Re: Low renin HTN - early PA

[Guest guest]

I had really two stages. On stage one, it started in December 2010 after two hospitalization with 245/125, I started to take 50 mg of eplerenone (just forced my PCP to prescribe it to me), my BP was resolved almost immediately, but other symptoms persisted for a couple of months. I restricted sodium, but didn't know many things about Na in a cheese, in row meat, and in deli products. I felt almost normal for 7.5 months. All of sudden I started to feel worse, I started to take K supplement (decided that my K is low) and decreased eplerenone to 37.5 mg. It was a big mistake! In two days I was hospitalized (in August 2011) with BP 180/110 and K = 6.6. So, this is a beginning of stage two. In the hospital they increased Micardis to 160, and eplerenone to 150 mg. After that I was

hospitalized one more time in September. Then I started to consult with Dr. Grim, and tapered Micardis and eplerenone step by step. Now my BP is almost always normal 125/75, except when I watch some horror or very emotional movies, but I still have some muscles problems, shortness of breath, cannot walk fast, cannot exercise as long as before. And I feel much, much worse right after eating.What is bad, I don't know what K I have every day, because symptoms of high K and low K are the same. Now I watch Na much better. Why do you think your diabetes got worse with PA resolution? Is not it too much fruits, grains, and vegetables? I was on 2000 mg of Metformin for last 15 years. My HbA1 is usually between 6.1 and 6.9. I will know in 2 weeks the last lab results. But approximately 3 weeks ago, all of a sudden, my morning glucose

number jumped from usual 115-125 to 135-150, and I don't have a clever explanation for that. I suspect that it's effected by my middle night snack, what usually contains some fruit. Did you notice that you have to eat fruits only until 6 pm? How well are you Dashing? What is your usual everyday food? Did you notice that you feel worse right after meal and what kind food effects it? Thank you very much,Natalia To: hyperaldosteronism Sent: Friday, October 28, 2011 10:36 AMSubject: Low renin HTN - early PA

You do sound very similar. I don't know how long you have been at it but it took me 10 months to resolve all SXs after BP corrected. Watch the NA. How controlled is your T2DM? Before PA resolution mine was controlled and I even had to take glucose tabs at times to keep it even. After, it shot up so they had to double my metformin, HbA1C jumprd to 7.2! Now it's flattened out again and HbA1C was 6.3 last week.

- 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.

> > > > > > >

> > > > > > > > Are you getting a real doctor this time or another resident?

> > > > > > > >

> > > > > > > > I was at the VA today and found out the new Neprologist was

> > > > as I

> > > > > > hoped, Dr. Luiz Kolankiewicz. He was the one I saw back in

> > > > December

> > > > > > and seemed to know about PA. I thought asked the right questions.

> > > > > > You might suggest a referral if appropriate!

> > > > > > > >

> > > > > > > > I also heard Dr. , Chief - Pulmonary Section, passed away

> > > > > > from a massive heart attack! 46 y/o, great shape and exersized

> > > > every

> > > > > > day! I told Dr. Webster that was it, I was going to remain fat,

> > > > dumb

> > > > > > and happy!

> > > > > > > >

> > > > > > > > - 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.

> > > > > > > >

> > > > > > > >

> > > > > > >

> > > > > >

> > > > > >

> > > > >

> > > >

> > > >

> > >

> >

>

[Guest guest]

