Re: PA and pregnancy

September 20, 2011

Hi,

My problems did not start during pregnancy but they started about 2 weeks after

my son was born. 10 years on and still trying to get sorted!

________________________________

From: hyperaldosteronism on behalf of Stump

Sent: Tue 20/09/2011 13:13

To: hyperaldosteronism

Subject: PA and pregnancy

I have searched the board and found a few people who had this show up during

pregnancy... Is it common for pregnancy to cause PA? Have been told by several

doctors " Your blood pressure problems will go away in 6 weeks " That was well

over a year ago, and it keeps getting worse! Just curious to hear stories of

women who's symptoms started while pregnant.

September 20, 2011

Another common story is that BP gets better during preg due to progesterone's Aldo blocking effect. PG Does not cause PA. Low K is not a finding in preeclampsia. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

I have searched the board and found a few people who had this show up during pregnancy... Is it common for pregnancy to cause PA? Have been told by several doctors "Your blood pressure problems will go away in 6 weeks" That was well over a year ago, and it keeps getting worse! Just curious to hear stories of women who's symptoms started while pregnant.

September 20, 2011

I don't remember ever hearing of anything causing PA other than some of the time

it is a tumor in the adrenal gland. The bottom line is that it is something in

the body that causes excess aldosterone. I think it has not been linked to

pregnacy although I presume it could be a preexisting condition or occcur during

or soon after and not have any direct relationship to the pregnacy.

If you can get your hands on a " Hypertension Primer " there is a chapter

dedicated to " TREATENT OF PREGNANT HYPERTENSION PATIENTS " that might answer many

of your questions.

- 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(last week ave): 122/73

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

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

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

>

> I have searched the board and found a few people who had this show up during

pregnancy... Is it common for pregnancy to cause PA? Have been told by several

doctors " Your blood pressure problems will go away in 6 weeks " That was well

over a year ago, and it keeps getting worse! Just curious to hear stories of

women who's symptoms started while pregnant.

>

September 20, 2011

Dr. Grim, That is one of the things that makes me wonder if I have this or not.

I do not get up to pee at all at night. I do pee quite a bit during the day but

I am on a diuretic so it could be due to that. I dont eat licorice at all,

gross! BP was always good prior to last trimester of pregnancy with my second

child. I had told my doctor before, it seems like I crave salt. Put popcorn in

front of me and it will be gone very shortly. Maybe thats why I feel bad all of

the time. I have noticed If I drink alcohol (which NEVER used to bother me) I

wake up the next morning with bp around 190/110 and pulse around 120's and it

stays that way for a day or two. and I feel HORRIBLE. Needless to say, I dont

drink anymore. I have been on 8 or 9 different types of medicine(at different

times) for the past year. None of which has brought bp down to where we are

comfortable. Symptoms I have noticed: headaches, feeling lightheaded, strange

muscle pains (even when K is not low) and a dull ache in right side of back a

little below ribs, which sometimes wraps around my side, and depression. I also

have irregular periods. I tend to go 6 mo-1year betweeen them,(which began about

6 yrs. ago) frustrates me that no doctor seems to know why or care to figure out

why. The only history I know to tell is That I was healthy before my 2nd

pregnancy and now I am not. I have lost postassium several times, although I

dont know down to what level when I was in hospital. (that was before I did my

research. I didnt even know what it really meant when they told me, much less

ask for a number) The last time it was 2.7. and 3.1 after that. BP was highest a

week after she was born at 240/140. Now with meds it stays 150/100-110 with

occasional spikes. Took a Long time to find a doctor who would listen. Finally

was referred to endo. I was always told it was essential hypertension, and he

didnt even seem to care about low k. My new dr. does, yay! I am 26, weigh 148

(within normal BMI) so I feel as I am too young for BP problems without a

cause?? The only family history I have of BP problems is my grandfather. Also my

mom passed away when she was 44 of Liver Cancer. Thanks so much for your

replies. It has helped a lot

> > >

> > > Hi,

> > >

> > > My problems did not start during pregnancy but they started about 2 weeks

after my son was born. 10 years on and still trying to get sorted!

> > >

> > > ________________________________

> > >

> > > From: hyperaldosteronism on behalf of Stump

> > > Sent: Tue 20/09/2011 13:13

> > > To: hyperaldosteronism

> > > Subject: PA and pregnancy

> > >

> > > I have searched the board and found a few people who had this show up

during pregnancy... Is it common for pregnancy to cause PA? Have been told by

several doctors " Your blood pressure problems will go away in 6 weeks " That was

well over a year ago, and it keeps getting worse! Just curious to hear stories

of women who's symptoms started while pregnant.

> > >

> >

>

September 20, 2011

Hi , FWIW I don't get up to pee at night either. Not ever! But I most

certainly do have PA (scheduled for adrenalectomy next month). So even though

nocturia is a pretty common symptom for most around here, it's not mandatory for

diagnosis

> > > >

> > > > Hi,

> > > >

> > > > My problems did not start during pregnancy but they started about 2

weeks after my son was born. 10 years on and still trying to get sorted!

> > > >

> > > > ________________________________

> > > >

> > > > From: hyperaldosteronism on behalf of Stump

> > > > Sent: Tue 20/09/2011 13:13

> > > > To: hyperaldosteronism

> > > > Subject: PA and pregnancy

> > > >

> > > > I have searched the board and found a few people who had this show up

during pregnancy... Is it common for pregnancy to cause PA? Have been told by

several doctors " Your blood pressure problems will go away in 6 weeks " That was

well over a year ago, and it keeps getting worse! Just curious to hear stories

of women who's symptoms started while pregnant.

> > > >

> > >

> >

>

September 20, 2011

My PA symptoms started 6 weeks after I had a hysterectomy (although they were not diagnosed until 7 years later). I went from low blood pressure to extremely high after the surgery. So hormones must play a pretty big part.

