Re: Feedback Requested on Recommended AVS

[Guest guest]

Would first need to know if there is a reason to do AVS. Having a normal saline

suppression test would seem to say you don't have PA. and if you don't have PA

no need to do AVS. For us to help us need as many lab numbers as you can give us

with lab ranges.

>

> I am new to this and find all the information a little daunting. I found out

that I had low potassium last August & my family doctor finally recommended that

I go to a kidney specialist in May. My aldo/PRA ratio was 466.7,so she referred

me to an endocrinologist. I had a CAT Scan which showed a 6.7 mm mass on my

left adrenal gland. The saline suppression test was close to normal, so I had

more blood drawn and my aldo/PRA ratio was 233.3. So the endo recommended that I

get an AVS - she likes Hershey Medical Center. I keep taking more potassium (up

to 150 MEQ now) but my potassium stays below normal. My BP is relatively

controlled with 2 meds and baby aspirin.

>

> My endo is fine if I go elsewhere for the AVS. I live in Central PA and see

that NIH and Dr. Liddell in Baltimore have been recommended for an AVS. I am

looking for feedback on good interventional radiologists in the balt/phila/DC

are and what questions I should ask them. Any other feedback is appreciated.

>

> Thank you!

>

[Guest guest]

Here are the results from the saline suppression test (6/22/11):

Aldo Serum: 10 @ 10:30 AM; 5 @ 3:30 PM

Cortisol Serum: 5.5 @ 10 AM; 5.7 @ 3:30 PM

PRA LC/MS/MS: 0.07@ 10:30 AM; 0.32 @3:30 PM

Here are the results from the two blood tests I had:

PRA LC/MS/MS: 0.06 on 5/25/11 and 0.06 on 6/8/11

ALDO/PRA ratio: 466.7 on 5/25/11 and 233.3 on 6/8/11

ALDO LC/MS/MS: 28 on 5/25/11 and 14 on 6/8/11

Here are my potassium levels since 1989:

Jul-11 3.2

Jun-11 4.4

May-11 3.4

Apr-11 2.8

Mar-11 3.3

Nov-10 3.3

Nov-10 3.1

Sep-10 3.4

Aug-10 3.4

Oct-09 3.5

Jul-09 3.6

Nov-08 3.4

Jun-08 3.6

Oct-07 3.6

May-07 3.6

Nov-06 3.6

May-06 3.7

Feb-06 3.6

Nov-05 3.6

Jul-05 3.8

Nov-04 3.7

Dec-03 3.7

Jun-03 3.7

Jul-02 3.7

Nov-01 4.0

Nov-00 3.8

Mar-99 4.1

Feb-97 4.2

Dec-95 3.7

Jul-94 3.7

Oct-92 4.1

Jun-90 4.4

Dec-89 5.3

I believe that my endochrinologist believes that my aldosterone levels with the

small mass merit an AVS. I have fatigue, weakness, tingling, migraines,

hypertension, and hypokalemia.

Do you need any additional information?

> >

> > I am new to this and find all the information a little daunting. I found

out that I had low potassium last August & my family doctor finally recommended

that I go to a kidney specialist in May. My aldo/PRA ratio was 466.7,so she

referred me to an endocrinologist. I had a CAT Scan which showed a 6.7 mm mass

on my left adrenal gland. The saline suppression test was close to normal, so I

had more blood drawn and my aldo/PRA ratio was 233.3. So the endo recommended

that I get an AVS - she likes Hershey Medical Center. I keep taking more

potassium (up to 150 MEQ now) but my potassium stays below normal. My BP is

relatively controlled with 2 meds and baby aspirin.

> >

> > My endo is fine if I go elsewhere for the AVS. I live in Central PA and see

that NIH and Dr. Liddell in Baltimore have been recommended for an AVS. I am

looking for feedback on good interventional radiologists in the balt/phila/DC

are and what questions I should ask them. Any other feedback is appreciated.

> >

> > Thank you!