DASH the Diabetes. CE Grim MD You do sound very similar. I don't know how long you have been at it but it took me 10 months to resolve all SXs after BP corrected. Watch the NA. How controlled is your T2DM? Before PA resolution mine was controlled and I even had to take glucose tabs at times to keep it even. After, it shot up so they had to double my metformin, HbA1C jumprd to 7.2! Now it's flattened out again and HbA1C was 6.3 last week. - 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. > > > > > > > > > > > > > > > Are you getting a real doctor this time or another resident? > > > > > > > > > > > > > > > > I was at the VA today and found out the new Neprologist was > > > > as I > > > > > > hoped, Dr. Luiz Kolankiewicz. He was the one I saw back in > > > > December > > > > > > and seemed to know about PA. I thought asked the right questions. > > > > > > You might suggest a referral if appropriate! > > > > > > > > > > > > > > > > I also heard Dr. , Chief - Pulmonary Section, passed away > > > > > > from a massive heart attack! 46 y/o, great shape and exersized > > > > every > > > > > > day! I told Dr. Webster that was it, I was going to remain fat, > > > > dumb > > > > > > and happy! > > > > > > > > > > > > > > > > - 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. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >

[Guest guest]

Try taking your BP when you feel bad after eating. Many older folks get a fall in BP with eating for any of a number of reasons but mostly unknown. CE Grim MD I had really two stages. On stage one, it started in December 2010 after two hospitalization with 245/125, I started to take 50 mg of eplerenone (just forced my PCP to prescribe it to me), my BP was resolved almost immediately, but other symptoms persisted for a couple of months. I restricted sodium, but didn't know many things about Na in a cheese, in row meat, and in deli products. I felt almost normal for 7.5 months. All of sudden I started to feel worse, I started to take K supplement (decided that my K is low) and decreased eplerenone to 37.5 mg. It was a big mistake! In two days I was hospitalized (in August 2011) with BP 180/110 and K = 6.6. So, this is a beginning of stage two. In the hospital they increased Micardis to 160, and eplerenone to 150 mg. After that I was hospitalized one more time in September. Then I started to consult with Dr. Grim, and tapered Micardis and eplerenone step by step. Now my BP is almost always normal 125/75, except when I watch some horror or very emotional movies, but I still have some muscles problems, shortness of breath, cannot walk fast, cannot exercise as long as before. And I feel much, much worse right after eating.What is bad, I don't know what K I have every day, because symptoms of high K and low K are the same. Now I watch Na much better. Why do you think your diabetes got worse with PA resolution? Is not it too much fruits, grains, and vegetables? I was on 2000 mg of Metformin for last 15 years. My HbA1 is usually between 6.1 and 6.9. I will know in 2 weeks the last lab results. But approximately 3 weeks ago, all of a sudden, my morning glucose number jumped from usual 115-125 to 135-150, and I don't have a clever explanation for that. I suspect that it's effected by my middle night snack, what usually contains some fruit. Did you notice that you have to eat fruits only until 6 pm? How well are you Dashing? What is your usual everyday food? Did you notice that you feel worse right after meal and what kind food effects it? Thank you very much,Natalia To: hyperaldosteronism Sent: Friday, October 28, 2011 10:36 AMSubject: Low renin HTN - early PA You do sound very similar. I don't know how long you have been at it but it took me 10 months to resolve all SXs after BP corrected. Watch the NA. How controlled is your T2DM? Before PA resolution mine was controlled and I even had to take glucose tabs at times to keep it even. After, it shot up so they had to double my metformin, HbA1C jumprd to 7.2! Now it's flattened out again and HbA1C was 6.3 last week. - 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. > > > > > > > > > > > > > > > Are you getting a real doctor this time or another resident? > > > > > > > > > > > > > > > > I was at the VA today and found out the new Neprologist was > > > > as I > > > > > > hoped, Dr. Luiz Kolankiewicz. He was the one I saw back in > > > > December > > > > > > and seemed to know about PA. I thought asked the right questions. > > > > > > You might suggest a referral if appropriate! > > > > > > > > > > > > > > > > I also heard Dr. , Chief - Pulmonary Section, passed away > > > > > > from a massive heart attack! 46 y/o, great shape and exersized > > > > every > > > > > > day! I told Dr. Webster that was it, I was going to remain fat, > > > > dumb > > > > > > and happy! > > > > > > > > > > > > > > > > - 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. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >

[Guest guest]

Tried. It's not BP. Thank you. To: hyperaldosteronism Sent: Friday, October 28, 2011 6:11 PMSubject: Re: Low renin HTN - early PA

Try taking your BP when you feel bad after eating. Many older folks get a fall in BP with eating for any of a number of reasons but mostly unknown. CE Grim MD I had really two stages. On stage one, it started in December 2010 after two hospitalization with 245/125, I started to take 50 mg of eplerenone (just forced my PCP to prescribe it to me), my BP was resolved almost immediately, but other symptoms persisted for a

couple of months. I restricted sodium, but didn't know many things about Na in a cheese, in row meat, and in deli products. I felt almost normal for 7.5 months. All of sudden I started to feel worse, I started to take K supplement (decided that my K is low) and decreased eplerenone to 37.5 mg. It was a big mistake! In two days I was hospitalized (in August 2011) with BP 180/110 and K = 6.6. So, this is a beginning of stage two. In the hospital they increased Micardis to 160, and eplerenone to 150 mg. After that I was hospitalized one more time in September. Then I started to consult with Dr. Grim, and tapered Micardis and eplerenone step by step. Now my BP is almost always normal 125/75, except when I watch some horror or very emotional movies, but I still have some muscles problems, shortness of breath, cannot walk fast, cannot exercise as long as before. And I feel much, much worse right after eating.What is

bad, I don't know what K I have every day, because symptoms of high K and low K are the same. Now I watch Na much better. Why do you think your diabetes got worse with PA resolution? Is not it too much fruits, grains, and vegetables? I was on 2000 mg of Metformin for last 15 years. My HbA1 is usually between 6.1 and 6.9. I will know in 2 weeks the last lab results. But approximately 3 weeks ago, all of a sudden, my morning glucose number jumped from usual 115-125 to 135-150, and I don't have a clever explanation for that. I suspect that it's effected by my middle night snack, what usually contains some fruit. Did you notice that you have to eat fruits only until 6 pm? How well are you Dashing? What is your usual everyday food? Did you notice that you feel worse right after meal and

what kind food effects it? Thank you very much,Natalia To: hyperaldosteronism Sent: Friday, October 28, 2011 10:36 AMSubject: Low renin HTN - early PA You do sound very similar. I don't know how long you have been at it but it took me 10 months to resolve all SXs after BP corrected. Watch the NA. How controlled is your T2DM? Before PA resolution mine was controlled and I even had to take glucose tabs at times to keep it even. After, it shot up so they had to double my metformin, HbA1C jumprd to 7.2! Now it's flattened out again and HbA1C was 6.3 last week. - 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. > > > > > > > > > > > > > > > Are you getting a real doctor this time or another resident? > > > > > > > > > > > > > > > > I was at the VA today and found out the

new Neprologist was > > > > as I > > > > > > hoped, Dr. Luiz Kolankiewicz. He was the one I saw back in > > > > December > > > > > > and seemed to know about PA. I thought asked the right questions. > > > > > > You might suggest a referral if appropriate! > > > > > > > > > > > > > > > > I also heard Dr. , Chief - Pulmonary Section, passed away > > > > > > from a massive heart attack! 46 y/o, great shape and exersized > > > > every > > > > > > day! I told Dr. Webster that was it, I was going to remain fat, > > > > dumb > > > > > > and happy! > > > > > > > > > > > > > > > > - 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. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >

[Guest guest]

My understanding is the release of glucose is often impared in PTNs

w/uncontrolled PA. When PA becomes controlled either via surgery or MCBs the

imparement is eliminated hence more glucose (sugar) in the system which must be

addressed. In my case HbA1C went from 6.1 to 7.2. Dr. Grim said Dr. Conn

talked about this back in the 60's and I believe I saw something about ~25% of

PTNs w/PA also had DM. I didn't change diet at that time so I don't believe

that was an issue, I did not start DASHing until later.