September 20, 2011

I was diagnosed just after my third baby was born. My BP was fine thorughout

pregnancy (well high end but not enough to require meds) but when I went back

for my post-partum check, it was really high (170/115) which is where the

diagnosis trail started.

It took a while to get the official diagnosis but it was PA, I've had an

adrenalectomy and now all is well. And I never got up in the night to pee

either.

That fits with Dr.Grim's theory that pregnancy relieves PA symptoms (assuming

I'd had PA before that pregnancy and possibly before the others - although BP

was never an issue previously). I don't think the pregnancy caused the PA - in

my case it was a definite growth on my left adrenal gland and I'd be surprised

if there was a link.

Have they checked your renin and aldosterone levels? Are those the blood test

results you're waiting on? They're the key figures - low K could be other things

(mine was low but symptomless).

H

> > > > >

> > > > > Hi,

> > > > >

> > > > > My problems did not start during pregnancy but they started about 2

weeks after my son was born. 10 years on and still trying to get sorted!

> > > > >

> > > > > ________________________________

> > > > >

> > > > > From: hyperaldosteronism on behalf of Stump

> > > > > Sent: Tue 20/09/2011 13:13

> > > > > To: hyperaldosteronism

> > > > > Subject: PA and pregnancy

> > > > >

> > > > > I have searched the board and found a few people who had this show up

during pregnancy... Is it common for pregnancy to cause PA? Have been told by

several doctors " Your blood pressure problems will go away in 6 weeks " That was

well over a year ago, and it keeps getting worse! Just curious to hear stories

of women who's symptoms started while pregnant.