> >

>

[Guest guest]

Also the limit of detection of CT in the adrenal is in the range of 5 mm as I recall. Was this a special CT?CE Grim MDOn Jul 14, 2011, at 4:56 PM, Francis Bill SUSPECTED PA wrote:Would first need to know if there is a reason to do AVS. Having a normal saline suppression test would seem to say you don't have PA. and if you don't have PA no need to do AVS. For us to help us need as many lab numbers as you can give us with lab ranges. >> I am new to this and find all the information a little daunting. I found out that I had low potassium last August & my family doctor finally recommended that I go to a kidney specialist in May. My aldo/PRA ratio was 466.7,so she referred me to an endocrinologist. I had a CAT Scan which showed a 6.7 mm mass on my left adrenal gland. The saline suppression test was close to normal, so I had more blood drawn and my aldo/PRA ratio was 233.3. So the endo recommended that I get an AVS - she likes Hershey Medical Center. I keep taking more potassium (up to 150 MEQ now) but my potassium stays below normal. My BP is relatively controlled with 2 meds and baby aspirin.> > My endo is fine if I go elsewhere for the AVS. I live in Central PA and see that NIH and Dr. Liddell in Baltimore have been recommended for an AVS. I am looking for feedback on good interventional radiologists in the balt/phila/DC are and what questions I should ask them. Any other feedback is appreciated. > > Thank you!>

[Guest guest]

Need a lot more info.what is normal in this lab?Saline test (which I was co developer) should be done from 8 am to noon with 2 L NS Delaying it may confuse the issue because PAs normally have a pretty good fall in PA from 8 am to noon. How much did you pee during the saline infusion?What was your 24 hr urine for Na and K when the renins and aldos were done?What meds have you been on.What has your BP been.You are sending a pot load of tests to look at.This is what I get paid for usually. Otherwise please plot out all of your Ks with details of meds and diet and Sx when each was takenMy expertise is available 24/7 for 1 year to help interpret all of these for a single $500 fee. This gives you and your medical team access to my expertise by email, cell or Skype.CE Grim MDHere are the results from the saline suppression test (6/22/11):Aldo Serum: 10 @ 10:30 AM; 5 @ 3:30 PMCortisol Serum: 5.5 @ 10 AM; 5.7 @ 3:30 PMPRA LC/MS/MS: 0.07@ 10:30 AM; 0.32 @3:30 PM Here are the results from the two blood tests I had:PRA LC/MS/MS: 0.06 on 5/25/11 and 0.06 on 6/8/11ALDO/PRA ratio: 466.7 on 5/25/11 and 233.3 on 6/8/11ALDO LC/MS/MS: 28 on 5/25/11 and 14 on 6/8/11Here are my potassium levels since 1989:Jul-11 3.2Jun-11 4.4May-11 3.4Apr-11 2.8Mar-11 3.3Nov-10 3.3Nov-10 3.1Sep-10 3.4Aug-10 3.4Oct-09 3.5Jul-09 3.6Nov-08 3.4Jun-08 3.6Oct-07 3.6May-07 3.6Nov-06 3.6May-06 3.7Feb-06 3.6Nov-05 3.6Jul-05 3.8Nov-04 3.7Dec-03 3.7Jun-03 3.7Jul-02 3.7Nov-01 4.0Nov-00 3.8Mar-99 4.1Feb-97 4.2Dec-95 3.7Jul-94 3.7Oct-92 4.1Jun-90 4.4Dec-89 5.3I believe that my endochrinologist believes that my aldosterone levels with the small mass merit an AVS. I have fatigue, weakness, tingling, migraines, hypertension, and hypokalemia. Do you need any additional information?> >> > I am new to this and find all the information a little daunting. I found out that I had low potassium last August & my family doctor finally recommended that I go to a kidney specialist in May. My aldo/PRA ratio was 466.7,so she referred me to an endocrinologist. I had a CAT Scan which showed a 6.7 mm mass on my left adrenal gland. The saline suppression test was close to normal, so I had more blood drawn and my aldo/PRA ratio was 233.3. So the endo recommended that I get an AVS - she likes Hershey Medical Center. I keep taking more potassium (up to 150 MEQ now) but my potassium stays below normal. My BP is relatively controlled with 2 meds and baby aspirin.> > > > My endo is fine if I go elsewhere for the AVS. I live in Central PA and see that NIH and Dr. Liddell in Baltimore have been recommended for an AVS. I am looking for feedback on good interventional radiologists in the balt/phila/DC are and what questions I should ask them. Any other feedback is appreciated. > > > > Thank you!> >>