I don't have experience with middle night snacks because I reserve the middle of

the night for sleeping! I usually sleep 8 or more hours uninterrupted! (My

bi-pap machine reported 9.18 hrs/night for the last 30 days when I looked this

morning!)

I DASH enough to constantly hit my goals which I just reviewed with my PCP.

(BP:130-135/70-80 and BS <140 which converts to a HbA1C = 6.5. (My DM dietician

wants HbA1C to be in the 6's and PCP wants 140 or less so that gives me a target

daily of 125 - 140. HbA1C was 6.3 (130 ave) last week!)

I eat fruit whenever and often that is the last thing I eat in the day, almost

always after 6pm. I have requested a consult w/dietician because while my

numbers are good I want to see how to loose weight with DASH and T2DM.

- 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.

> > > > > > > >

> > > > > > > > > Are you getting a real doctor this time or another resident?

> > > > > > > > >

> > > > > > > > > I was at the VA today and found out the new Neprologist was

> > > > > as I

> > > > > > > hoped, Dr. Luiz Kolankiewicz. He was the one I saw back in

> > > > > December

> > > > > > > and seemed to know about PA. I thought asked the right questions.

> > > > > > > You might suggest a referral if appropriate!

> > > > > > > > >

> > > > > > > > > I also heard Dr. , Chief - Pulmonary Section, passed away

> > > > > > > from a massive heart attack! 46 y/o, great shape and exersized

> > > > > every

> > > > > > > day! I told Dr. Webster that was it, I was going to remain fat,

> > > > > dumb

> > > > > > > and happy!

> > > > > > > > >

> > > > > > > > > - 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.

> > > > > > > > >

> > > > > > > > >

> > > > > > > >

> > > > > > >

> > > > > > >

> > > > > >

> > > > >

> > > > >

> > > >

> > >

> >

>

[Guest guest]

What is the effect if your K is 4.8 - 5.0 (range 3.5-5.0)?

- 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.

> > > > >

> > > > > If you don't mind my asking, are your levels indicative of someone

with PA? I am trying to decipher my most recent blood work. Thanks!

> > > > >

> > > > > >

> > > > > >27 y/o , 115 lb at 5'6, female with 4+ year history of hypertension

(Avg 135/95). Recently taken off of all bp meds because of resistance to them.

Currently awaiting a second Nephrology appointment and up-to-date blood work.

Last Aldosterone Level was 88. No known underlying illnesses other than systemic

hypertension.ÃÆ'‚ÂÂ

> > > > > >

> > > > >

> > > > >

> > > > > ________________________________

> > > > > From: <jclark24p@>

> > > > > To: hyperaldosteronism

> > > > > Sent: Thursday, October 27, 2011 11:49 AM

> > > > > Subject: Re: Francis - New PCP

> > > > >

> > > > >

> > > > > ÃÆ'‚ÂÂ

> > > > > In reviewing my lab records in the VA Chemistry/Hematology Personal

Health Record of JOHN M. CLARK on 12/29/2010 and found 12 entries (I know

because I had to take my shoe off and use one toe!) Here is what was reported,

maybe you can point out the duplicates!

> > > > >

> > > > > Here is what Dr. KOLANKIEWICZ saw:

> > > > >

> > > > > ALANINE AMINOTRANSFERASE 31 U/L 7-52 Details

> > > > > ALKALINE PHOSPHATASE 59 U/L 40-150 Details

> > > > > ASPARTATE AMINOTRANSFERASE 20 U/L 5-40 BILIRUBIN 0.5 mg/dL 0.2-1.2

Details

> > > > > CALCIUM 9.7 mg/dL 8.5-10.5 Details

> > > > > CARBON DIOXIDE 24 mmol/L 20-30 Details

> > > > > CHLORIDE 102 mmol/L 100-110 Details

> > > > > CREATININE 1.04 mg/dl 0.5-1.5 Details

> > > > > GAMMA GLUTAMYL TRANSFERASE 53 U/L 10-65 GLOMERULAR FILTRATION

RATE.PREDICTED 72 mL/min >60 GLUCOSE 130 High mg/dL 65-100 Details

> > > > > MAGNESIUM 2.5 High mg/dL 1.8-2.4 Details

> > > > > PHOSPHATE 3.6 mg/dL 2.5-5.0 Details

> > > > > POTASSIUM 5.0 mmol/L 3.5-5.0 Details

> > > > > SODIUM 135 mmol/L 135-145 Details

> > > > > UREA NITROGEN 26 High mg/dL 7-25 Details

> > > > >

> > > > > BASOPHILS/100 LEUKOCYTES 0.7 % 0-2.0 Details

> > > > > EOSINOPHILS/100 LEUKOCYTES 1.7 % 0-7.0

> > > > > ERYTHROCYTE DISTRIBUTION WIDTH 13.7 % 11.5-14.5 ERYTHROCYTE MEAN

CORPUSCULAR HEMOGLOBIN 30.0 27-34 ERYTHROCYTE MEAN CORPUSCULAR HEMOGLOBIN

CONCENTRATION 33.7 g/dl 32-37 Details

> > > > > ERYTHROCYTES 4.76 M/cmm 4.7-6.1 Details

> > > > > GRANULOCYTES/100 LEUKOCYTES 59.1 % 40-75

> > > > > HEMATOCRIT 42.3 % 40-52 Details

> > > > > HEMOGLOBIN 14.3 g/dl 14-18 Details

> > > > > LEUKOCYTES 6.6 K/cmm 4.5-11.0 Details

> > > > > LYMPHOCYTES/100 LEUKOCYTES 27.0 % 10-55

> > > > > MEAN CORPUSCULAR VOLUME 88.8 fl 80-98 Details

> > > > > MONOCYTES/100 LEUKOCYTES 11.5 % 2-12 Details

> > > > > PLATELET MEAN VOLUME 7.6 fl 7.4-10.4 Details

> > > > > PLATELETS 245 K/cmm 130-450 Details

> > > > >

> > > > > CREATININE 27.15 mg/dL Details

> > > > > PROTEIN <2.6 mg/dL Details

> > > > >

> > > > > APPEARANCE CLEAR Clear Details

> > > > > BILIRUBIN NEG NEG Details

> > > > > COLOR Light-Yellow YELLOW Details

> > > > > GLUCOSE NEG mg/dL NEG Details

> > > > > HEMOGLOBIN NEG NEG Details

> > > > > KETONES NEG mg/dL NEG Details

> > > > > LEUKOCYTES NEG NEG Details

> > > > > NITRITE NEG NEG Details

> > > > > PH 5.0 5-9 Details

> > > > > PROTEIN NEG mg/dL NEG Details

> > > > > SPECIFIC GRAVITY 1.005 Low 1.016-1.022 UROBILINOGEN <2.0 mg/dL ><2.0

Details

> > > > >

> > > > > CHLORIDE (URINE,RANDOM) 140 Details

> > > > > POTASSIUM (URINE,RANDOM) 40.6 Details

> > > > > SODIUM 104 mmol/l Details

> > > > >

> > > > > CORTICOTROPIN 10 pg/mL Details

> > > > >

> > > > > CORTISOL~MORNING 7.29 ug/dL 6-28 Details

> > > > >

> > > > > OSMOLALITY 298 High mOsm/Kg 280-295 Details

> > > > >

> > > > > OSMOLALITY 369 mOsm/kg 50-1400 Details

> > > > >

> > > > > METANEPHRINES <25 pg/mL 0-57 Details

> > > > > METANEPHRINES 117 pg/mL 0-205 Details

> > > > > NORMETANEPHRINE 117 pg/mL 0-148 Details

> > > > >

> > > > > Test Name Result Units Reference Range Test Amended ALDOSTERONE

comment mcg/24hr 2.3-21.0 Details

> > > > >

> > > > > Test Name: ALDOSTERONE

> > > > > Result: comment

> > > > > Units: mcg/24hr

> > > > > Reference Range: 2.3-21.0

