Re: Young with high bp

[Guest guest]

When you had your aldo levels tested, had you been on any BP meds recently?

Certain meds can produce false negatives.

I was under the impression that ultrasound won't show adrenal tumors; CT scan

will. If your PCP can order a CT scan, I'd recommend that as your next step.

Have you ever taken spironolactone or eplerenone? Another option would be to try

one of these; if it works when other BP meds did not, there's a good chance you

have hyperaldosteronism.

Also, how is your potassium level?

Your history sounds pretty similar to mine - it took me 10 years and many

doctors to get a diagnosis after onset of HTN when I was 36. My tumor was

finally discovered in February, and I just came home from having it and my

adrenal gland removed a couple days ago. Too soon to tell if the surgery was

successful but remaining hopeful

>

> Hi All,

>

> I just turned 27, am 116 pounds at 5'6. I eat a healthy diet for the most

part, and get at least 30 minutes of exercise every day. Despite the picture of

health, for the last 5 years my blood pressure has remained in the 135/90 range.

The highest it has ever been was 155/102. I have seen 4 cardiologists, 2

pulmonologists, 1 nephrologist/renal hypertension specialist, and numerous other

family practice physicians. My current pcp sent me to a renal hypertension

specialist because of high aldosterone levels. The specialist dismissed the idea

that my aldosterone was high enough to exhibit symptoms of hyperaldosteronism.

However, I did receive a renal ultrasound to check for growths on my adrenal

glands, which came back clear. My pcp still insists that my aldosterone is high,

but does not know where else to go with it. Postual Orthostatic Tachycardia

Syndrome is something that has been mentioned in other forums I have been apart

of for hypertension. I have tried testing my heart rate in the lying down,

sitting up, and standing. All of which, I haven't been able to come to a solid

conclusion on. The only other condition anyone has been able to detect is a

minor murmur that was found in the aortic region of my heart, but other than

that all suspected underlying illnesses have been ruled out. My current PCP and

myself are completely stumped and have come to a fork in the road. Do I go back

on high blood pressure medications that previously did nothing to lower my blood

pressure, or are there other possible tests and/or possible conditions that have

been overlooked? Any other suggestions, ideas, experiences are welcomed!

>

[Guest guest]

Likely had CT so would go back and look at this Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

When you had your aldo levels tested, had you been on any BP meds recently? Certain meds can produce false negatives.

I was under the impression that ultrasound won't show adrenal tumors; CT scan will. If your PCP can order a CT scan, I'd recommend that as your next step.

Have you ever taken spironolactone or eplerenone? Another option would be to try one of these; if it works when other BP meds did not, there's a good chance you have hyperaldosteronism.

Also, how is your potassium level?

Your history sounds pretty similar to mine - it took me 10 years and many doctors to get a diagnosis after onset of HTN when I was 36. My tumor was finally discovered in February, and I just came home from having it and my adrenal gland removed a couple days ago. Too soon to tell if the surgery was successful but remaining hopeful

>

> Hi All,

>

> I just turned 27, am 116 pounds at 5'6. I eat a healthy diet for the most part, and get at least 30 minutes of exercise every day. Despite the picture of health, for the last 5 years my blood pressure has remained in the 135/90 range. The highest it has ever been was 155/102. I have seen 4 cardiologists, 2 pulmonologists, 1 nephrologist/renal hypertension specialist, and numerous other family practice physicians. My current pcp sent me to a renal hypertension specialist because of high aldosterone levels. The specialist dismissed the idea that my aldosterone was high enough to exhibit symptoms of hyperaldosteronism. However, I did receive a renal ultrasound to check for growths on my adrenal glands, which came back clear. My pcp still insists that my aldosterone is high, but does not know where else to go with it. Postual Orthostatic Tachycardia Syndrome is something that has been mentioned in other forums I have been apart of for hypertension. I have tried testing my heart rate

in the lying down, sitting up, and standing. All of which, I haven't been able to come to a solid conclusion on. The only other condition anyone has been able to detect is a minor murmur that was found in the aortic region of my heart, but other than that all suspected underlying illnesses have been ruled out. My current PCP and myself are completely stumped and have come to a fork in the road. Do I go back on high blood pressure medications that previously did nothing to lower my blood pressure, or are there other possible tests and/or possible conditions that have been overlooked? Any other suggestions, ideas, experiences are welcomed!