[Guest guest]

You may want to do this clinical trial.

http://www.clinicaltrials.gov/ct2/show/NCT00005927?term=Adrenal+Tumors & rank=4

> > > >

> > > > I am new to this and find all the information a little daunting.

> > I found out that I had low potassium last August & my family doctor

> > finally recommended that I go to a kidney specialist in May. My aldo/

> > PRA ratio was 466.7,so she referred me to an endocrinologist. I had

> > a CAT Scan which showed a 6.7 mm mass on my left adrenal gland. The

> > saline suppression test was close to normal, so I had more blood

> > drawn and my aldo/PRA ratio was 233.3. So the endo recommended that

> > I get an AVS - she likes Hershey Medical Center. I keep taking more

> > potassium (up to 150 MEQ now) but my potassium stays below normal.

> > My BP is relatively controlled with 2 meds and baby aspirin.

> > > >

> > > > My endo is fine if I go elsewhere for the AVS. I live in Central

> > PA and see that NIH and Dr. Liddell in Baltimore have been

> > recommended for an AVS. I am looking for feedback on good

> > interventional radiologists in the balt/phila/DC are and what

> > questions I should ask them. Any other feedback is appreciated.

> > > >

> > > > Thank you!

> > > >

> > >

> >

> >

> >

>

[Guest guest]

Dr. Grim,

Thank you for your interpretation offer. I am like msmith, cash poor but my

insurance covers 100% of tests.

I will provide a time chart with Ks and K supplents - do you need any other

medicines charted? Daily I take 30 mg cymbalta, 5mg of amlodipine, 20 mg. of

lisiniprol, 150 MEQ of potassium, 81 mg. of baby aspirin and 10 mg of

loratadine. Just started 20 mg of omeprazole. Not sure what " Sx " means. I eat

pretty healthy and stopped salting food about a month ago. I make 85% of my

meals from scratch - eat four servings of fruit a day. Mostly veggies with 1-2

starches and about 4 oz of protein each at lunch and dinner.

My blood pressure got as high as 188/90 in the Fall of 2008 - that is when I

started to take BP meds. I was taking furosemide or another diuretic until

August 2010 when I went to ER with dizziness and tingling in head, neck, arms

and back. For the past three weeks, my BP has ranged between 120/73 and 148/73.

I only peed twice during saline infusion. They did not collect/test my urine.

Here are my results of my saline suppression test with lab ranges at end in

parentheses:

Aldo Serum: 10 @ 10:30 AM; 5 @ 3:30 PM (no ref. range)

Cortisol Serum: 5.5 @ 10 AM; 5.7 @ 3:30 PM (10-25)

PRA LC/MS/MS: 0.07@ 10:30 AM; 0.32 @3:30 PM (0.25-5.82)

Here are the results of blood tests with ranges:

PRA LC/MS/MS: 0.06 on 5/25/11 and 0.06 on 6/8/11 (0.25-5.82)

ALDO/PRA ratio: 466.7 on 5/25/11 and 233.3 on 6/8/11 (0.9-28.9)

ALDO LC/MS/MS: 28 on 5/25/11 and 14 on 6/8/11 (<15)

Should I request any additional tests? What other condition has low K, high BP,

and low ARR?