> > > > >

> > > >

> > >

> >

>

September 20, 2011

You have Primary Aldo I suspect based on this Hx.Do you have any labs results yet?In case you did not get our welcome it is below.With right meds and DASH you will be back to good health in a few weeks.CE Grim MD Welcome to the exciting world of Hyperaldosteronism You are in the right place! I am Dr. CE Grim a retired Professor of Medicine and Endocrinology. I have had a long standing interest is Primary Aldosteronism since medical school days when I saw my first patient with Primary Aldosteronism in 1963 as a 4th year medical student. I did a Nephrology Fellowship at Duke and an Endocrinology and Metabolism Fellowship with Dr. Conn (1969-70). I have been on the faculty of the University of MO, Indiana Univ, UCLA/ R. Drew, and the Medical College of Wisconsin in Divisions of Nephrology, Endocrinology, Hypertension, Cardiology and Epidemiology. I have published over 240 papers and book chapters in most areas of the broad discipline of High Blood Pressure. My CV is in our files for details. The GOAL of our group is to teach you and your health care team about the ins and outs of the causes, diagnosis and control of the many forms of hyperaldosteronism. The steps below will introduce you into the fascinating world of high blood pressure, salt and potassium and the role of the adrenal hormone aldosterone in health and disease. Doing these in sequence will save you time and effort in getting up to speed in taking control of you health and educating your own health care team. While we can’t make you a doctor we will make you into a pretty good BP doctor-a skill that you will have for life. 1. Overview: Read my article in our files on the evolution of PA (Evolution_of_PA-Grim.pdf ) and take to all members of health care team. Tell us what stage you believe you are in. This is a brief review of most causes of hyperaldosteronism, high blood pressure, low potassium (K). Be certain that you and your health care team understand the key role of excess diet salt in HTN and especially in PA. Go to: http://www.worldactiononsalt.com/evidence/treatment_trials.htm For a state of the art and science discussion of salt and health. 2. Other patients with hyperaldosteronism (Conn’s syndrome). Read our Conn's stories in our files and then give us your own in as much detail as you can. Dr. Conn was the first to describe this disease process and the syndrome is named after him. To see others' stories, on the Hyperaldosteronism home page, go to Files/Conn’s Stories. You'll find instructions in "A - How to put your story here.doc "Then send us your story in an email and then we will likely ask more questions and make suggestions before you upload it to our files. 3. Hyperaldosteronism and Salt: The deadly Duo. Eating Plan to control high blood pressure due to hyperaldosteronism and most others with high blood pressure. This will reduce your need for medications and in many will get your BP and K to goal without meds.. Get the DASH diet book by T. et al, read it and use it: $8 in paperback at your local bookstore. If they don’t have it ask them to order it for you. Learning to eat the DASH way will play a major role in your road to good BP and K control and, in many of our folks here, will revolutionize your life. Go to chapter 9 and do the 14 day challenge. Tell your Dr you are doing this as your BP may plummet if you are on other meds in only 2-3 days. or go to http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf download this 64 page booklet free and do the Week on the DASH Diet for 2 weeks. If you are on BP meds be prepared for a large fall in BP and let your Dr. know you are doing this. Or go to (but costs money) DASH Diet for Health ProgramThe DASH Diet for Health Program is designed to help you improve your eating and exercise habits. Twice each week we will provide you with information on our website about food, food preparation, eating out, losing weight, getting fit and much more. In addition to providing new information each week on our website, we create a web page specially for you where you can track progress in areas such as your weight, blood pressure, and exercise.http://www.dashforhealth.com/ I strongly recommend you get the book and read it now! 4. Measure your BP: Measure your BP daily so you can see if it is getting better. If you are taking meds be sure to tell your health care team you are doing this as your BP may plummet to normal quickly. We recommend you use a device you listen to and will help you learn how to do this. If this is not something you want to do we can teach a significant other how to do it. See sharedcareinc.com or email to sharedcare@... to order a video on how to do this. If you already have one we will teach you how to teach your health care team how to validate your device. Your life and health depends on accurate BP measurements. Go to the amricanheart.org and download the Guidelines for Human Blood Pressure Measurement. Insist the your health care team do BP the AHA way. Your life is in the hands of those who measure your BP. Never trust your life to an automatic BP machine unless you know it is accurate on YOU. 5. Genetics and your BP: Go to familyhistory.hhs.gov and do your detailed family medical history so we can review with you to help Dx familial causes of high blood pressure and heart disease. If BP runs in your family you may save lives in your family by checking their BP yourself. There is a brief discussion of this in my Evolution Article. 6. How to DX and treat PA: Go to our file/Conn's Articles of Note/Medications/Bravo spir 1973.pdf and read this article and take to your health care team. It is old but still one of the best in the medical management of PA. Also see our file from the Endocrine Society Guidelines on PA. 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. Our PA Registry: If you have been Dxed with PA already and are on Rx or have had surgery please go to http://www.kwiksurveys.com/online-survey.php?surveyID=HIJIO_f2685379 and complete our survey with as much information as you know. If there is some information you don't know ask us and we will help. If you need to update this as you journey thru the diagnostic/treatment process you can add another entry but label it as Nameyymmdd. For example today 4/20/11 for me would be Grim110420. This way of writing the date is an ever increasing number and will allow us and you to sort your multiple entries into a dated order. We are working on a more extensive database. 8. Learn the language: If you are new to medical lingo then download the acroyms from http://health.groups.yahoo.com/group/bloodpressureline/message/291869. Salt and high blood pressure: To learn the state of the science of salt and blood pressure please spend some time looking at http://www.worldactiononsalt.com/evidence/treatment_trials.htm10. Become a HBP expert consumer: Expect that it will take at least several weeks to get all this digested and to learn the new language of high blood pressure health care. As most doctors and nurses in practice have had very little training in high blood pressure you must become an expert yourself. For example most have never had anyone listen with them with a double stethoscope to verify that they can hear BP sounds. We cannot make you a doctor but we will make you a pretty good BP doctor.11. How High Blood Pressure should be managed: Go to nih.gov and download and read the Joint National Commission (JNC) Report 7 to get an overview on current guidelines. I ask all my secretaries to read this so they can communicate the importance of high blood pressure to my patients. JNC 8 will be out soon.Then: get (and study) the Hypertension Primer from americanheart.org. This is the most up-to-date compendium of what is known about high blood pressure and what every Dr. should know when they graduate from Medical School. Every chapter is only 2-3 pages. Read one chapter every week-night and you will finish it in about a year. I am working on a reading guide for lay people for the Primer. Stay tuned.12. Ask us questions: Ask any questions about high blood pressure you want answered. That is what we are here for.13. One-on-one Consulting: I can provide individual consulting if you do not want to go public. If you want individual one-on-one consulting for you and your Doctor contract me directly at lowerbp2@....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. Dr. Grim, That is one of the things that makes me wonder if I have this or not. I do not get up to pee at all at night. I do pee quite a bit during the day but I am on a diuretic so it could be due to that. I dont eat licorice at all, gross! BP was always good prior to last trimester of pregnancy with my second child. I had told my doctor before, it seems like I crave salt. Put popcorn in front of me and it will be gone very shortly. Maybe thats why I feel bad all of the time. I have noticed If I drink alcohol (which NEVER used to bother me) I wake up the next morning with bp around 190/110 and pulse around 120's and it stays that way for a day or two. and I feel HORRIBLE. Needless to say, I dont drink anymore. I have been on 8 or 9 different types of medicine(at different times) for the past year. None of which has brought bp down to where we are comfortable. Symptoms I have noticed: headaches, feeling lightheaded, strange muscle pains (even when K is not low) and a dull ache in right side of back a little below ribs, which sometimes wraps around my side, and depression. I also have irregular periods. I tend to go 6 mo-1year betweeen them,(which began about 6 yrs. ago) frustrates me that no doctor seems to know why or care to figure out why. The only history I know to tell is That I was healthy before my 2nd pregnancy and now I am not. I have lost postassium several times, although I dont know down to what level when I was in hospital. (that was before I did my research. I didnt even know what it really meant when they told me, much less ask for a number) The last time it was 2.7. and 3.1 after that. BP was highest a week after she was born at 240/140. Now with meds it stays 150/100-110 with occasional spikes. Took a Long time to find a doctor who would listen. Finally was referred to endo. I was always told it was essential hypertension, and he didnt even seem to care about low k. My new dr. does, yay! I am 26, weigh 148 (within normal BMI) so I feel as I am too young for BP problems without a cause?? The only family history I have of BP problems is my grandfather. Also my mom passed away when she was 44 of Liver Cancer. Thanks so much for your replies. It has helped a lot > > > > > > Hi, > > > > > > My problems did not start during pregnancy but they started about 2 weeks after my son was born. 10 years on and still trying to get sorted! > > > > > > ________________________________ > > > > > > From: hyperaldosteronism on behalf of Stump > > > Sent: Tue 20/09/2011 13:13 > > > To: hyperaldosteronism > > > Subject: PA and pregnancy > > > > > > > > > > > > > > > I have searched the board and found a few people who had this show up during pregnancy... Is it common for pregnancy to cause PA? Have been told by several doctors "Your blood pressure problems will go away in 6 weeks" That was well over a year ago, and it keeps getting worse! Just curious to hear stories of women who's symptoms started while pregnant. > > > > > > > >

September 20, 2011

please go to our database in the intro to our site and enter all you the information you have now.CE Grim MD Hi , FWIW I don't get up to pee at night either. Not ever! But I most certainly do have PA (scheduled for adrenalectomy next month). So even though nocturia is a pretty common symptom for most around here, it's not mandatory for diagnosis > > > > > > > > Hi, > > > > > > > > My problems did not start during pregnancy but they started about 2 weeks after my son was born. 10 years on and still trying to get sorted! > > > > > > > > ________________________________ > > > > > > > > From: hyperaldosteronism on behalf of Stump > > > > Sent: Tue 20/09/2011 13:13 > > > > To: hyperaldosteronism > > > > Subject: PA and pregnancy > > > > > > > > > > > > > > > > > > > > I have searched the board and found a few people who had this show up during pregnancy... Is it common for pregnancy to cause PA? Have been told by several doctors "Your blood pressure problems will go away in 6 weeks" That was well over a year ago, and it keeps getting worse! Just curious to hear stories of women who's symptoms started while pregnant. > > > > > > > > > > > > >

