/HDL ratio without Lipitor, with Pravastatin=20, 40:

Your LDL/HDL= 2.1 and mine is getting below 2. Each +1 unit increase in this ratio is equal to 75% increase in MI risk (ref.)

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}

[Guest guest]

Thank you again Dr Grim - I'll try to get my story posted in the next couple

days.

Re: family history, it's unknown. My father died young (53) of a heart attack,

but was dealing with alcoholism and mental illness. My mother is still alive,

but elderly and not forthcoming about her medical issues. I'll see what I can

find out.

>

> > First off, my info:

> > 45, female, aldosterone 42.3, renin 0.5, potassium <2.9 when not

> > taking supplements. Suspected primary aldosteronism, still in

> > process of diagnosis.

> >

> > I have a really strange cholesterol pattern that has persisted for

> > probably around 20 years. Triglycerides are always low, HDL is

> > always really high, and my LDL has gone from being really low to

> > really high.

> >

> > Every doctor I've seen has commented that my HDL is the highest they

> > have ever seen.

> >

> > Since I don't have any other known risk factors, none of the

> > internists I've had have pursued the cause of my odd cholesterol

> > patterns.

> >

> > My HDL came down a bit while I was taking CCBs and/or ARBS, and at

> > the same time my triglycerides and LDL started to rise.

> >

> > I'm wondering if anybody else here has this pattern, or if you have

> > seen it in other hyperaldosteronism patients, Dr. Grim?

> >

> > My last cholesterol labs were:

> > Triglycerides 51

> > HDL 104

> > LDL 219

> >

> > Additional data points: not overweight (5'3 " , 120 lbs), exercise

> > regularly and practice yoga, eat low sodium/no processed junk, avoid

> > all sugars and grains because they cause gastrointestinal symptoms.

> >

> >

> >

>

[Guest guest]

> BTW based on your numbers so far you have PA. The next question, if

> you want to answer it, is which type do I have.

Dr Grim, can you elaborate on this? I'm guessing you mean an adrenal adenoma vs.

bilateral hyperplasia, but if there is more to it than that, please point me in

the right direction. Thank you!

My doctor just called my with my CT scan results. I have a 1cm nodule on my left

adrenal with the characteristics of an aldosterone secreting adenoma.

Next test will be saline suppression (if he can find a facility that does it) or

else oral salt loading test.

(Me: 45, female, 1cm left adrenal nodule, aldosterone 42.3, renin 0.5, potassium

<2.9 when not taking supplements.)

[Guest guest]

Just get the chloride sticks and measure chloride in your urine.CE Grim MDExcellent point. After specialist added Meftformin to my combo, I noticed my food reduced to about 60%-75%...and although I have not yet developed OCD about DASH, but I usually take <2000 mg salt daily without precise measurements. I suspect the precision DASHing that requires counting number of beans in food will cause anxiety disorder in me that worsens my HTN!!! 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} Have you added DASH diet in there?CE Grim MDIn my case, htn medications disturbed my CHOL, LDL, HDL, TRIG and I had to take Lipitor=10 for 2-3 years until it was known that the cause of my shoulder pain was muscle damage due to Lipitor. For a while I was on Fenofibrate but was not strong enough so Pravastatin=20 and then 40 mg/d now controls all my lipids. Here is my records of LDL/HDL ratio without Lipitor, with Pravastatin=20, 40:Your LDL/HDL= 2.1 and mine is getting below 2. Each +1 unit increase in this ratio is equal to 75% increase in MI risk (ref.)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}

[Guest guest]

Unless you are thinking about surgery I recommend skipping the saline test. You will need to stop all meds for 2 weeks unless on spiro then 6-8 weeks. Read my article for the things that look like PA but are something different. GRA eg is inherited. Rarely PA is caused by ectopic tumors that are not in the adrenal.CE Grim MD> BTW based on your numbers so far you have PA. The next question, if > you want to answer it, is which type do I have.Dr Grim, can you elaborate on this? I'm guessing you mean an adrenal adenoma vs. bilateral hyperplasia, but if there is more to it than that, please point me in the right direction. Thank you!My doctor just called my with my CT scan results. I have a 1cm nodule on my left adrenal with the characteristics of an aldosterone secreting adenoma.Next test will be saline suppression (if he can find a facility that does it) or else oral salt loading test.(Me: 45, female, 1cm left adrenal nodule, aldosterone 42.3, renin 0.5, potassium <2.9 when not taking supplements.)

[Guest guest]

>

> Unless you are thinking about surgery I recommend skipping the saline

> test. You will need to stop all meds for 2 weeks unless on spiro then

> 6-8 weeks.

>

> Read my article for the things that look like PA but are something

> different.

>

> GRA eg is inherited.

>

> Rarely PA is caused by ectopic tumors that are not in the adrenal.

>

> CE Grim MD

I'm already considering the surgery! I'm already off of all HTN meds (for longer

than 2 weeks), and not planning on taking spiro. Early on in my HTN diagnosis I

was prescribed spiro, and even at a low dose (25mg IIRC) I developed

excruciating breast pain. I know that cynecomastia is more typical in males than

females, but it definitely happened to me and was painful beyond words.

If my insurance will cover it, or if I'm not a good candidate for surgery, I'm

willing to give Inspra a try. But at my age (45) I would really prefer to not

have to start relying on daily meds if it can be avoided.

[Guest guest]

And you want to be as sure as you can that surgery will help. Did spiro control BP and K. The cost of AVS may run $20,000 and surgery more. Be sure you insurance is going to pay.I would think about Inspra but a few can't tolerate that either.Maybe get the testing done now that you have been off drugs and then see how you do on Inspra. If it does not work then the surgery is worth a try.CE Grim MD>> Unless you are thinking about surgery I recommend skipping the saline > test. You will need to stop all meds for 2 weeks unless on spiro then > 6-8 weeks.> > Read my article for the things that look like PA but are something > different.> > GRA eg is inherited.> > Rarely PA is caused by ectopic tumors that are not in the adrenal.> > CE Grim MDI'm already considering the surgery! I'm already off of all HTN meds (for longer than 2 weeks), and not planning on taking spiro. Early on in my HTN diagnosis I was prescribed spiro, and even at a low dose (25mg IIRC) I developed excruciating breast pain. I know that cynecomastia is more typical in males than females, but it definitely happened to me and was painful beyond words.If my insurance will cover it, or if I'm not a good candidate for surgery, I'm willing to give Inspra a try. But at my age (45) I would really prefer to not have to start relying on daily meds if it can be avoided.

[Guest guest]

Spiro did control the BP, and had the added bonus of cleaning up my adult-onset

acne - I was pretty disappointed when I learned that I couldn't tolerate it. Not

sure if it helped the K at all. At the time the lab my then-doctor (there have

been so many!) used had a different range for " normal " potassium - mine was

always around 3.1 but their cutoff for normal was 3.0. And they always had me

make a fist when they did the blood draws.

I suppose the final decision as to whether I am a candidate for surgery or not

will be made by my insurance company! If they aren't going to pay - well, I

certainly can't, so I guess that won't leave me many choices, will it