> > > > > Lab Test: Aldosterone

> > > > > Ordering Provider: KOLANKIEWICZ, LUIZ

> > > > > Ordering Location: WHITE RIVER JCT VAMROC

> > > > > Performing Location: QUEST 14225 NEWBROOK DRIVE , CHANTILLY, VA 20153

> > > > > Status: Amended

> > > > > Interpretation: Reference Ranges: Random Sodium diet

> > > > > Age_________mcg/24 h

> > > > > _2-_7 years______5.7 or less

> > > > > _8-11 years_____10.2 or less

> > > > > 12-16 years_____15.6 or less

> > > > > _Adults_____2.3-21.0

> > > > > Post Florinef or IV saline suppression____5 mcg/24 h

> > > > > or less

> > > > > Creatinine, 24-Hour Urine

> > > > > Age (yrs)__g/24 hours

> > > > > ___<3_____Not

> > > > > established

> > > > > _3-_8______0.11-0.68

> > > > > _9-12______0.17-1.41

> > > > > 13-17______0.29-1.87

> > > > > _Adults____0.63-2.50

> > > > > Reference Range prior to 11/22/2005 was: 6-25 ug/24 hrs

> > > > > This 24 hr urine range applies to patients on normal salt diet. Low

salt

> > > > > diet: 17-44 ug/24hr. High salt diet: 0-6 ug/24hr

> > > > > Comments: ALDOSTERONE, SERUM= 12 ng/dL

> > > > > REFERENCE RANGE (SERUM): Upright 8:00-10:00am < or = 28ng/dL

> > > > > Upright 4:00-6:00pm < or = 21ng/dL

> > > > > Supine 8:00-10:00am 3-16ng/dL

> > > > > TV=2400 (24 HR URINE COLLECTION)

> > > > > ALDOSTERONE,URINE: 12.7 mcg/24h

> > > > > Test performed at Quest Diag. Lab.

> > > > >

> > > > > CREATININE 1734.48c mg/24hrs 600-2000 Details SPECIMEN VOLUME 2400 ml.

Details

> > > > >

> > > > > What did he miss?

> > > > >

> > > > > - 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

>

[Guest guest]

It is articles like this that confuse me!

In conclusion, primary aldosteronism is associated with increased plasma insulin

response to an oral glucose load and insulin resistance independent of plasma

potassium levels. Impairment of insulin sensitivity in this condition is less

important than in essential hypertension and is rapidly and persistently

reversed after adrenalectomy or treatment with aldosterone antagonists.

Source: http://jcem.endojournals.org/content/91/9/3457.full

Insulin Sensitivity in Patients with Primary Aldosteronism: A Follow-Up Study

Cristiana Catena,

a Lapenna,

Sara Baroselli,

Nadalini,

GianLuca Colussi,

Marileda Novello,

Grazia Favret,

Alessandra Melis,

Alessandro Cavarape and

Leonardo A. Sechi

- Author Affiliations

Division of Internal Medicine, Department of Experimental and Clinical Pathology

and Medicine, University of Udine, 33100 Udine, Italy

- 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.

> > > > >

> > > > > If you don't mind my asking, are your levels indicative of someone

with PA? I am trying to decipher my most recent blood work. Thanks!

> > > > >

> > > > > >

> > > > > >27 y/o , 115 lb at 5'6, female with 4+ year history of hypertension

(Avg 135/95). Recently taken off of all bp meds because of resistance to them.

Currently awaiting a second Nephrology appointment and up-to-date blood work.

