Re: Steadily increasing aldosterone level over last year

December 19, 2011

Hi and Tim,

I could try and answer but you may get a better answer here:

http://www.jnephrol.com/public/JN/Article/Article.aspx?UidArticle=261FD3B8-E9D5-\

4B99-B1B1-FA037B7F2290

Take the download option and I think it will answer most of your questions. My

guess is he is just getting extra radiation if they haven't found one in a year

but Dr. Grim my think differently.

I'm dealing with gynecomstia at the moment and have a couple questions. Did it

go away when he switched? Did he have other symptoms? I'm experiencing

symptoms of low testosterone which I presume would be corrected by switching.

Quality of Life issues and comparing the two? Any info you can give me will be

appreciated, I'm looking for experienced help!

Thanks

- 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): 131/76 HR 60

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

Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin

2000MG and Spironolactone 50 MG.

>

> Hi all,

>

> Below is my husband's thumbprint details. He's been on Inspra since

> March 2011 and on his current increased dose of 100mg twice a day since

> August. Before March, he'd been on spiro but developed gynecomastia

> after being on it 4-5 months. Things are going well in that he feels

> well, no more leg cramps and good blood pressures until now. He follows

> a low sodium diet and has eaten basically the same way for the last 6

> months. Bp has gone from 130/80 up to last month to 160/90 now. He is

> on no other BP meds.

>

> Here's the issue that concerns me: when he was diagnosed with PA, his

> aldo level was 700 pmol/L (Canada, normal upright 100-840) but his renin

> was very low, hence the diagnosis considering low K, peeing 4xper night

> and ++drug resitent hypertension. With spiro and then Inspra and DASHing

> well most of the time, BP's were good but aldo level rose to 950. Then,

> 3 months later or so, it rose to 1100 and now, 4 more months down the

> road, it's 1500. It just keeps going up and I'm convinced an

> eczema-type skin flaking condition on his face that keeps worsening is

> related to this.

>

> He's had several CT scans, MRI's and ultrasounds done over the last

> several years, most recently less than a year ago and they keep showing

> normal adrenals, normal size, no adenomas.

>

> Does the rising aldo level mean that something will likely show up on

> MRI eventually? Does the rising aldo level suggest Tim should go for

> the AVS to figure out what's going on? How high can the aldo level get

> before it becomes downright worrisome?

>

> Thanks all and Happy Holidays,

>

> Husband Tim finally diagnosed with PA (no renin, high ARR and

> aldosterone, very low K for years) after 5 years on 6 different BP meds

> in October 2010.

>

> pmol/L 100-860 upright

>

> (Husband Tim finally diagnosed with PA (no renin, high ARR and

> aldosterone, very low K for years) after 5 years on 6 different BP meds

> in October 2010.)

>

December 19, 2011

Hi and thanks for the link.

Yes, Tim's gynecomastia did go away after a few weeks on the Inspra but

interestingly, he is currently dealing with a slightly tender left breast and

feels like there is a swollen small gland in there. It's not gotten worse and

in fact, has finally started to get better but he's still going to have his GP

have a look at it this week just to be safe. The gynecomastia he had on spiro

wasn't tender at all but rather just larger fleshy breast tissue. But as I

said, on Inspra they returned to normal appearance.

Interesting side note: Tim was found to have a very low testosterone level

during all of his PA work-up and he has just gotten started on Androgel

testosterone hormaone replacement to improve his energy, strength and other

things . I've posted before but didn't get much feedback re: PA and low

testosterone levels. Of course, when you have one hormone out of balance, quite

often other hormones are thrown out of whack.

I doubt your testosterone level will go up by switching to Inspra, it's a

seperate issue. Tim is tolerating the Inspra well and the Androgel has already

improved *things* too.

Best wishes.

> >

> > Hi all,

> >

> > Below is my husband's thumbprint details. He's been on Inspra since

> > March 2011 and on his current increased dose of 100mg twice a day since

> > August. Before March, he'd been on spiro but developed gynecomastia

> > after being on it 4-5 months. Things are going well in that he feels

> > well, no more leg cramps and good blood pressures until now. He follows

> > a low sodium diet and has eaten basically the same way for the last 6

> > months. Bp has gone from 130/80 up to last month to 160/90 now. He is

> > on no other BP meds.

> >

> > Here's the issue that concerns me: when he was diagnosed with PA, his

> > aldo level was 700 pmol/L (Canada, normal upright 100-840) but his renin

> > was very low, hence the diagnosis considering low K, peeing 4xper night

> > and ++drug resitent hypertension. With spiro and then Inspra and DASHing

> > well most of the time, BP's were good but aldo level rose to 950. Then,

> > 3 months later or so, it rose to 1100 and now, 4 more months down the

> > road, it's 1500. It just keeps going up and I'm convinced an

> > eczema-type skin flaking condition on his face that keeps worsening is

> > related to this.