September 20, 2011

But suddent HTN after deliverly and low K and very high BP after preg shouts PA! PA!. Just wish medical care providers could hear it shout.CE Grim MD I was diagnosed just after my third baby was born. My BP was fine thorughout pregnancy (well high end but not enough to require meds) but when I went back for my post-partum check, it was really high (170/115) which is where the diagnosis trail started. It took a while to get the official diagnosis but it was PA, I've had an adrenalectomy and now all is well. And I never got up in the night to pee either. That fits with Dr.Grim's theory that pregnancy relieves PA symptoms (assuming I'd had PA before that pregnancy and possibly before the others - although BP was never an issue previously). I don't think the pregnancy caused the PA - in my case it was a definite growth on my left adrenal gland and I'd be surprised if there was a link. Have they checked your renin and aldosterone levels? Are those the blood test results you're waiting on? They're the key figures - low K could be other things (mine was low but symptomless). H > > > > > > > > > > Hi, > > > > > > > > > > My problems did not start during pregnancy but they started about 2 weeks after my son was born. 10 years on and still trying to get sorted! > > > > > > > > > > ________________________________ > > > > > > > > > > From: hyperaldosteronism on behalf of Stump > > > > > Sent: Tue 20/09/2011 13:13 > > > > > To: hyperaldosteronism > > > > > Subject: PA and pregnancy > > > > > > > > > > > > > > > > > > > > > > > > > I have searched the board and found a few people who had this show up during pregnancy... Is it common for pregnancy to cause PA? Have been told by several doctors "Your blood pressure problems will go away in 6 weeks" That was well over a year ago, and it keeps getting worse! Just curious to hear stories of women who's symptoms started while pregnant. > > > > > > > > > > > > > > > > > > >

September 20, 2011

It is called aldosterone. Did the put you on hormones after the Hyst or did they not also do an ooph? My PA symptoms started 6 weeks after I had a hysterectomy (although they were not diagnosed until 7 years later). I went from low blood pressure to extremely high after the surgery. So hormones must play a pretty big part.

September 20, 2011

The peeing ins most common in those with low K as that is the cause of the Kid resistance to ADH. This blocks the normal ability to make a concentrated urine (normal) and you can sleep all night.CE Grim MD Dr. Grim, That is one of the things that makes me wonder if I have this or not. I do not get up to pee at all at night. I do pee quite a bit during the day but I am on a diuretic so it could be due to that. I dont eat licorice at all, gross! BP was always good prior to last trimester of pregnancy with my second child. I had told my doctor before, it seems like I crave salt. Put popcorn in front of me and it will be gone very shortly. Maybe thats why I feel bad all of the time. I have noticed If I drink alcohol (which NEVER used to bother me) I wake up the next morning with bp around 190/110 and pulse around 120's and it stays that way for a day or two. and I feel HORRIBLE. Needless to say, I dont drink anymore. I have been on 8 or 9 different types of medicine(at different times) for the past year. None of which has brought bp down to where we are comfortable. Symptoms I have noticed: headaches, feeling lightheaded, strange muscle pains (even when K is not low) and a dull ache in right side of back a little below ribs, which sometimes wraps around my side, and depression. I also have irregular periods. I tend to go 6 mo-1year betweeen them,(which began about 6 yrs. ago) frustrates me that no doctor seems to know why or care to figure out why. The only history I know to tell is That I was healthy before my 2nd pregnancy and now I am not. I have lost postassium several times, although I dont know down to what level when I was in hospital. (that was before I did my research. I didnt even know what it really meant when they told me, much less ask for a number) The last time it was 2.7. and 3.1 after that. BP was highest a week after she was born at 240/140. Now with meds it stays 150/100-110 with occasional spikes. Took a Long time to find a doctor who would listen. Finally was referred to endo. I was always told it was essential hypertension, and he didnt even seem to care about low k. My new dr. does, yay! I am 26, weigh 148 (within normal BMI) so I feel as I am too young for BP problems without a cause?? The only family history I have of BP problems is my grandfather. Also my mom passed away when she was 44 of Liver Cancer. Thanks so much for your replies. It has helped a lot > > > > > > Hi, > > > > > > My problems did not start during pregnancy but they started about 2 weeks after my son was born. 10 years on and still trying to get sorted! > > > > > > ________________________________ > > > > > > From: hyperaldosteronism on behalf of Stump > > > Sent: Tue 20/09/2011 13:13 > > > To: hyperaldosteronism > > > Subject: PA and pregnancy > > > > > > > > > > > > > > > I have searched the board and found a few people who had this show up during pregnancy... Is it common for pregnancy to cause PA? Have been told by several doctors "Your blood pressure problems will go away in 6 weeks" That was well over a year ago, and it keeps getting worse! Just curious to hear stories of women who's symptoms started while pregnant. > > > > > > > >

September 20, 2011

I dont really have any information as of now. I couldnt get any doctors to do

anything. The only labs I have are a few Basic Metabolic Panels from May- Aug of

this year. Was Just tested for Pheochromocytoma(CATS,METS,VMA i think) (was

told over the phone labs were normal) and havent gotten them in writing yet. I

go to do blood test for PA on October 3. My dr. did not mention another 24 hour

urine, although I will call his office and request one. I read that you should

eat a high salt diet 2 weeks prior to test, Doesnt high sodium cause aldosterone

levels to drop?? im confused.

> > > > > >

> > > > > > Hi,

> > > > > >

> > > > > > My problems did not start during pregnancy but they started

> > about 2 weeks after my son was born. 10 years on and still trying to

> > get sorted!

> > > > > >

> > > > > > ________________________________

> > > > > >

> > > > > > From: hyperaldosteronism on behalf of

> > Stump

> > > > > > Sent: Tue 20/09/2011 13:13

> > > > > > To: hyperaldosteronism

> > > > > > Subject: PA and pregnancy

> > > > > >

> > > > > > I have searched the board and found a few people who had

> > this show up during pregnancy... Is it common for pregnancy to cause

> > PA? Have been told by several doctors " Your blood pressure problems

> > will go away in 6 weeks " That was well over a year ago, and it keeps

> > getting worse! Just curious to hear stories of women who's symptoms

> > started while pregnant.