I had an MRI in December which showed chronic small vessel ischemic change. An

echocardigram in March showed mildly dilated right and left atria; mild mitral

and tricuspid regurgitation; and mildy elevated right heart pressures. I saw a

hemotologist in January who diagnosed thrombocytopenia and

hypogammaglobulinemia.

Sorry this is so long, I find all this a little confusing and scary, while at

the same time I am relieved I am not alone and we seem closer to finding out why

I am so tired and weak and can't seem to retain potassium. Nonetheless,

although I don't understand all the technical terms and can't follow everything,

I am picking up a little at a time as I read the other posts and materials.

The recent article from Medscape was especially helpful.

Thank you and anyone else who has experience or expertise in advance for any

feedback or suggestions you offer.

Georgia

> > > >

> > > > I am new to this and find all the information a little daunting.

> > I found out that I had low potassium last August & my family doctor

> > finally recommended that I go to a kidney specialist in May. My aldo/

> > PRA ratio was 466.7,so she referred me to an endocrinologist. I had

> > a CAT Scan which showed a 6.7 mm mass on my left adrenal gland. The

> > saline suppression test was close to normal, so I had more blood

> > drawn and my aldo/PRA ratio was 233.3. So the endo recommended that

> > I get an AVS - she likes Hershey Medical Center. I keep taking more

> > potassium (up to 150 MEQ now) but my potassium stays below normal.

> > My BP is relatively controlled with 2 meds and baby aspirin.

> > > >

> > > > My endo is fine if I go elsewhere for the AVS. I live in Central

> > PA and see that NIH and Dr. Liddell in Baltimore have been

> > recommended for an AVS. I am looking for feedback on good

> > interventional radiologists in the balt/phila/DC are and what

> > questions I should ask them. Any other feedback is appreciated.

> > > >

> > > > Thank you!

> > > >

> > >

> >

> >

> >

>

[Guest guest]

Suspecting aldosteronism, the kidney specialist ordered the CT. I am not sure

the limit of detection, execpt the CT report noted that there was a 1 mm

calyceal calculus at the lower pole of the left kidney. I am going to request a

CD or film of the CT scan, so I can ask what the limit of the range was. Should

I ask for anything else?

> > >

> > > I am new to this and find all the information a little daunting. I

> > found out that I had low potassium last August & my family doctor

> > finally recommended that I go to a kidney specialist in May. My aldo/

> > PRA ratio was 466.7,so she referred me to an endocrinologist. I had

> > a CAT Scan which showed a 6.7 mm mass on my left adrenal gland. The

> > saline suppression test was close to normal, so I had more blood

> > drawn and my aldo/PRA ratio was 233.3. So the endo recommended that

> > I get an AVS - she likes Hershey Medical Center. I keep taking more

> > potassium (up to 150 MEQ now) but my potassium stays below normal.

> > My BP is relatively controlled with 2 meds and baby aspirin.

> > >

> > > My endo is fine if I go elsewhere for the AVS. I live in Central

> > PA and see that NIH and Dr. Liddell in Baltimore have been

> > recommended for an AVS. I am looking for feedback on good

> > interventional radiologists in the balt/phila/DC are and what

> > questions I should ask them. Any other feedback is appreciated.

> > >

> > > Thank you!

> > >

> >

> >

> >

>

[Guest guest]

Georgia, you don't have a low ARR (aldosterone/renin ratio). You have a very high ARR. That and low potassium are indicative of primary aldosteronism. The treatment is a mineralocorticoid blocker (Inspra or spironolactone) + DASH, or surgery. If surgery is a consideration, you must have AVS before. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of GeorgiaWhat other condition has low K, high BP, and low ARR? .

[Guest guest]

Sx = symptoms

> > > > >

> > > > > I am new to this and find all the information a little daunting.