>

[Guest guest]

I have had a chest ct scan I believe - back when they suspected heart and lung problems. Would an abdominal CT scan be required to rule out adrenal tumors?

[Guest guest]

I believe so; I don't think a chest CT would show the adrenals at all.

>

> I have had a chest ct scan I believe - back when they suspected heart and lung

problems. Would an abdominal CT scan be required to rule out adrenal tumors?

>

[Guest guest]

Not sure if all chest CT show adrenals but the ones I have had done show them

and they show the 2 cm tumor.

> >

> > I have had a chest ct scan I believe - back when they suspected heart and

lung problems. Would an abdominal CT scan be required to rule out adrenal

tumors?

> >

>

[Guest guest]

Unless good reason to have CT best to avoid them. MRI most of the time shows the

same information with far less risk.

If they did chest CT get the report and see what is in it.

The report is going to look something this.

Findings: There is a well defined 7 mm nodule at the medial aspect of the right

base. No additional nodules are identified. There are no pleural effusions.

There is no mediastinal or hilaradenopathy. There is a slightly lobulated 2.3 cm

low attenuation lesion in the left lobe of the liver and a similar 2.0 cm low

attenuation lesion inferior to this in the left lobe, consistent with simple

cysts. There is a 1.3 cm low attenuation lesion in the posterior segment of the

right lobe and a lobulated 2.1 cm low attenuation lesion in the anterior segment

of the right lobe, also consistent with simple cysts. The spleen, gallbladder,

and visualized portions of the pancreas are normal. The right adrenal gland is

normal. There is a 2.1 cm nodule in the left adrenal gland measuring soft tissue

attenuation, which is statistically most likely an adenoma. Visualized portions

of the kidneys are unremarkable.

In my case I recived a letter from My then PCP

Your recent CAT scan looks decent - There Was nothing specific on this that

explains your shortness of breath . There was, however , a small nodule in your

lung and it is unclear what this is . Our radiologists have recommended that we

repeat a CAT scan in three to six months time. I will have this scheduled for

you. I will also try to arrange the sleep study for you.

Note that letter doesn't say any thing about the 2.1 cm nodule in the left

adrenal gland.

>

> I have had a chest ct scan I believe - back when they suspected heart and lung

problems. Would an abdominal CT scan be required to rule out adrenal tumors?

>

[Guest guest]

Who cares whether CT 'will do' or not? MRI is a better technology and on that

basis you deserve to have it. My endos said they would give me a CT, I said no

and demanded an MRI: I got an MRI.

Getting the results of it is another matter though - 3+ weeks since I had it and

still waiting...

> >

> > I have had a chest ct scan I believe - back when they suspected heart and

lung problems. Would an abdominal CT scan be required to rule out adrenal

tumors?

> >

>

[Guest guest]

guess you haven't looked at many.First issue is does she need one yet. There is some risk of radiation and renal damage so I only do when needed.CE Grim MD I believe so; I don't think a chest CT would show the adrenals at all. > > I have had a chest ct scan I believe - back when they suspected heart and lung problems. Would an abdominal CT scan be required to rule out adrenal tumors? >

[Guest guest]

Hey hey hey Dr. Grim wins this beer.CE Grim MDOn Oct 17, 2011, at 8:00 AM, Francis Bill SUSPECTED PA wrote: Not sure if all chest CT show adrenals but the ones I have had done show them and they show the 2 cm tumor. dr. > > > > I have had a chest ct scan I believe - back when they suspected heart and lung problems. Would an abdominal CT scan be required to rule out adrenal tumors? > > >

