Re: Hyperaldosteronism secondary to hyperparathyroidism

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hard way to dx PA and much more rare.CE Grim MDThe following article might help me get a diagnosis - finally!To short cut a long story, my doctor took tests for parathyroid hormone (PTH) levels, and found my PTH was elevated. With further testing, including a parathyroid gland scan and a pituitary (brain) scan, nothing was found. Because I had been keeping track of my blood sugars to see if I had reactive hypoglycemia, I had a follow-up appointment. My blood sugars were fine. I was a mystery. I think my endocronologist was about to give up on providing me with a diagnosis, and was ending the appointment but then I presented the following article, Hyperparathyroidism Secondary to Hyperaldosteronism (see abstract below) to the endocronologist. I am now being sent for all the tests for hyperaldosteronism. If you want to read my long story, I have included it after the abstract. I am hoping that I might soon have a diagnosis. Hyperparathyroidism Secondary to Hyperaldosteronism Authors: Fortina, Felice1; Bellosta, Stefano2Source: High Blood Pressure & Cardiovascular Prevention, Volume 17, Number 1, 1 March 2010 , pp. 27-30(4)Publisher: Adis InternationalAbstract below. Abstract:Introduction Hyperparathyroidism has been associated with essential hypertension. In rats, volume expansion, the deoxycorticosterone (DOC)-salt hypertension model and primary aldosteronism cause a reduction in plasma calcium levels and secondary hyperparathyroidism. In these rats, urinary calcium decreases with thiazides and/or aldosterone antagonists, while furosemide gives the opposite effect. Also, licorice causes an increase in parathyroid hormone and urinary calcium excretion.Aim To report clinical observations on different clinical cases of aldosteronism, with and without nephrolithiasis, and to elucidate the mechanism causing lithogenesis in patients affected by this pathology.Methods In our hypertension unit, we studied 11 patients with primary aldosteronism: 4 with adenomas and 7 with bilateral adrenal cortex hyperplasia. Only 6 of 11 showed calcium oxalate stones. In all patients we measured parathormone (PTH), calcium, potassium and phosphorus levels in serum and urine before and after treatment with aldosterone antagonists. None of the patients showed either chronic renal insufficiency or any pathologies at the parathyroid glands. No patients received diuretics in the month before the study.Results All patients affected by primary aldosteronism showed an increased PTH level, which was reduced following therapy with aldosterone antagonists. Calcium and phosphorus serum levels remained unchanged, while the treatment reduced urinary calcium and phosphorus levels and increased serum potassium levels in a statistically significant manner (t-test = p < 0.01).Conclusions Our data support the hypothesis of a hyperparathyroidism secondary to aldosteronism. In fact, the aldosterone antagonist normalizes all the values we measured. Therefore, we conclude that (i) aldosterone seems to play a new and important role in the pathogenesis of calcium nephrolithiasis; (ii) aldosterone antagonists may efficiently reduce calcium loss and PTH activation, thus preventing nephrolithiasis in aldosteronism, and most probably also in osteopenia; and (iii) nephrolithiasis is not automatically caused by these conditions, but it requires the contemporary presence of lithogenic factors or the absence of protective factors or it needs a prolonged stimulus. Received for publication 12 February 2010; accepted for publication 10 March 2010. Keywords: Hyperaldosteronism, assessment; Hypercalciuria, general; Hyperparathyroidism, contributory factors; Renal-calculi, generalDocument Type: Research article Affiliations: 1: 1 Ex Director in retirement of the Medical Office of Hypertension, Borgomanero Hospital, Novara, Italy 2: 2 Department of Pharmacological Sciences, University of Milan, Milan, Italy Publication date: 2010-03-01Now for my long story:I have been very healthy. But in the past 2-3yrs, I have been packing on the abdominal weight and feeling more and more tired and overall not well. Prior to seeing an endocrinologist starting in December, 2010, my GP was looking for the obvious, but not finding much of anything. It was a mystery that I still had periods at age 56yr, so this was looked into, but no fibroids. I was getting numerous bladder infections. I was being tested for hypothyroid, diabetes, high blood cholesterol, etc, on and off, but always everything was normal. which was somewhat surprising as I continued to gain weight, about 30lb in last three