> > > I found out that I had low potassium last August & my family doctor

> > > finally recommended that I go to a kidney specialist in May. My aldo/

> > > PRA ratio was 466.7,so she referred me to an endocrinologist. I had

> > > a CAT Scan which showed a 6.7 mm mass on my left adrenal gland. The

> > > saline suppression test was close to normal, so I had more blood

> > > drawn and my aldo/PRA ratio was 233.3. So the endo recommended that

> > > I get an AVS - she likes Hershey Medical Center. I keep taking more

> > > potassium (up to 150 MEQ now) but my potassium stays below normal.

> > > My BP is relatively controlled with 2 meds and baby aspirin.

> > > > >

> > > > > My endo is fine if I go elsewhere for the AVS. I live in Central

> > > PA and see that NIH and Dr. Liddell in Baltimore have been

> > > recommended for an AVS. I am looking for feedback on good

> > > interventional radiologists in the balt/phila/DC are and what

> > > questions I should ask them. Any other feedback is appreciated.

> > > > >

> > > > > Thank you!

> > > > >

> > > >

> > >

> > >

> > >

> >

>

[Guest guest]

Val you missed that saline test was Negative for PA. So having AVS may be the

thing to yet.

>

> Georgia, you don't have a low ARR (aldosterone/renin ratio). You have a

> very high ARR. That and low potassium are indicative of primary

> aldosteronism. The treatment is a mineralocorticoid blocker (Inspra or

> spironolactone) + DASH, or surgery. If surgery is a consideration, you must

> have AVS before.

>

> Val

>

> From: hyperaldosteronism

> [mailto:hyperaldosteronism ] On Behalf Of Georgia

>

> What other condition has low K, high BP, and low ARR?

>

>

> .

>

> <http://geo.yahoo.com/serv?s=97359714/grpId=7299303/grpspId=1705132763/msgId

> =33388/stime=1310958055/nc1=5191951/nc2=5191948/nc3=3848643>

>

[Guest guest]

Georgia,

Don't be intiminated by your lack of knowledge, you are about to get an

" education of a lifetime " ! I started at ground zero in Feb. and now feel like

the resident expert at my local VA hospital! Just remember, " The only dumb

question is the one that is not asked! " There are a lot of good people here

ready to jump in and help you, Welcome Aboard!

- 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank &

testicle pain. I have decided against an adrenalectomy at this time since

Meds. are working so well. Current BP: 130/77

Other Issues/Opportunities: COPD w/ft Oxygen, OSA w Bi-Pap settings 13/19, DM2.

and PTSD

Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG,

Metformin 2000MG and Spironolactone 75 MG.

> > > > >

> > > > > I am new to this and find all the information a little daunting.

> > > I found out that I had low potassium last August & my family doctor

> > > finally recommended that I go to a kidney specialist in May. My aldo/

> > > PRA ratio was 466.7,so she referred me to an endocrinologist. I had

> > > a CAT Scan which showed a 6.7 mm mass on my left adrenal gland. The

> > > saline suppression test was close to normal, so I had more blood

> > > drawn and my aldo/PRA ratio was 233.3. So the endo recommended that

> > > I get an AVS - she likes Hershey Medical Center. I keep taking more

> > > potassium (up to 150 MEQ now) but my potassium stays below normal.

> > > My BP is relatively controlled with 2 meds and baby aspirin.

> > > > >

> > > > > My endo is fine if I go elsewhere for the AVS. I live in Central

> > > PA and see that NIH and Dr. Liddell in Baltimore have been

> > > recommended for an AVS. I am looking for feedback on good

> > > interventional radiologists in the balt/phila/DC are and what

> > > questions I should ask them. Any other feedback is appreciated.

> > > > >

> > > > > Thank you!