> > > > > >

> > > > >

> > > >

> > >

> >

>

September 20, 2011

How long did it take you to get a diagnosis?

> > > > > >

> > > > > > Hi,

> > > > > >

> > > > > > My problems did not start during pregnancy but they started about 2

weeks after my son was born. 10 years on and still trying to get sorted!

> > > > > >

> > > > > > ________________________________

> > > > > >

> > > > > > From: hyperaldosteronism on behalf of Stump

> > > > > > Sent: Tue 20/09/2011 13:13

> > > > > > To: hyperaldosteronism

> > > > > > Subject: PA and pregnancy

> > > > > >

> > > > > > I have searched the board and found a few people who had this show

up during pregnancy... Is it common for pregnancy to cause PA? Have been told by

several doctors " Your blood pressure problems will go away in 6 weeks " That was

well over a year ago, and it keeps getting worse! Just curious to hear stories

of women who's symptoms started while pregnant.

> > > > > >

> > > > >

> > > >

> > >

> >

>

September 20, 2011

I'm not the expert on here but no, high sodium doesn't influence aldosterone

levels as far as I understand it. This is how I understand PA in layman's terms

(and I'm sure the experts will chime in with corrections ;-) ).

The link is that if your adrenal gland(s) is playing up - for whatever reason -

you could be overproducing aldosterone and underproducing renin (in the case of

Conns at least).

These two hormones are normally the ones that send a message to your kidneys

about which salts the body needs to retain and what to expel via urine. If the

balance is wrong, your kidneys get the wrong message so you end up expelling

potassium (K) and retaining sodium (Na). The secondary effects of this are that

the excess sodium causes fluid retention in the body which in turn is what

causes the high blood pressure.

So the options are:

1) To make sure your dietary intake of sodium is very low so even if your

kidneys try and retain it, there's not enough there to muck up your blood

pressure (and the blood pressure part is what causes the most long term damage

to your body).

2) To ensure you have lots of potassium in your diet so even if a lot is

expelled, you retain enough for good health (prevent muscle wastage etc.)

3) Use the appropriate drugs which block the receptors in the kidneys which

normally respond to renin and aldosterone. So even if they're still produced

wrongly, your kidneys don't 'realise' and keep a happy Na/K balance. Normal bp

drugs will not do this which is why PA is pretty resistant to the 'normal'

primary hypertension treatments.

4) If the cause of the hormone imbalance can be narrowed down to one adrenal

gland via MRI/CT and then AVS, have that adrenal gland removed and hope that the

other adrenal gland kicks in by producing the correct levels of hormones.

So for general feeling better health, you should eat as little sodium as

possible (easier said than done) and lots of potassium containing foods. But for

the sake of some of the tests, they might want you to 'sodium load' for a while

to see how your body reacts. Personally I didn't have to do that as part of my

diagnosis at all and if you haven't yet had your aldosterone/renin ration

measured, I think that sounds like it should be the first step and I don't think

eating a lot of salt prior to it will make any difference and if it is PA will

just make you feel worse. I was warned of some things not to eat before the test

- liquorice being one - and I think the aldosterone levels can be influenced by

whether you've been resting before hand and what position you are in when the

blood is taken but my results were so clear cut, it was immaterial.

Hope you get some answers from your Oct 3rd test.

H

> > > > > > >

> > > > > > > Hi,

> > > > > > >

> > > > > > > My problems did not start during pregnancy but they started

> > > about 2 weeks after my son was born. 10 years on and still trying to

> > > get sorted!

> > > > > > >

> > > > > > > ________________________________

> > > > > > >

> > > > > > > From: hyperaldosteronism on behalf of

> > > Stump

> > > > > > > Sent: Tue 20/09/2011 13:13

> > > > > > > To: hyperaldosteronism

> > > > > > > Subject: PA and pregnancy

> > > > > > >

> > > > > > > I have searched the board and found a few people who had

> > > this show up during pregnancy... Is it common for pregnancy to cause

> > > PA? Have been told by several doctors " Your blood pressure problems

> > > will go away in 6 weeks " That was well over a year ago, and it keeps

> > > getting worse! Just curious to hear stories of women who's symptoms

> > > started while pregnant.

> > > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

September 20, 2011

Just over 12 months from first high BP reading to final, encrinologist backed PA

diagnosis (but suspicion was there from very early on - after my first blood

tests came back with a low K reading). Then a further few months to schedule

surgery.

H

> > > > > > >

> > > > > > > Hi,

> > > > > > >

> > > > > > > My problems did not start during pregnancy but they started about

2 weeks after my son was born. 10 years on and still trying to get sorted!

> > > > > > >

> > > > > > > ________________________________

> > > > > > >

> > > > > > > From: hyperaldosteronism on behalf of Stump

> > > > > > > Sent: Tue 20/09/2011 13:13

> > > > > > > To: hyperaldosteronism

> > > > > > > Subject: PA and pregnancy

> > > > > > >

> > > > > > > I have searched the board and found a few people who had this show

up during pregnancy... Is it common for pregnancy to cause PA? Have been told by

several doctors " Your blood pressure problems will go away in 6 weeks " That was

well over a year ago, and it keeps getting worse! Just curious to hear stories

of women who's symptoms started while pregnant.

> > > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

September 20, 2011

If you have PA it will not drop to normal.Indeed to be better assured that it is high some recommend a 200 mM sodium diet a day for 2 weeks before the 24 hr urine.Better to do my testing as described below.See 6 A below. Welcome to the exciting world of Hyperaldosteronism You are in the right place! I am Dr. CE Grim a retired Professor of Medicine and Endocrinology. I have had a long standing interest is Primary Aldosteronism since medical school days when I saw my first patient with Primary Aldosteronism in 1963 as a 4th year medical student. I did a Nephrology Fellowship at Duke and an Endocrinology and Metabolism Fellowship with Dr. Conn (1969-70). I have been on the faculty of the University of MO, Indiana Univ, UCLA/ R. Drew, and the Medical College of Wisconsin in Divisions of Nephrology, Endocrinology, Hypertension, Cardiology and Epidemiology. I have published over 240 papers and book chapters in most areas of the broad discipline of High Blood Pressure. My CV is in our files for details. The GOAL of our group is to teach you and your health care team about the ins and outs of the causes, diagnosis and control of the many forms of hyperaldosteronism. The steps below will introduce you into the fascinating world of high blood pressure, salt and potassium and the role of the adrenal hormone aldosterone in health and disease. Doing these in sequence will save you time and effort in getting up to speed in taking control of you health and educating your own health care team. While we can’t make you a doctor we will make you into a pretty good BP doctor-a skill that you will have for life. 1. Overview: Read my article in our files on the evolution of PA (Evolution_of_PA-Grim.pdf ) and take to all members of health care team. Tell us what stage you believe you are in. This is a brief review of most causes of hyperaldosteronism, high blood pressure, low potassium (K). Be certain that you and your health care team understand the key role of excess diet salt in HTN and especially in PA. Go to: http://www.worldactiononsalt.com/evidence/treatment_trials.htm For a state of the art and science discussion of salt and health. 2. Other patients with hyperaldosteronism (Conn’s syndrome). Read our Conn's stories in our files and then give us your own in as much detail as you can. Dr. Conn was the first to describe this disease process and the syndrome is named after him. To see others' stories, on the Hyperaldosteronism home page, go to Files/Conn’s Stories. You'll find instructions in "A - How to put your story here.doc "Then send us your story in an email and then we will likely ask more questions and make suggestions before you upload it to our files. 3. Hyperaldosteronism and Salt: The deadly Duo. Eating Plan to control high blood pressure due to hyperaldosteronism and most others with high blood pressure. This will reduce your need for medications and in many will get your BP and K to goal without meds.. Get the DASH diet book by T. et al, read it and use it: $8 in paperback at your local bookstore. If they don’t have it ask them to order it for you. Learning to eat the DASH way will play a major role in your road to good BP and K control and, in many of our folks here, will revolutionize your life. Go to chapter 9 and do the 14 day challenge. Tell your Dr you are doing this as your BP may plummet if you are on other meds in only 2-3 days. or go to http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf download this 64 page booklet free and do the Week on the DASH Diet for 2 weeks. If you are on BP meds be prepared for a large fall in BP and let your Dr. know you are doing this. Or go to (but costs money) DASH Diet for Health ProgramThe DASH Diet for Health Program is designed to help you improve your eating and exercise habits. Twice each week we will provide you with information on our website about food, food preparation, eating out, losing weight, getting fit and much more. In addition to providing new information each week on our website, we create a web page specially for you where you can track progress in areas such as your weight, blood pressure, and exercise.http://www.dashforhealth.com/ I strongly recommend you get the book and read it now! 4. Measure your BP: Measure your BP daily so you can see if it is getting better. If you are taking meds be sure to tell your health care team you are doing this as your BP may plummet to normal quickly. We recommend you use a device you listen to and will help you learn how to do this. If this is not something you want to do we can teach a significant other how to do it. See sharedcareinc.com or email to sharedcare@... to order a video on how to do this. If you already have one we will teach you how to teach your health care team how to validate your device. Your life and health depends on accurate BP measurements. Go to the amricanheart.org and download the Guidelines for Human Blood Pressure Measurement. Insist the your health care team do BP the AHA way. Your life is in the hands of those who measure your BP. Never trust your life to an automatic BP machine unless you know it is accurate on YOU. 5. Genetics and your BP: Go to familyhistory.hhs.gov and do your detailed family medical history so we can review with you to help Dx familial causes of high blood pressure and heart disease. If BP runs in your family you may save lives in your family by checking their BP yourself. There is a brief discussion of this in my Evolution Article. 6. How to DX and treat PA: Go to our file/Conn's Articles of Note/Medications/Bravo spir 1973.pdf and read this article and take to your health care team. It is old but still one of the best in the medical management of PA.Also see our file from the Endocrine Society Guidelines on PA. 6 A 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. Our PA Registry: If you have been Dxed with PA already and are on Rx or have had surgery please go to http://www.kwiksurveys.com/online-survey.php?surveyID=HIJIO_f2685379 and complete our survey with as much information as you know. If there is some information you don't know ask us and we will help. If you need to update this as you journey thru the diagnostic/treatment process you can add another entry but label it as Nameyymmdd. For example today 4/20/11 for me would be Grim110420. This way of writing the date is an ever increasing number and will allow us and you to sort your multiple entries into a dated order. We are working on a more extensive database. 8. Learn the language: If you are new to medical lingo then download the acroyms from http://health.groups.yahoo.com/group/bloodpressureline/message/291869. Salt and high blood pressure: To learn the state of the science of salt and blood pressure please spend some time looking at http://www.worldactiononsalt.com/evidence/treatment_trials.htm10. Become a HBP expert consumer: Expect that it will take at least several weeks to get all this digested and to learn the new language of high blood pressure health care. As most doctors and nurses in practice have had very little training in high blood pressure you must become an expert yourself. For example most have never had anyone listen with them with a double stethoscope to verify that they can hear BP sounds. We cannot make you a doctor but we will make you a pretty good BP doctor.11. How High Blood Pressure should be managed: Go to nih.gov and download and read the Joint National Commission (JNC) Report 7 to get an overview on current guidelines. I ask all my secretaries to read this so they can communicate the importance of high blood pressure to my patients. JNC 8 will be out soon.Then: get (and study) the Hypertension Primer from americanheart.org. This is the most up-to-date compendium of what is known about high blood pressure and what every Dr. should know when they graduate from Medical School. Every chapter is only 2-3 pages. Read one chapter every week-night and you will finish it in about a year. I am working on a reading guide for lay people for the Primer. Stay tuned.12. Ask us questions: Ask any questions about high blood pressure you want answered. That is what we are here for.13. One-on-one Consulting: I can provide individual consulting if you do not want to go public. If you want individual one-on-one consulting for you and your Doctor contract me directly at lowerbp2@....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. I dont really have any information as of now. I couldnt get any doctors to do anything. The only labs I have are a few Basic Metabolic Panels from May- Aug of this year. Was Just tested for Pheochromocytoma(CATS,METS,VMA i think) (was told over the phone labs were normal) and havent gotten them in writing yet. I go to do blood test for PA on October 3. My dr. did not mention another 24 hour urine, although I will call his office and request one. I read that you should eat a high salt diet 2 weeks prior to test, Doesnt high sodium cause aldosterone levels to drop?? im confused. > > > > > > > > > > > > Hi, > > > > > > > > > > > > My problems did not start during pregnancy but they started > > about 2 weeks after my son was born. 10 years on and still trying to > > get sorted! > > > > > > > > > > > > ________________________________ > > > > > > > > > > > > From: hyperaldosteronism on behalf of > > Stump > > > > > > Sent: Tue 20/09/2011 13:13 > > > > > > To: hyperaldosteronism > > > > > > Subject: PA and pregnancy > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > I have searched the board and found a few people who had > > this show up during pregnancy... Is it common for pregnancy to cause > > PA? Have been told by several doctors "Your blood pressure problems > > will go away in 6 weeks" That was well over a year ago, and it keeps > > getting worse! Just curious to hear stories of women who's symptoms > > started while pregnant. > > > > > > > > > > > > > > > > > > > > > > > > > > > >