years. Then when I asked the GP to take my hormones to find out why I was still having periods, I did get diagnosed with low progesterone compared to Estrogen, and have recently been put on this. I think that made me feel better. However, I was gaining abdominal weight, having inflammatory problems in knees and wrists, lots of aches and pains, continuous back pain, feeling generally weak often and brain fog oftern. Oh wel, I thought this is all part of peri-menopause. But, progressively finding it very difficult to work or get through a night or day without severe headaches, dizziness, nausea, brain fog, urinary problems (night trips to bathroom., urinary urgency. Occassionally what might be called dumping syndrome (strong urgent need to have a bowel movement and then diarrhea - especially if I went out for breakfast - usually a high carbohydrate meal). Otherwise, no bowel problesm. In the last year I was having lots of bladder infections. Because I was having sleep problems and some mood control problems, and tired all the time, I was put on Fluoxetine (antidepressant), even though I insisted I was not depressed. I was even offered sleeping pills, but refused these. So, this last October, I just broke down n GP office and insisted something must be wrong. So, she dug a little deeper and ordered tests for PTH levels, Vit D, calcium phosphorous and ferritin. Ferritin was low, PTH was high, Vit D was low, phosphorous was low, and Calcium was normal. Interesting that ferritin was very low, yet hemoglobin was still in normal range 122. I was put on iron for low ferritin. I was told I had secondary hyperparathyroidism from low Vit D. Yet, I insisted I should not have low Vit D, I take a supplement and am outside a lot. After two months on Ferritin, I was still feeling very weak, getting neck and back pains. There was times I could hardly hold my head up, my neck and upper back hurt so much. At that time I was also having heart palpitations, but the doctor said it was all just from the low iron. She said she wouldn't take anymore tests for about three months - time for iron levels to come back up. However, in December, after being on iron for two months, I went back to the doctor, concerned about the continued heart palpitations and general weakness. Luckily there was a replacement doctor covering for my general GP. He immediately took my blood pressure it was found to be high (I have always had very good blood pressure so it wasn't routinely checked). So, at that time, in November, I was put on beta-blocker, Atenolol. I was so scared about the heart palpitations that I agreed to taking the medication for high blood pressure. At that time, the doctor thought it was just secondary to the elevated parathyroid hormone. I was waiting for a parathyoid scan to see if I had a tumor on my parathyroid. (I didn't). On the Atenolol, I began to feel somewhat better. I have just recently found out that Atenolol works by lowering Aldosterone and Renin levels. As well, a few weeks ago, a nurse friend asked if I had ever had my potassium levels tested. She thought that my headaches and muscle weakness might be due to low potassium. Well I hadn't had my potassium levels taken. Thank goodness, I have been working with a very open minded endocrinologist for the past month. My GP was not very open to discussions, she seemed offended and defensive when I wanted to discuss information I had found on the internet. somethingToday, when I showed my endocrinologist, the above abstract, he immediately ordered the blood work to test for hyperaldosteronism. I have not been to the lab yet, but I have a recquisition for Aldosterone and Renin levels. Also, potassium, magnesium, sodium levels are being taken. I really want a diagnosis. I spend most of the day with a bad headache, dizzy, nauseated, brain fog. I bought a home blood pressure machine today. I am thinking the Atenolol might not be controlling my blood pressure. Plus, I read that I should be off the Atenolol (beta blocker) for two weeks prior to going for Aldosterone testing. So, I am thinking of taking myself off the Atenolol. My endocronologist didn't want to discuss this or my mention of Spirolactone, as he was running out of time. So, I think I will just take myself off the Atenolol for now. I expect I will not feel great for a couple weeks. Also, my husband, doesn't want me to go off the Atenolol as he is afraid my blood pressure might cause me to have a stroke. I think he is worrying too much. I said that I would moniter my blood pressure carefully. I wanted to be off the Atenolol so that if indeed I have hyperaldosteronism, then I would get proper test results. Any thoughts or comments- anyone?.