> > > > >

> > > >

> > >

> > >

> > >

> >

>

[Guest guest]

My advice is to not do AVS unless DASH and MCBs have failed to control BP and K and let you feel normal again.Take my evolution article to your team.CE Grim MDSuspecting aldosteronism, the kidney specialist ordered the CT. I am not sure the limit of detection, execpt the CT report noted that there was a 1 mm calyceal calculus at the lower pole of the left kidney. I am going to request a CD or film of the CT scan, so I can ask what the limit of the range was. Should I ask for anything else? > > >> > > I am new to this and find all the information a little daunting. I > > found out that I had low potassium last August & my family doctor > > finally recommended that I go to a kidney specialist in May. My aldo/ > > PRA ratio was 466.7,so she referred me to an endocrinologist. I had > > a CAT Scan which showed a 6.7 mm mass on my left adrenal gland. The > > saline suppression test was close to normal, so I had more blood > > drawn and my aldo/PRA ratio was 233.3. So the endo recommended that > > I get an AVS - she likes Hershey Medical Center. I keep taking more > > potassium (up to 150 MEQ now) but my potassium stays below normal. > > My BP is relatively controlled with 2 meds and baby aspirin.> > >> > > My endo is fine if I go elsewhere for the AVS. I live in Central > > PA and see that NIH and Dr. Liddell in Baltimore have been > > recommended for an AVS. I am looking for feedback on good > > interventional radiologists in the balt/phila/DC are and what > > questions I should ask them. Any other feedback is appreciated.> > >> > > Thank you!> > >> >> >> >>

[Guest guest]

Read my Evolution article.What other condition has low K, high BP, and low ARR?

[Guest guest]

Print out our list of acrynoms. You are learning a new language.CE Grim MDOn Jul 17, 2011, at 8:10 PM, Francis Bill SUSPECTED PA wrote:Sx = symptoms > > > > >> > > > > I am new to this and find all the information a little daunting. > > > I found out that I had low potassium last August & my family doctor > > > finally recommended that I go to a kidney specialist in May. My aldo/ > > > PRA ratio was 466.7,so she referred me to an endocrinologist. I had > > > a CAT Scan which showed a 6.7 mm mass on my left adrenal gland. The > > > saline suppression test was close to normal, so I had more blood > > > drawn and my aldo/PRA ratio was 233.3. So the endo recommended that > > > I get an AVS - she likes Hershey Medical Center. I keep taking more > > > potassium (up to 150 MEQ now) but my potassium stays below normal. > > > My BP is relatively controlled with 2 meds and baby aspirin.> > > > >> > > > > My endo is fine if I go elsewhere for the AVS. I live in Central > > > PA and see that NIH and Dr. Liddell in Baltimore have been > > > recommended for an AVS. I am looking for feedback on good > > > interventional radiologists in the balt/phila/DC are and what > > > questions I should ask them. Any other feedback is appreciated.> > > > >> > > > > Thank you!> > > > >> > > >> > >> > >> > >> >>

[Guest guest]

Note the saline was not done are recommended by the developer ( me et al) and we don't know how much was given over what time and we do not know drugs and Na intake (documented by 24 hr urine collected the day before the infusion for Na, K and creatinine so we know what her sodium state was. Dr. Grim's Perfect Primary Aldosteronism Blood and Urine Testing to diagnose PA in one day. 1. Eat a high salt diet for 2 weeks-at least 4000 mg of Na a day.2. No BP meds in last 4-12 weeks depending on meds and Drs advice.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 1-4 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. I call this Dr. Grim’s “Quick Pee Test” for PA. 8. Learn the language: If you are new to medical lingo then download the acroyms from May your pressure be low!Clarence E. Grim BS, MS, MD, FACP, FACCBoard Certified in Internal Medicine, Geriatrics, and High Blood Pressure Specializing in Primary Aldosteronism and Difficult to Control High Blood Pressure. On Jul 17, 2011, at 8:19 PM, Francis Bill SUSPECTED PA wrote:Val you missed that saline test was Negative for PA. So having AVS may be the thing to yet. >> Georgia, you don't have a low ARR (aldosterone/renin ratio). You have a> very high ARR. That and low potassium are indicative of primary> aldosteronism. The treatment is a mineralocorticoid blocker (Inspra or> spironolactone) + DASH, or surgery. If surgery is a consideration, you must> have AVS before.> > Val> > From: hyperaldosteronism > [mailto:hyperaldosteronism ] On Behalf Of Georgia> > What other condition has low K, high BP, and low ARR? > > > .> > <http://geo.yahoo.com/serv?s=97359714/grpId=7299303/grpspId=1705132763/msgId> =33388/stime=1310958055/nc1=5191951/nc2=5191948/nc3=3848643>>

[Guest guest]

Thank you Val.