[Guest guest]

some MRI enhancers can also cause renal damage. So always some risk. Maybe better to get an adrenal nuclear scan if renal problems.Better yet be sure you need one first.CE Grim MD Who cares whether CT 'will do' or not? MRI is a better technology and on that basis you deserve to have it. My endos said they would give me a CT, I said no and demanded an MRI: I got an MRI. Getting the results of it is another matter though - 3+ weeks since I had it and still waiting... > > > > I have had a chest ct scan I believe - back when they suspected heart and lung problems. Would an abdominal CT scan be required to rule out adrenal tumors? > > >

[Guest guest]

I've only looked at my own. One doctor (who I fired) ordered one of the kidneys

but neglected to request that the adrenals be included and they weren't. When I

changed doctors I had to be exposed to the radiation/contrast a second time

because of this.

Curious to know if it's true that MRI is equal or better? I was told it was less

accurate.

> > >

> > > I have had a chest ct scan I believe - back when they suspected

> > heart and lung problems. Would an abdominal CT scan be required to

> > rule out adrenal tumors?

> > >

> >

> >

>

[Guest guest]

Depends on what they are looking for. Also CT take much less time so they can do

more in a day. Not All can have MRI

> > > >

> > > > I have had a chest ct scan I believe - back when they suspected

> > > heart and lung problems. Would an abdominal CT scan be required to

> > > rule out adrenal tumors?

> > > >

> > >

> > >

> >

>

[Guest guest]

The adrenals are always there on a kidney CT or MRI unless they are not there. CE Grim MD I've only looked at my own. One doctor (who I fired) ordered one of the kidneys but neglected to request that the adrenals be included and they weren't. When I changed doctors I had to be exposed to the radiation/contrast a second time because of this. Curious to know if it's true that MRI is equal or better? I was told it was less accurate. > > > > > > I have had a chest ct scan I believe - back when they suspected > > heart and lung problems. Would an abdominal CT scan be required to > > rule out adrenal tumors? > > > > > > > >

[Guest guest]

Can you post more information Like Sx. Lab information with lab ranges. High

aldosterone can be from other things then PA. need renin to give better idea as

to possable cause of high aldo. Specialist may not be a expert.

>

> Hi All,

>

> I just turned 27, am 116 pounds at 5'6. I eat a healthy diet for the most

part, and get at least 30 minutes of exercise every day. Despite the picture of

health, for the last 5 years my blood pressure has remained in the 135/90 range.

The highest it has ever been was 155/102. I have seen 4 cardiologists, 2

pulmonologists, 1 nephrologist/renal hypertension specialist, and numerous other

family practice physicians. My current pcp sent me to a renal hypertension

specialist because of high aldosterone levels. The specialist dismissed the idea

that my aldosterone was high enough to exhibit symptoms of hyperaldosteronism.

However, I did receive a renal ultrasound to check for growths on my adrenal

glands, which came back clear. My pcp still insists that my aldosterone is high,

but does not know where else to go with it. Postual Orthostatic Tachycardia

Syndrome is something that has been mentioned in other forums I have been apart

of for hypertension. I have tried testing my heart rate in the lying down,

sitting up, and standing. All of which, I haven't been able to come to a solid

conclusion on. The only other condition anyone has been able to detect is a

minor murmur that was found in the aortic region of my heart, but other than

that all suspected underlying illnesses have been ruled out. My current PCP and

myself are completely stumped and have come to a fork in the road. Do I go back

on high blood pressure medications that previously did nothing to lower my blood

pressure, or are there other possible tests and/or possible conditions that have

been overlooked? Any other suggestions, ideas, experiences are welcomed!

>

[Guest guest]

I know size can be a factor for MRI although they do have a newer open MRI

machine that is less clostrifobic. No MRI works very well for me but I am both

clostrifobic and large!

Here, this what I found at:

http://www.ehow.com/about_5410284_cat-scan-vs-mri.html

Comparison

Both tests have their advantages and disadvantages. An MRI usually takes longer

than a CT scan and is usually more expensive. The time for an MRI is typically

30 minutes, where a CT scan can be done within five. An MRI is usually better at

detailing soft tissue such as tendons and menisci. Details of bone structure,

blood vessels and organs are typically better seen with an CT scan. Your doctor

will be able to advise the correct exam to order based on your medical history

and symptoms.

