To AVS ro not to AVS....that is the question

[Guest guest]

I am new to the board and would like some opinions on whether or not to strongly

consider Adrenal Venous Sampling.

Particulars: Male, mid 40's, good health

Medical History:

- Mildly hypertensive (140-150/90-100 without meds) starting about 8 years ago

- On Norvasc 10mg (up from 5mg)

- About 3 years ago a low Potassium reading (3.1) led to CT scan, 24-hour urine

test and other bloodwork which led to hyper aldo diagnosis

- CT scans (3 years ago)say there is some " nodularity " or thickening apparently

in both adrenals

- On 5mg Amiloride (twice daily) to help with Potassium

- MRI scan last fall confirms CT scan but they are not directly comparable to

see if the nodularity has increased or not

The latest:

- Had to switch Endos due to insurance

- The new Endo got me into NIH Clinic which did some bloodwork and has me

scheduled for Saline Suppression test soon

Quandary:

- My new Endo is a bit concerned about long term effects of high Aldosterone so

he thought I was lucky to get into see NIH people

- He trusts there is a Radiologist at NIH to do AVS if I go that route

- So the next question is: assuming all the tests from NIH again confirm

Hyper-Aldo, should I consider AVS to see if the high Aldo is localized to one

side? Or consider Eplerenone trial as the alternative recommendation from NIH?

Since the MRI and CT scans did not detect a unilateral adenoma (vs. nodules or

thickening) - which would indicate that surgery might solve the problem - and

since it seems AVS is tricky procedure that is inconclusive about 25% of the

time...and since my hypertensions has been controlled so far with meds, I am

really wondering if I want to bother with AVS (and I am not a pain wimp).

That statistician in me gives me an intuitive feel that I will not be a logical

candidate for adrenalectomy.

On the other hand, if I'm ever going to get this done (AVS) - wouldn't I want to

consider it while I'm still relatively young and healthy? And if it's a tricky

procedure and the NIH guy is extremely qualified, am I missing out on something?

Thoughts / opinions welcome.

- Graham

[Guest guest]

Check out the 2008 Endocrine Society Practice Guideline on PA. I believe a copy

is in the files section. If you seek a surgical treatment, then AVS is

recommended by that organization to biochemically lateralize. If you're content

with medical treatment, then why bother.

The procedure requires an experienced hand. I asked my radiologist how many he

had performed. He answered and also told me the success rate for each side,

explained the procedure in detail using diagrams, and described his background

in neurovenography. I felt very comfortable and had no complications.

>

> I am new to the board and would like some opinions on whether or not to

strongly consider Adrenal Venous Sampling.

>

> Particulars: Male, mid 40's, good health

> Medical History:

> - Mildly hypertensive (140-150/90-100 without meds) starting about 8 years ago

> - On Norvasc 10mg (up from 5mg)

> - About 3 years ago a low Potassium reading (3.1) led to CT scan, 24-hour

urine test and other bloodwork which led to hyper aldo diagnosis

> - CT scans (3 years ago)say there is some " nodularity " or thickening

apparently in both adrenals

> - On 5mg Amiloride (twice daily) to help with Potassium

> - MRI scan last fall confirms CT scan but they are not directly comparable to

see if the nodularity has increased or not

>

> The latest:

> - Had to switch Endos due to insurance

> - The new Endo got me into NIH Clinic which did some bloodwork and has me

scheduled for Saline Suppression test soon

>

> Quandary:

> - My new Endo is a bit concerned about long term effects of high Aldosterone

so he thought I was lucky to get into see NIH people

> - He trusts there is a Radiologist at NIH to do AVS if I go that route

> - So the next question is: assuming all the tests from NIH again confirm

Hyper-Aldo, should I consider AVS to see if the high Aldo is localized to one

side? Or consider Eplerenone trial as the alternative recommendation from NIH?

>

> Since the MRI and CT scans did not detect a unilateral adenoma (vs. nodules or

thickening) - which would indicate that surgery might solve the problem - and

since it seems AVS is tricky procedure that is inconclusive about 25% of the

time...and since my hypertensions has been controlled so far with meds, I am

really wondering if I want to bother with AVS (and I am not a pain wimp).

>

> That statistician in me gives me an intuitive feel that I will not be a

logical candidate for adrenalectomy.

>

> On the other hand, if I'm ever going to get this done (AVS) - wouldn't I want

to consider it while I'm still relatively young and healthy? And if it's a

tricky procedure and the NIH guy is extremely qualified, am I missing out on

something?

>

> Thoughts / opinions welcome.

>

> - Graham

>