Last Aldosterone Level was 88. No known underlying illnesses other than systemic

hypertension.ÃÆ'‚ÂÂ

> > > > > >

> > > > >

> > > > >

> > > > > ________________________________

> > > > > From: <jclark24p@>

> > > > > To: hyperaldosteronism

> > > > > Sent: Thursday, October 27, 2011 11:49 AM

> > > > > Subject: Re: Francis - New PCP

> > > > >

> > > > >

> > > > > ÃÆ'‚ÂÂ

> > > > > In reviewing my lab records in the VA Chemistry/Hematology Personal

Health Record of JOHN M. CLARK on 12/29/2010 and found 12 entries (I know

because I had to take my shoe off and use one toe!) Here is what was reported,

maybe you can point out the duplicates!

> > > > >

> > > > > Here is what Dr. KOLANKIEWICZ saw:

> > > > >

> > > > > ALANINE AMINOTRANSFERASE 31 U/L 7-52 Details

> > > > > ALKALINE PHOSPHATASE 59 U/L 40-150 Details

> > > > > ASPARTATE AMINOTRANSFERASE 20 U/L 5-40 BILIRUBIN 0.5 mg/dL 0.2-1.2

Details

> > > > > CALCIUM 9.7 mg/dL 8.5-10.5 Details

> > > > > CARBON DIOXIDE 24 mmol/L 20-30 Details

> > > > > CHLORIDE 102 mmol/L 100-110 Details

> > > > > CREATININE 1.04 mg/dl 0.5-1.5 Details

> > > > > GAMMA GLUTAMYL TRANSFERASE 53 U/L 10-65 GLOMERULAR FILTRATION

RATE.PREDICTED 72 mL/min >60 GLUCOSE 130 High mg/dL 65-100 Details

> > > > > MAGNESIUM 2.5 High mg/dL 1.8-2.4 Details

> > > > > PHOSPHATE 3.6 mg/dL 2.5-5.0 Details

> > > > > POTASSIUM 5.0 mmol/L 3.5-5.0 Details

> > > > > SODIUM 135 mmol/L 135-145 Details

> > > > > UREA NITROGEN 26 High mg/dL 7-25 Details

> > > > >

> > > > > BASOPHILS/100 LEUKOCYTES 0.7 % 0-2.0 Details

> > > > > EOSINOPHILS/100 LEUKOCYTES 1.7 % 0-7.0

> > > > > ERYTHROCYTE DISTRIBUTION WIDTH 13.7 % 11.5-14.5 ERYTHROCYTE MEAN

CORPUSCULAR HEMOGLOBIN 30.0 27-34 ERYTHROCYTE MEAN CORPUSCULAR HEMOGLOBIN

CONCENTRATION 33.7 g/dl 32-37 Details

> > > > > ERYTHROCYTES 4.76 M/cmm 4.7-6.1 Details

> > > > > GRANULOCYTES/100 LEUKOCYTES 59.1 % 40-75

> > > > > HEMATOCRIT 42.3 % 40-52 Details

> > > > > HEMOGLOBIN 14.3 g/dl 14-18 Details

> > > > > LEUKOCYTES 6.6 K/cmm 4.5-11.0 Details

> > > > > LYMPHOCYTES/100 LEUKOCYTES 27.0 % 10-55

> > > > > MEAN CORPUSCULAR VOLUME 88.8 fl 80-98 Details

> > > > > MONOCYTES/100 LEUKOCYTES 11.5 % 2-12 Details

> > > > > PLATELET MEAN VOLUME 7.6 fl 7.4-10.4 Details

> > > > > PLATELETS 245 K/cmm 130-450 Details

> > > > >

> > > > > CREATININE 27.15 mg/dL Details

> > > > > PROTEIN <2.6 mg/dL Details

> > > > >

> > > > > APPEARANCE CLEAR Clear Details

> > > > > BILIRUBIN NEG NEG Details

> > > > > COLOR Light-Yellow YELLOW Details

> > > > > GLUCOSE NEG mg/dL NEG Details

> > > > > HEMOGLOBIN NEG NEG Details

> > > > > KETONES NEG mg/dL NEG Details