Read more: Cat Scan Vs. MRI | eHow.com

http://www.ehow.com/about_5410284_cat-scan-vs-mri.html#ixzz1b3pbjZYx

- 65 yo super ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank

pain. Treating with Meds. And DASH. . Current BP(last week ave): 125/73

Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, and PTSD.

Meds: Duloxetine hcl 80 MG, Mirtazapine 7.5 MG, Metoprolol Tartrate 200 MG,

81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

> > > > >

> > > > > I have had a chest ct scan I believe - back when they suspected

> > > > heart and lung problems. Would an abdominal CT scan be required to

> > > > rule out adrenal tumors?

> > > > >

> > > >

> > > >

> > >

> >

>

[Guest guest]

I was going to mention renin too - the first time I had my aldosterone measured,

it was also within the 'normal' range (right at the top end though) so my

general doctor wondered whether that eliminated PA. My renin, though, was

undetectably low so the aldosterone/renin ratio was clearly v.high. So when my

general doc phoned the endocrinologist, she was told it probably was PA - the

next blood test a couple of months later and aldosterone had increasesd out of

normal too.

So get your renin tested too. I know there were all sorts of things on my blood

test about lying down before hand and stuff which also worried my general doc

because we'd not stuck to it very precisely. But again the endocrinologist

confirmed that the result was so clear no amount of lying down or fasting was

going to affect it.

H

> >

> > Hi All,

> >

> > I just turned 27, am 116 pounds at 5'6. I eat a healthy diet for the most

part, and get at least 30 minutes of exercise every day. Despite the picture of

health, for the last 5 years my blood pressure has remained in the 135/90 range.

The highest it has ever been was 155/102. I have seen 4 cardiologists, 2

pulmonologists, 1 nephrologist/renal hypertension specialist, and numerous other

family practice physicians. My current pcp sent me to a renal hypertension

specialist because of high aldosterone levels. The specialist dismissed the idea

that my aldosterone was high enough to exhibit symptoms of hyperaldosteronism.

However, I did receive a renal ultrasound to check for growths on my adrenal

glands, which came back clear. My pcp still insists that my aldosterone is high,

but does not know where else to go with it. Postual Orthostatic Tachycardia

Syndrome is something that has been mentioned in other forums I have been apart

of for hypertension. I have tried testing my heart rate in the lying down,

sitting up, and standing. All of which, I haven't been able to come to a solid

conclusion on. The only other condition anyone has been able to detect is a

minor murmur that was found in the aortic region of my heart, but other than

that all suspected underlying illnesses have been ruled out. My current PCP and

myself are completely stumped and have come to a fork in the road. Do I go back

on high blood pressure medications that previously did nothing to lower my blood

pressure, or are there other possible tests and/or possible conditions that have

been overlooked? Any other suggestions, ideas, experiences are welcomed!

> >

>

[Guest guest]

yeah but probably not nearly as much renal damage as having PA go undiagnosed

will do...I have read up about PA patients who were dismissed as hypochondriacs

because their tumour(s) was too small to be seen on CT...

> > > >

> > > > I have had a chest ct scan I believe - back when they suspected

> > heart and lung problems. Would an abdominal CT scan be required to

> > rule out adrenal tumors?

> > > >

> > >

> >

> >

>

[Guest guest]

So since my pcp sent me to a nephrologist for a renal ultrasound instead of a CT scan or MRI, when she suspected hyperaldosteronism, should I conclude that she doesn't know enough about this condition and find another pcp? I would like to be seen sometime asap so I can mention that I need different tests.To: hyperaldosteronism Sent: Monday, October 17, 2011 3:58 PMSubject: Re: Young with high bp

yeah but probably not nearly as much renal damage as having PA go undiagnosed will do...I have read up about PA patients who were dismissed as hypochondriacs because their tumour(s) was too small to be seen on CT...

> > > >

> > > > I have had a chest ct scan I believe - back when they suspected

> > heart and lung problems. Would an abdominal CT scan be required to

> > rule out adrenal tumors?