Sent from my Verizon Wireless Phone

Valarie wrote:

>Georgia, you don't have a low ARR (aldosterone/renin ratio). You have a

>very high ARR. That and low potassium are indicative of primary

>aldosteronism. The treatment is a mineralocorticoid blocker (Inspra or

>spironolactone) + DASH, or surgery. If surgery is a consideration, you must

>have AVS before.

>

>Val

>

>From: hyperaldosteronism

>[mailto:hyperaldosteronism ] On Behalf Of Georgia

>

>What other condition has low K, high BP, and low ARR?

>

>

>.

>

><http://geo.yahoo.com/serv?s=97359714/grpId=7299303/grpspId=1705132763/msgId

>=33388/stime=1310958055/nc1=5191951/nc2=5191948/nc3=3848643>

>

[Guest guest]

Thing to yet?

Sent from my Verizon Wireless Phone

Francis Bill SUSPECTED PA wrote:

>Val you missed that saline test was Negative for PA. So having AVS may be the

thing to yet.

>

>

>>

>> Georgia, you don't have a low ARR (aldosterone/renin ratio). You have a

>> very high ARR. That and low potassium are indicative of primary

>> aldosteronism. The treatment is a mineralocorticoid blocker (Inspra or

>> spironolactone) + DASH, or surgery. If surgery is a consideration, you must

>> have AVS before.

>>

>> Val

>>

>> From: hyperaldosteronism

>> [mailto:hyperaldosteronism ] On Behalf Of Georgia

>>

>> What other condition has low K, high BP, and low ARR?

>>

>>

>> .

>>

>> <http://geo.yahoo.com/serv?s=97359714/grpId=7299303/grpspId=1705132763/msgId

>> =33388/stime=1310958055/nc1=5191951/nc2=5191948/nc3=3848643>

>>

>

>

[Guest guest]

Thing to do yet. Since many of us have brain fog you will see many missed words.

> >>

> >> Georgia, you don't have a low ARR (aldosterone/renin ratio). You have a

> >> very high ARR. That and low potassium are indicative of primary

> >> aldosteronism. The treatment is a mineralocorticoid blocker (Inspra or

> >> spironolactone) + DASH, or surgery. If surgery is a consideration, you

must

> >> have AVS before.

> >>

> >> Val

> >>

> >> From: hyperaldosteronism

> >> [mailto:hyperaldosteronism ] On Behalf Of Georgia

> >>

> >> What other condition has low K, high BP, and low ARR?

> >>

> >>

> >> .

> >>

> >>

<http://geo.yahoo.com/serv?s=97359714/grpId=7299303/grpspId=1705132763/msgId

> >> =33388/stime=1310958055/nc1=5191951/nc2=5191948/nc3=3848643>

> >>

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[Guest guest]

Get?Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

Thing to yet?

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Francis Bill SUSPECTED PA wrote:

>Val you missed that saline test was Negative for PA. So having AVS may be the thing to yet.

>

>

>>

>> Georgia, you don't have a low ARR (aldosterone/renin ratio). You have a

>> very high ARR. That and low potassium are indicative of primary

>> aldosteronism. The treatment is a mineralocorticoid blocker (Inspra or

>> spironolactone) + DASH, or surgery. If surgery is a consideration, you must

>> have AVS before.

>>

>> Val

>>

>> From: hyperaldosteronism

>> [mailto:hyperaldosteronism ] On Behalf Of Georgia

>>

>> What other condition has low K, high BP, and low ARR?

>>

>>

>> .

