CEG comments on notes.

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For every pheo there are prob 1-10,000 PAs.In the old days the most common diagnosis we made in error was pheochromocytoma based on clinical history. Can someone see if there is a pheo site at Yahoo.If not I could start one also and have published several articles about it.CE Grim MDMy Endocrinologist is alright. Like I said lose a little personality that I can live with it seems with decent care, but he knew Conn's and he made the PA dx based on history and my long history of hypokalemia and the no doubt response to spiro. He is really worried about a pheo too because Norepi is pretty high (plasma) and other metanepherines are not (I have done the urine a few times, but that was before I knew how to do it right from this site, and they didn't instruct me right and I think it was normal - I didn't get those labs with my other records). I also have these runs of tach that never had happened prior to the thyroid issue and a sudden peak in blood pressure spike occasionally especially when I roll over at night on my belly (I tend to put my hands under me and I am pressing on SOMETHING I think). So MIGB and a better specific adrenal CT is scheduled. They scheduled it a while ago, but I have so many CT's with dye lately I had to put some mileage between them since I already had such a malignant HTN for so long and I want to keep my kidneys.CEG Malignant HTN is diagnosed only if there are hemorrahges and exudates on the fundoscopic exam. Most are dead in 1 year without Rx.But when the spiro worked in just 2 doses of 25mg (does it work THAT good in alot of you?) when I was already on 5 other meds, he said there was no doubt, and he calls it Conn's, not PA - so Dr Conn's legacy is reaching a few!,And he mentioned DASH too. That damn sodium.......the first time I actually say him was when I very very ill with hyperthyroidism and I was at his visit with a BP 160ish over 130ish. He sent me to cardiology who actually started the spiro.Good but they did not Dx PA? Please take them my article.and what got me THAT dx of hyperthyroid was a good ER doc when I finally said to him, after so many visits, that "something is wrong!" I told the ER doc that Sunday morning that I "was not depressed. I am not stressed more than the average guy is right now, and I can't exercise because I can barely walk!" I had been getting progressively worse with this weakness (among a million other things)I couldn't explain and woke up that Sunday feeling like I was paralyzed almost. Heatrt was 140 that am too. In the old days the Dx was made when people could not step up into the bus.What are the chances of PA, hyperthyroid, and pheo all in one? Would I be a "case for the ages"......okay anyone who's read my posts and those who know me know I am at least a "basket case for the ages"........Hyper is common, pheo very rare, PA more common that HThy.So chances are not zero but if metas are normal you dont likely have pheo-if you were HTN when they were collected.There is a great book called Pheochromocytoma by Manger and Gifford that every ER doc should read. Have you lib get it and read it in your spare time. Perhaps the best overall HTN book is Norman Kaplan's Clinical Hypertension.CE Grim MDSubject: Re: Makes one wonder.....To: hyperaldosteronism Date: Saturday, March 5, 2011, 10:10 AM I have a feeling this is not an uncommon experience - my low K was overlooked for 4 years, then attributed to HCTZ for the next year after that, while all the while the doctor kept putting me on more and stronger ARBs and CCBs - all of which did nothing except make my BP higher!-msmith192845, female, 5'3", 120 lbs, 1cm left adrenal nodule, aldosterone 42.3, renin 0.5, potassium <2.9 (when not taking supplements); 25mg spiro caused gynecomastia, no HTN meds; other meds are 20MEQ K 2x/day, singulair 10mg, norethindrone .35mg, and cyclobenzaprine 5mg as needed; low sodium, fructose- and grain-free diet>> I was reading through this research article and it discusses a 60ish female who had "years" of high blood pressure that could not be controlled on multiple meds and severe hypokalemia. They seemed to initially attribute the low K to hctz (they just made it worse actually). > > But It doesn't say which meds she was on prior to finally figuring out what was going on, but if any of us could guess it was likely some combo of an ACEI, a beta blocker, maybe a CCB, and maybe clonodine, and including the mentioned hctz. > > http://www.ispub.com/journal/the_internet_journal_of_surgery/volume_24_number_1_1/article/conn-s-syndrome-a-diagnostic-dilemma-case-report.html> > I say in the tag "makes one wonder" because no mention is made of whether she was on or off the medications when they did the actual testing of blood and urine. They state that she had an atypical presentation of PA because while only her serum potassium was off, herurine K> was not, and aldosterone and renin were normal. I kind of suspect, if this lady's story is anything like so many of us on this list, she never stopped her meds and so those particular classes of blood pressure medicines, likely gave her a "net" level that was in the normal range when this wasn't entirely true. If understand correctly these medicines, ACEI, BB's etc, do interfere. > > So I wonder if she was actually a classic typical case and they just missed it (and sadly LITERALLY a classic case from our experiences here wherein they kept missing it for years, didn't do any tests right, and she went on for so long without the right diagnosis).> > I>