September 20, 2011

Even when I had K=6.6 I still went 5 -6 times a night. NataliaTo: hyperaldosteronism Sent: Tuesday, September 20, 2011 3:05 PMSubject: Re: Re: PA and pregnancy

The peeing ins most common in those with low K as that is the cause of the Kid resistance to ADH. This blocks the normal ability to make a concentrated urine (normal) and you can sleep all night.CE Grim MD Dr. Grim, That is one of the things that makes me wonder if I have this or not. I do not get up to pee at all at night. I do pee quite a bit during the day but I am on a diuretic so it could be due to that. I dont eat licorice at all, gross! BP was always good prior to last trimester of pregnancy with my second child. I had told my doctor before, it seems like I crave salt. Put popcorn in front of me and it will be gone very shortly. Maybe thats why I

feel bad all of the time. I have noticed If I drink alcohol (which NEVER used to bother me) I wake up the next morning with bp around 190/110 and pulse around 120's and it stays that way for a day or two. and I feel HORRIBLE. Needless to say, I dont drink anymore. I have been on 8 or 9 different types of medicine(at different times) for the past year. None of which has brought bp down to where we are comfortable. Symptoms I have noticed: headaches, feeling lightheaded, strange muscle pains (even when K is not low) and a dull ache in right side of back a little below ribs, which sometimes wraps around my side, and depression. I also have irregular periods. I tend to go 6 mo-1year betweeen them,(which began about 6 yrs. ago) frustrates me that no doctor seems to know why or care to figure out why. The only history I know to tell is That I was healthy before my 2nd pregnancy and now I am not. I have lost postassium several times, although I dont know down

to what level when I was in hospital. (that was before I did my research. I didnt even know what it really meant when they told me, much less ask for a number) The last time it was 2.7. and 3.1 after that. BP was highest a week after she was born at 240/140. Now with meds it stays 150/100-110 with occasional spikes. Took a Long time to find a doctor who would listen. Finally was referred to endo. I was always told it was essential hypertension, and he didnt even seem to care about low k. My new dr. does, yay! I am 26, weigh 148 (within normal BMI) so I feel as I am too young for BP problems without a cause?? The only family history I have of BP problems is my grandfather. Also my mom passed away when she was 44 of Liver Cancer. Thanks so much for your replies. It has helped a lot > > > > > > Hi, > > > > > > My problems did not start during pregnancy but they started about 2 weeks after my son was born. 10 years on and still trying to get sorted! > > > > > > ________________________________ > > > > > > From: hyperaldosteronism on behalf of Stump > > > Sent: Tue 20/09/2011 13:13 > > > To: hyperaldosteronism > > > Subject: PA and pregnancy > > > > > > > > > > > > > > > I have searched the board and found a few people who had this show up during pregnancy... Is it common for pregnancy to cause PA? Have been told by several doctors "Your blood pressure problems will go away in 6 weeks" That was well over a year ago, and it keeps getting worse! Just curious to hear stories of women who's symptoms started while pregnant. > > > > > > > >

September 20, 2011

Curious. Wonder if there was a problem drawing your blood then. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

Even when I had K=6.6 I still went 5 -6 times a night. NataliaTo: hyperaldosteronism Sent: Tuesday, September 20, 2011 3:05 PMSubject: Re: Re: PA and pregnancy

The peeing ins most common in those with low K as that is the cause of the Kid resistance to ADH. This blocks the normal ability to make a concentrated urine (normal) and you can sleep all night.CE Grim MD Dr. Grim, That is one of the things that makes me wonder if I have this or not. I do not get up to pee at all at night. I do pee quite a bit during the day but I am on a diuretic so it could be due to that. I dont eat licorice at all, gross! BP was always good prior to last trimester of pregnancy with my second child. I had told my doctor before, it seems like I crave salt. Put popcorn in front of me and it will be gone very shortly. Maybe thats why I