>>

>> <http://geo.yahoo.com/serv?s=97359714/grpId=7299303/grpspId=1705132763/msgId

>> =33388/stime=1310958055/nc1=5191951/nc2=5191948/nc3=3848643>

>>

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[Guest guest]

And again we only recommend surgery if DASH and MCBs fail to control BP K and let you feel normal again. Then it is time to do AVS TO see if surgery is likely to improve the situation. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

Thank you Val.

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Valarie wrote:

>Georgia, you don't have a low ARR (aldosterone/renin ratio). You have a

>very high ARR. That and low potassium are indicative of primary

>aldosteronism. The treatment is a mineralocorticoid blocker (Inspra or

>spironolactone) + DASH, or surgery. If surgery is a consideration, you must

>have AVS before.

>

>Val

>

>From: hyperaldosteronism

>[mailto:hyperaldosteronism ] On Behalf Of Georgia

>

>What other condition has low K, high BP, and low ARR?

>

>

>.

>

><http://geo.yahoo.com/serv?s=97359714/grpId=7299303/grpspId=1705132763/msgId

>=33388/stime=1310958055/nc1=5191951/nc2=5191948/nc3=3848643>

>

[Guest guest]

The renin being very low IS Classic for a salt loaded PA. SYou do need the 24 hr urine that was collected when the renin and Aldo were done and drugs on or u can't interpret the numbers correctly. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

Georgia,

First and foremost. I'm not a doctor but from reading up on the internet, here's my interpretation.

1) Your PAC/PRA ratios are sky high. But that's mostly because your renin activity level is so low. When you get that low you have to worry about the sensitivity level of the test. It's not just about the ratio, the PAC needs to be sufficiently high also.

2) AVS is only really useful to determine lateralization. Granted you got imaging. How old are you? <40 would lean toward APA. How high is your BP? In a study I read, APAs have slightly higher BPs 180ish vs. 160-170ish for bilateral hyperplasia. Forgot where I read this but it's a great paper.

3) Did you mention what 2 meds you were on? "My BP is relatively controlled with 2 meds and baby aspirin." As others have mentioned you might want to try spironolactone or eplerenone before the AVS. If aldosterone blockade will cure hypertension and hypokalemia, you'll be hard pressed to convince a surgeon to operate on you.

4) You may not get a definitive answer with AVS. The results may be ambiguous. Your lateralization ratio may not be up to snuff. They may miss the adrenals. Things could get mislabeled. Personally I had 2 AVSs, my first one was bungled big time. So much so I think he may have gotten the protocol out of a box of crackerjacks. Make sure they use 2 ports to sample both sides at the same time. Make sure they use ATCH. AVS has risks. I personally had a huge hematoma and count myself lucky. There could have been clotting or worse.

5) If after all the above, you're still up for it, I recommend Dr. Christos Georgiades at s Hopkins. He did my second AVS and is a Pro. That and his name has Georgia in it. Hopkins is super pricy though, hope your insurance will cover it. While you're there get some crab cakes at Fadleys.

Good Luck

>

> I am new to this and find all the information a little daunting. I found out that I had low potassium last August & my family doctor finally recommended that I go to a kidney specialist in May. My aldo/PRA ratio was 466.7,so she referred me to an endocrinologist. I had a CAT Scan which showed a 6.7 mm mass on my left adrenal gland. The saline suppression test was close to normal, so I had more blood drawn and my aldo/PRA ratio was 233.3. So the endo recommended that I get an AVS - she likes Hershey Medical Center. I keep taking more potassium (up to 150 MEQ now) but my potassium stays below normal. My BP is relatively controlled with 2 meds and baby aspirin.

>

> My endo is fine if I go elsewhere for the AVS. I live in Central PA and see that NIH and Dr. Liddell in Baltimore have been recommended for an AVS. I am looking for feedback on good interventional radiologists in the balt/phila/DC are and what questions I should ask them. Any other feedback is appreciated.

>

> Thank you!

>