> > > > > LEUKOCYTES NEG NEG Details

> > > > > NITRITE NEG NEG Details

> > > > > PH 5.0 5-9 Details

> > > > > PROTEIN NEG mg/dL NEG Details

> > > > > SPECIFIC GRAVITY 1.005 Low 1.016-1.022 UROBILINOGEN <2.0 mg/dL ><2.0

Details

> > > > >

> > > > > CHLORIDE (URINE,RANDOM) 140 Details

> > > > > POTASSIUM (URINE,RANDOM) 40.6 Details

> > > > > SODIUM 104 mmol/l Details

> > > > >

> > > > > CORTICOTROPIN 10 pg/mL Details

> > > > >

> > > > > CORTISOL~MORNING 7.29 ug/dL 6-28 Details

> > > > >

> > > > > OSMOLALITY 298 High mOsm/Kg 280-295 Details

> > > > >

> > > > > OSMOLALITY 369 mOsm/kg 50-1400 Details

> > > > >

> > > > > METANEPHRINES <25 pg/mL 0-57 Details

> > > > > METANEPHRINES 117 pg/mL 0-205 Details

> > > > > NORMETANEPHRINE 117 pg/mL 0-148 Details

> > > > >

> > > > > Test Name Result Units Reference Range Test Amended ALDOSTERONE

comment mcg/24hr 2.3-21.0 Details

> > > > >

> > > > > Test Name: ALDOSTERONE

> > > > > Result: comment

> > > > > Units: mcg/24hr

> > > > > Reference Range: 2.3-21.0

> > > > > Lab Test: Aldosterone

> > > > > Ordering Provider: KOLANKIEWICZ, LUIZ

> > > > > Ordering Location: WHITE RIVER JCT VAMROC

> > > > > Performing Location: QUEST 14225 NEWBROOK DRIVE , CHANTILLY, VA 20153

> > > > > Status: Amended

> > > > > Interpretation: Reference Ranges: Random Sodium diet

> > > > > Age_________mcg/24 h

> > > > > _2-_7 years______5.7 or less

> > > > > _8-11 years_____10.2 or less

> > > > > 12-16 years_____15.6 or less

> > > > > _Adults_____2.3-21.0

> > > > > Post Florinef or IV saline suppression____5 mcg/24 h

> > > > > or less

> > > > > Creatinine, 24-Hour Urine

> > > > > Age (yrs)__g/24 hours

> > > > > ___<3_____Not

> > > > > established

> > > > > _3-_8______0.11-0.68

> > > > > _9-12______0.17-1.41

> > > > > 13-17______0.29-1.87

> > > > > _Adults____0.63-2.50

> > > > > Reference Range prior to 11/22/2005 was: 6-25 ug/24 hrs

> > > > > This 24 hr urine range applies to patients on normal salt diet. Low

salt

> > > > > diet: 17-44 ug/24hr. High salt diet: 0-6 ug/24hr

> > > > > Comments: ALDOSTERONE, SERUM= 12 ng/dL

> > > > > REFERENCE RANGE (SERUM): Upright 8:00-10:00am < or = 28ng/dL

> > > > > Upright 4:00-6:00pm < or = 21ng/dL

> > > > > Supine 8:00-10:00am 3-16ng/dL

> > > > > TV=2400 (24 HR URINE COLLECTION)

> > > > > ALDOSTERONE,URINE: 12.7 mcg/24h

> > > > > Test performed at Quest Diag. Lab.

> > > > >

> > > > > CREATININE 1734.48c mg/24hrs 600-2000 Details SPECIMEN VOLUME 2400 ml.

Details

> > > > >

> > > > > What did he miss?

> > > > >

> > > > > - 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

>