feel bad all of the time. I have noticed If I drink alcohol (which NEVER used to bother me) I wake up the next morning with bp around 190/110 and pulse around 120's and it stays that way for a day or two. and I feel HORRIBLE. Needless to say, I dont drink anymore. I have been on 8 or 9 different types of medicine(at different times) for the past year. None of which has brought bp down to where we are comfortable. Symptoms I have noticed: headaches, feeling lightheaded, strange muscle pains (even when K is not low) and a dull ache in right side of back a little below ribs, which sometimes wraps around my side, and depression. I also have irregular periods. I tend to go 6 mo-1year betweeen them,(which began about 6 yrs. ago) frustrates me that no doctor seems to know why or care to figure out why. The only history I know to tell is That I was healthy before my 2nd pregnancy and now I am not. I have lost postassium several times, although I dont know down

to what level when I was in hospital. (that was before I did my research. I didnt even know what it really meant when they told me, much less ask for a number) The last time it was 2.7. and 3.1 after that. BP was highest a week after she was born at 240/140. Now with meds it stays 150/100-110 with occasional spikes. Took a Long time to find a doctor who would listen. Finally was referred to endo. I was always told it was essential hypertension, and he didnt even seem to care about low k. My new dr. does, yay! I am 26, weigh 148 (within normal BMI) so I feel as I am too young for BP problems without a cause?? The only family history I have of BP problems is my grandfather. Also my mom passed away when she was 44 of Liver Cancer. Thanks so much for your replies. It has helped a lot > > > > > > Hi, > > > > > > My problems did not start during pregnancy but they started about 2 weeks after my son was born. 10 years on and still trying to get sorted! > > > > > > ________________________________ > > > > > > From: hyperaldosteronism on behalf of Stump > > > Sent: Tue 20/09/2011 13:13 > > > To: hyperaldosteronism > > > Subject: PA and pregnancy > > > > > > > > > > > > > > > I have searched the board and found a few people who had this show up during pregnancy... Is it common for pregnancy to cause PA? Have been told by several doctors "Your blood pressure problems will go away in 6 weeks" That was well over a year ago, and it keeps getting worse! Just curious to hear stories of women who's symptoms started while pregnant. > > > > > > > >

September 20, 2011

Most of us have been on medicine after medicine. I was on 5 at once for BP when the docput me on Spiro. 2 doses of spiro and my BP was already down from 170/130 to 120ish/80.

It's the "right" medicine that works.

Subject: Re: PA and pregnancyTo: hyperaldosteronism Date: Tuesday, September 20, 2011, 1:56 PM

Dr. Grim, That is one of the things that makes me wonder if I have this or not. I do not get up to pee at all at night. I do pee quite a bit during the day but I am on a diuretic so it could be due to that. I dont eat licorice at all, gross! BP was always good prior to last trimester of pregnancy with my second child. I had told my doctor before, it seems like I crave salt. Put popcorn in front of me and it will be gone very shortly. Maybe thats why I feel bad all of the time. I have noticed If I drink alcohol (which NEVER used to bother me) I wake up the next morning with bp around 190/110 and pulse around 120's and it stays that way for a day or two. and I feel HORRIBLE. Needless to say, I dont drink anymore. I have been on 8 or 9 different types of medicine(at different times) for the past year. None of which has brought bp down to where we are comfortable. Symptoms I have noticed: headaches, feeling lightheaded, strange muscle pains (even

when K is not low) and a dull ache in right side of back a little below ribs, which sometimes wraps around my side, and depression. I also have irregular periods. I tend to go 6 mo-1year betweeen them,(which began about 6 yrs. ago) frustrates me that no doctor seems to know why or care to figure out why. The only history I know to tell is That I was healthy before my 2nd pregnancy and now I am not. I have lost postassium several times, although I dont know down to what level when I was in hospital. (that was before I did my research. I didnt even know what it really meant when they told me, much less ask for a number) The last time it was 2.7. and 3.1 after that. BP was highest a week after she was born at 240/140. Now with meds it stays 150/100-110 with occasional spikes. Took a Long time to find a doctor who would listen. Finally was referred to endo. I was always told it was essential hypertension, and he didnt even seem to care about low k. My new

dr. does, yay! I am 26, weigh 148 (within normal BMI) so I feel as I am too young for BP problems without a cause?? The only family history I have of BP problems is my grandfather. Also my mom passed away when she was 44 of Liver Cancer. Thanks so much for your replies. It has helped a lot> > >> > > Hi,> > > > > > My problems did not start during pregnancy but they started about 2 weeks after my son was born. 10 years on and still trying to get sorted!> > > > > >

________________________________> > > > > > From: hyperaldosteronism on behalf of Stump> > > Sent: Tue 20/09/2011 13:13> > > To: hyperaldosteronism > > > Subject: PA and pregnancy> > > > > > > > > > > > > > > I have searched the board and found a few people who had this show up during pregnancy... Is it common for pregnancy to cause PA? Have been told by several doctors "Your blood pressure problems will go away in 6

weeks" That was well over a year ago, and it keeps getting worse! Just curious to hear stories of women who's symptoms started while pregnant.> > >> > > >>

September 21, 2011

I was told by the nurse taking my blood once that if the tourniquet is left on

for too long then this affects the blood results.

________________________________

From: hyperaldosteronism on behalf of Clarence Grim

Sent: Wed 21/09/2011 02:14

To: hyperaldosteronism

Subject: Re: Re: PA and pregnancy

Curious. Wonder if there was a problem drawing your blood then.

Tiped sad Send form mi

iPhone ;-)

May your pressure be low!

CE Grim MD

Specializing in Difficult

Hypertension

Even when I had K=6.6 I still went 5 -6 times a night.

Natalia

________________________________

To: <mailto:hyperaldosteronism >

hyperaldosteronism

Sent: Tuesday, September 20, 2011 3:05 PM

Subject: Re: Re: PA and pregnanc! y

The peeing ins most common in those with low K as that is the cause of the Kid

resistance to ADH. This blocks the normal ability to make a concentrated urine

(normal) and you can sleep all night.

CE Grim MD

Dr. Grim, That is one of the things that makes me wonder if I have this or

not. I do not get up to pee at all at night. I do pee quite a bit during the day

but I am on a diuretic so it could be due to that. I dont eat licorice at all,