> > > >

> > >

> >

> >

>

[Guest guest]

So a renal ultrasound will not indicate adrenal growths/tumors? Wonder why my pcp and nephrologist had me do this when PA was suspected. To: hyperaldosteronism Sent: Monday, October 17, 2011 10:51 AMSubject: Re: Re: Young with high bp

The adrenals are always there on a kidney CT or MRI unless they are not there. CE Grim MD I've only looked at my own. One doctor (who I fired) ordered one of the kidneys but neglected to request that the adrenals be included and they weren't. When I changed doctors I had to be exposed to the radiation/contrast a second time because of this. Curious to know if it's true that MRI is equal or better? I was told it was less accurate. > > > > > > I have had a chest ct scan I believe - back when they suspected > > heart and lung problems. Would an abdominal CT scan be required to > > rule out adrenal tumors? > > > > > >

> >

[Guest guest]

Prior to any CT scan usually doc needs test your 24-hr urine sample for several hormones etc. Max From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Marchelle SyktichSent: Monday, October 17, 2011 17:22To: hyperaldosteronism Subject: Re: Re: Young with high bp So since my pcp sent me to a nephrologist for a renal ultrasound instead of a CT scan or MRI, when she suspected hyperaldosteronism, should I conclude that she doesn't know enough about this condition and find another pcp? I would like to be seen sometime asap so I can mention that I need different tests.

[Guest guest]

If you are sent to ultra sound for adenoma then most likely its purpose has been for new student to learn how to use ultra sound devices!! When you start with a 24-urine sample then doc is on right track. Max. From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Marchelle SyktichSent: Monday, October 17, 2011 18:15To: hyperaldosteronism Subject: Re: Re: Young with high bp So a renal ultrasound will not indicate adrenal growths/tumors? Wonder why my pcp and nephrologist had me do this when PA was suspected.

[Guest guest]

The nephrologist to whom my pcp sent me othered blood test for aldo & renin.

When my ARR exceeded 466, she sent me for saline suppression test & CT scan as

well as to an endocrinologist who is familiar with PA.

Lucy Sage

Sent from my Verizon Wireless Phone

Marchelle Syktich wrote:

>So a renal ultrasound will not indicate adrenal growths/tumors? Wonder why my

pcp and nephrologist had me do this when PA was suspected. 

>

>

>________________________________

>

>To: hyperaldosteronism

>Sent: Monday, October 17, 2011 10:51 AM

>Subject: Re: Re: Young with high bp

>

>

> 

>The adrenals are always there on a kidney CT or MRI unless they are not

there. 

>

>CE Grim MD

>

>

>

> 

>>I've only looked at my own. One doctor (who I fired) ordered one of the

kidneys but neglected to request that the adrenals be included and they weren't.

When I changed doctors I had to be exposed to the radiation/contrast a second

time because of this.

>>

>>Curious to know if it's true that MRI is equal or better? I was told it was

less accurate.

>>

>>

>>> > >

>>> > > I have had a chest ct scan I believe - back when they suspected

>>> > heart and lung problems. Would an abdominal CT scan be required to

>>> > rule out adrenal tumors?

>>> > >

>>> >

>>> >

>>>

>>

>>

>

>

[Guest guest]

There may be other reasons depending on whose protocol you use! They have

ultrsounded mine three times although it might be for other reasons!

Source: http://www.caring4urology.com/go/urology/diagnosis/kidney-ultrasound.htm

Reasons for the Procedure

A kidney ultrasound may be used to assess the size, location, and shape of the

kidneys and related structures, such as the ureters and bladder. Ultrasound can

detect cysts, tumors, abscesses, obstructions, fluid collection, and infection

within or around the kidneys. Calculi (stones) of the kidneys and ureters may be

detected by ultrasound.

A kidney ultrasound may be performed to assist in placement of needles used to

take a biopsy (obtain a tissue sample) from the kidneys, to drain fluid from a

cyst or abscess, or to place a drainage tube. This procedure may also be used to

determine blood flow to the kidneys through the renal arteries and veins.

Kidney ultrasound may be used after a kidney transplant to evaluate the

transplanted kidney.

There may be other reasons for your physician to recommend a kidney ultrasound.

- 65 yo super ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank

pain. Treating with Meds. And DASH. . Current BP(last week ave): 125/73

Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, and PTSD.

Meds: Duloxetine hcl 80 MG, Mirtazapine 7.5 MG, Metoprolol Tartrate 200 MG,

81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

>

> If you are sent to ultra sound for adenoma then most likely its purpose has

been for new student to learn how to use ultra sound devices!!

>

>

>

> When you start with a 24-urine sample then doc is on right track.

>

>

>

> Max.

>

>

>

> From: hyperaldosteronism

[mailto:hyperaldosteronism ] On Behalf Of Marchelle Syktich

> Sent: Monday, October 17, 2011 18:15

> To: hyperaldosteronism

> Subject: Re: Re: Young with high bp

>

>

>

>

>

>

>

>

> So a renal ultrasound will not indicate adrenal growths/tumors? Wonder why my

pcp and nephrologist had me do this when PA was suspected.

>

[Guest guest]

If renin wasn't tested than can not know it you have PA.

> >> > >

> >> > > I have had a chest ct scan I believe - back when they suspected

> >> > heart and lung problems. Would an abdominal CT scan be required to

> >> > rule out adrenal tumors?

> >> > >

> >> >

> >> >

> >>

> >

> >

>

[Guest guest]

I can't speak for them, but some insurances require this, and some docs do it to decrease the risk of radiation and cost to the patient, is that they "step up" the studies. In other words if this doesn't work, THEN we do this, and so on. And if they find an adenoma or abnormality on U/S what a lucky day - alot less radiation exposure. If they find renal artery stenosis - not likely though, or a severely enlarged kidney they may not need to subject you to the extra radiation.

We have high power antibiotics that we sort of keep in reserve for the severe things (vancomycin) that are resistant to other things, but they have risk and some severe side effects. But one could rationalize the idea of why don't we just use them for everything and get people back to work immediately instead of after a 10 day course of amoxicillin if the vanco works so much better for everything? Because of risk. Think of it like this - what if your doc just did CT after CT and MRI after MRI and xray after xray to "find" the cause of PA, which, say the patient, is SURE they have because they matched up the symptoms on the internet (and we all do this sometimes) - but then you don't end up having PA and it was something else?

I be willing to bet you'd/we all would then be mad when we find out a year later we have lung cancer and are told it was likely due to the exposure to all that radiation and some would even sue the doc . But as a patient we'd be mad back then that they "didn't find it" or look hard enough, but then be mad later because they looked for something that wasn't there as we stare at our chemo drip. So reasons are many for not just going to the big things. It doesn't cost or hurt a doc to order a CT or MRI financially (unless they own the ultrasound machine, then that's another story) .

If we could just get them to follow to a T Dr G's recommendations for deciding if it is PA then we could minimize alot of risk and save patients ALOT of grief. But as we know, most do not seem to read the directions or understand PA at all.

Subject: Re: Re: Young with high bpTo: "hyperaldosteronism " <hyperaldosteronism >Date: Monday, October 17, 2011, 6:22 PM

So since my pcp sent me to a nephrologist for a renal ultrasound instead of a CT scan or MRI, when she suspected hyperaldosteronism, should I conclude that she doesn't know enough about this condition and find another pcp? I would like to be seen sometime asap so I can mention that I need different tests.

To: hyperaldosteronism Sent: Monday, October 17, 2011 3:58 PMSubject: Re: Young with high bp

yeah but probably not nearly as much renal damage as having PA go undiagnosed will do...I have read up about PA patients who were dismissed as hypochondriacs because their tumour(s) was too small to be seen on CT...> > > >> > > > I have had a chest ct scan I believe - back when they suspected > > heart and lung problems. Would an abdominal CT scan be required to > > rule out adrenal tumors?> > > >> > >> >> >>