Guest guest Posted October 18, 2011 Report Share Posted October 18, 2011 No the nephrologist should have known this.CE Grim MD 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? > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 18, 2011 Report Share Posted October 18, 2011 One of our pts on here (with bilat hyperplasia) developed stage 3 renal failure after 2 CT scans. It appears to be getting better. Another had a doubling of the PCr with one never wants to do. PA as a cause of renal damage seems to be very rare if one considers classic PA at least. Indeed at one time it was thought that because renin does much more vascular damage (via AII) that having low renin was protective against HTN vas disease.You always seem fail to mention both aldo and sodium (salt) in the same breath. Without excess diet salt aldo does little or no damage.CE Grim MD 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? > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 18, 2011 Report Share Posted October 18, 2011 US will pick up large adrenal tumors and renal cancers that can cause HTN. Were are you located. Outside the US practice may be different.CE Grim MD 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? > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 18, 2011 Report Share Posted October 18, 2011 and Na and K and creatinine 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 18, 2011 Report Share Posted October 18, 2011 The first task is to get the biochemical Dx of PA-aka Dr. Grim's one day test for PA. Then one needs to see if it can be controlled by DASH and MCBs. If not Then one needs to determine what causes it. Genes-GRA-then no reason for CT or MRI Adrenal adenoma Adrenal rest tumor in liver Adrenal rest tumor in ovary Adrenal rest tumor in the brain.and likely in other places that have been missed.CE Grim MD 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?> > > >> > >> >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 21, 2011 Report Share Posted October 21, 2011 I had a renal MRI. The doc was looking for renal stenosis. It came back normal. If there was a tumor on the adrenal would the MRI say so? Or would they have to be looking for the tumor? Phyllis US will pick up large adrenal tumors and renal cancers that can cause HTN. Were are you located. Outside the US practice may be different. CE Grim MD On Oct 17, 2011, at 7:14 PM, 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. From: Clarence Grim 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 On Oct 17, 2011, at 10:29 AM, msmith_1928 wrote: 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? > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 2, 2011 Report Share Posted November 2, 2011 Tumor not always big enough to show on CT or MRI. Many times when it does show up PCP Dr do not pay any attention to them. Do you have the report of the scan? > >>> > > > > >>> > > > 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? > >>> > > > > >>> > > > >>> > > > >>> > > >>> > >> > >> > >> > >> > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 2, 2011 Report Share Posted November 2, 2011 Tell them to look for it and they are more likely to see it.MRI is not the definitive test for RAS but if you have a very low renin you do not have RAS.CE Grim MD I had a renal MRI. The doc was looking for renal stenosis. It came back normal. If there was a tumor on the adrenal would the MRI say so? Or would they have to be looking for the tumor? Phyllis US will pick up large adrenal tumors and renal cancers that can cause HTN. Were are you located. Outside the US practice may be different. CE Grim MD 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? > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.