> >

> > He's had several CT scans, MRI's and ultrasounds done over the last

> > several years, most recently less than a year ago and they keep showing

> > normal adrenals, normal size, no adenomas.

> >

> > Does the rising aldo level mean that something will likely show up on

> > MRI eventually? Does the rising aldo level suggest Tim should go for

> > the AVS to figure out what's going on? How high can the aldo level get

> > before it becomes downright worrisome?

> >

> > Thanks all and Happy Holidays,

> >

> > Husband Tim finally diagnosed with PA (no renin, high ARR and

> > aldosterone, very low K for years) after 5 years on 6 different BP meds

> > in October 2010.

> >

> > pmol/L 100-860 upright

> >

> > (Husband Tim finally diagnosed with PA (no renin, high ARR and

> > aldosterone, very low K for years) after 5 years on 6 different BP meds

> > in October 2010.)

> >

>

December 19, 2011

-My husband (ironically also named Tim) recently went through recent AVS and adrenaletcomy. He also went through several years of testing/med adjustments for PA w/ similar hx as your husband. He was " relatively " controlled for on BP meds until early 2011, but then despite med adjustments and 6 BP meds creeped higher finally becoming out of control. K issues and on up to 60 to 120meq daily of K to keep it stable.

AVS was able to show that it was the left adrenal gland was definitely the issue even though 2 CT's did not reveal adenoma. Biopsy on adrenal gland post-surgery showed a 0.9 mm adenoma. His BP has been great on very little BP meds post-surgery.

Pre-adrenaletcomy, the ONLY thing that worked for him to regain control of htn was strict DASH diet and higher dose Inspra per Dr. Grim's recommendations. While I can't answer your questions directly re: renin and aldosterone levels, wanted to let you know my husband's experience. I would recommend exploring if AVS is an appropriate option. You'll get great info from this group, I only wish I had known about it sooner! Know what you are going through trying to find answers and worrying...

Take care,

December 19, 2011

We do not have a lot of data on also levels over time. We do know that. Mixing also with inspra may lead to an increased Aldo as renin rises. What has renin been doing at the sAme time the aldos were measured. BP rise is more likely related to salt intake. Do you have any spot urine checks over the same time? If not I would recommend a spot urine for Na K creat and albumin to assess if there is room to tighten up on DASH. Is there a family Hx of Htn and low K?E May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension

Hi all,

Below is my husband's thumbprint details. He's been on Inspra since March 2011 and on his current increased dose of 100mg twice a day since August. Before March, he'd been on spiro but developed gynecomastia after being on it 4-5 months. Things are going well in that he feels well, no more leg cramps and good blood pressures until now. He follows a low sodium diet and has eaten basically the same way for the last 6 months. Bp has gone from 130/80 up to last month to 160/90 now. He is on no other BP meds.

Here's the issue that concerns me: when he was diagnosed with PA, his aldo level was 700 pmol/L (Canada, normal upright 100-840) but his renin was very low, hence the diagnosis considering low K, peeing 4xper night and ++drug resitent hypertension. With spiro and then Inspra and DASHing well most of the time, BP's were good but aldo level rose to 950. Then, 3 months later or so, it rose to 1100 and now, 4 more months down the road, it's 1500. It just keeps going up and I'm convinced an eczema-type skin flaking condition on his face that keeps worsening is related to this.

He's had several CT scans, MRI's and ultrasounds done over the last several years, most recently less than a year ago and they keep showing normal adrenals, normal size, no adenomas.

Does the rising aldo level mean that something will likely show up on MRI eventually? Does the rising aldo level suggest Tim should go for the AVS to figure out what's going on? How high can the aldo level get before it becomes downright worrisome?

Thanks all and Happy Holidays,

Husband Tim finally diagnosed with PA (no renin, high ARR and aldosterone, very low K for years) after 5 years on 6 different BP meds in October 2010.

pmol/L 100-860 upright

(Husband Tim finally diagnosed with PA (no renin, high ARR and aldosterone, very low K for years) after 5 years on 6 different BP meds in October 2010.)

December 19, 2011

Another option would be to do a radioactive adrenal scan but need to be off CMBs for as long as possible 12 weeks. Be sure to let CT folks know of possible risk of kidney damage with contrast. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension

Hi and Tim,

I could try and answer but you may get a better answer here:

http://www.jnephrol.com/public/JN/Article/Article.aspx?UidArticle=261FD3B8-E9D5-4B99-B1B1-FA037B7F2290

Take the download option and I think it will answer most of your questions. My guess is he is just getting extra radiation if they haven't found one in a year but Dr. Grim my think differently.

I'm dealing with gynecomstia at the moment and have a couple questions. Did it go away when he switched? Did he have other symptoms? I'm experiencing symptoms of low testosterone which I presume would be corrected by switching. Quality of Life issues and comparing the two? Any info you can give me will be appreciated, I'm looking for experienced help!

Thanks

- 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): 131/76 HR 60

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

Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG.