Stowasser on PA review of Dx and Rx - except no mention of DASH.

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This is an excellent review that I thought we had in our files but if not the pdf should be uploaded. It is better and more current than Endo Guidelines.It is clearly "biased" towards surgery.We need to await their long term followup of surgery. As I mentioned I lectured to the group in 1983 on the evolution of PA. One would think they must have some very good long term data now. They are organizing a satellite conference in Brisbane after the Int Soc of HTN in 2012 and I have requested that they have a session on dietary management of PA. They must have many cases that moved from LREH to PA. Indeed in GRA they have clearly documented this as I mention in my review.Curious that they do not mention low sodium/high K diet as an important way to manage PA. But then Aussies never did believe much in the role of Na in BP. It is interesting that many chairs of Med down under had been trained and done research in HTN. Prob more than any other country I know of. I hate to detract from the current lively exchange but thought others might like to review some or all of this article! I have only skim/read and will likely have questions, especially regarding recommended follow on treatment. I copied one very small section since this subject came up today and will probably be thought-provoking for some. Enjoy! http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2874431/pdf/cbr_31_2_39.pdf Laboratory Investigation of Primary Aldosteronism Stowasser,* J , Pimenta, Ashraf H Al-Asaly Ahmed, and D Gordon Excerpt from above article: "Assessment of Treatment Response Available treatment modalities for PA include the following: i.unilateral laparoscopic adrenalectomy is usually reserved for patients with unilateral PA (as defined by AVS) in whom surgery results in cure of hypertension in at least 50% and improvement in virtually all the remainder.2,3,6 It is occasionally also performed in carefully-selected patients with bilateral forms (for example, those in whom aldosterone antagonist medications have been poorly tolerated or failed to result in adequate hypertension control) in which case the blood pressure response is less predictable121 ii.medications which antagonise aldosterone action, including spironolactone and eplerenone (mineralocorticoid receptor antagonists) and amiloride (a sodium epithelial channel inhibitor) are the treatment of first choice for patients with bilateral forms of PA, but are also utilised in those with unilateral forms who are unsuitable for (or decline) surgery or to facilitate control of hypertension and hypokalaemia while awaiting surgery5,34,39 iii.glucocorticoids (in low dose) are the favoured treatment for patients with FH-I (although they can also be treated with aldosterone antagonists).84,88 Because blood pressure can be affected by multiple factors, residual hypertension following institution of one or more of the above specific treatment approaches does not necessarily mean that (a) aldosterone excess has not been corrected by surgery for unilateral PA or glucocorticoid treatment for FH-I; or ( its effects have not been adequately blocked (by mineralocorticoid antagonist agents). Laboratory investigations help to assess responses to both surgical and medical treatment in patients with PA." - 65 yo morb. 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 been dealing with hbp since I went into labor with my 2nd child in 2005. I was 31 at the time and it went from being completely fine one morning to escalating to 195/140 when I went into labor later that same evening. It took months to finally settle back down to a normal range. However a year later it started to spike again. My Diastolic is sometimes high even on medicine and my Systolic is usually fine. > >> > > >> >I currently take Propranolol and HCTZ. I am a runner and don't really watch my sodium intake, but do eat a pretty decent diet otherwise. In pursuing a cause for my HBP, I went to an endocrinologist. I don't see that I even had my aldosterone or renin checked. However, I did have a CT scan for some abdominol pain and found out I have a small adrenal adenoma. The CT scan was without contrast and the report says it is consistent with being a benign adenoma. I was told there was no cause for concern just something to monitor from time to time to make sure it does not grow. > >> > > >> >I just had lab work to check my blood levels of elctrolytes since I am on HCTZ and there were no reported concerns. So I guess my Na and K levels were fine. > >> > > >> >My question is, would the normal blood work run by my Primary for K and Na rule out the possibility of Conn's? My sister has recently started having similar symptoms so this has brought everything to head again for me. Thanks so much for any insight you might be able to give to me! > >> > > >> > > >> > > >> > > > > >