Re: Test Results in, Dr. says high bp is not caused by adrenal disease. Attn dr grim

[Guest guest]

Hmm what is your story/thumnail? I do not know who you are or what you are.But you have not only borderline low K in some labs would be called low K and very low renin AND very low aldo which is very unusual esp if your were on HCTZ and apresoline which today is a rare combo but I used it extensively before BB, ACEs, ARBs, RI. Possible CausesBad laboratory: ask Dr how often he gets an aldo this low back. Licorice eating-you Dr should have asked you this even before testing.licorice flavored snuff or chewing tobaccoSalt gluttony so why we always do a 24 hr urine for Na, K and creatine and aldo.FH of HTN and/or low K would suggest Liddle's syndrome or AME. If this was done on on a dex suppression test them you have GRA.Did you read my Evolution article yet as these are mentioned? I guess I will be leaving the group, since my endo does not think this is the cause of my problems. Are tests usually right? Blood was drawn at 10:00 a.m. but no return for blood 4 hours later. and No 24 hr. urine was given. Test results were: Potassium: 3.5 Lab range: 3.5-5.2 Sodium : 141 Lab range: 135-145 Renin : .59 Lab range: UPRIGHT 1.31-3.95 (I was upright) SUPINE 0.15-2.33 Aldosterone: <1.0 Lab range: 0.0-30.0 Was wondering if there is any other cause for renin to be low? At the time test was done I was on Hydrochlorithiazide and Hydralazine. I also take diphenhydramine nightly, for sleep.

[Guest guest]

26 years old. Hypertension started during last trimester of pregnancy. was

given IV K 4 times while pregnant. Hospitalized wk. after giving birth with BP

240/140. Over last year lowest K recorded was 2.7. BP normally 140-150/100-110

Do not eat licorice. No family history of high Bp and Low K. Family history of

high BP in grandfather but not at young age.

>

> > I guess I will be leaving the group, since my endo does not think

> > this is the cause of my problems. Are tests usually right? Blood was

> > drawn at 10:00 a.m. but no return for blood 4 hours later. and No 24

> > hr. urine was given. Test results were:

> > Potassium: 3.5 Lab range: 3.5-5.2

> > Sodium : 141 Lab range: 135-145

> > Renin : .59 Lab range: UPRIGHT 1.31-3.95 (I was upright)

> > SUPINE 0.15-2.33

> > Aldosterone: <1.0 Lab range: 0.0-30.0

> >

> > Was wondering if there is any other cause for renin to be low?

> > At the time test was done I was on Hydrochlorithiazide and

> > Hydralazine.

> > I also take diphenhydramine nightly, for sleep.

> >

> >

>

[Guest guest]

In her first posting she states being hospitalized with

blood pressure of 240/140 and has recieved IV potassium. One k test was 2.7.

>

> > I guess I will be leaving the group, since my endo does not think

> > this is the cause of my problems. Are tests usually right? Blood was

> > drawn at 10:00 a.m. but no return for blood 4 hours later. and No 24

> > hr. urine was given. Test results were:

> > Potassium: 3.5 Lab range: 3.5-5.2

> > Sodium : 141 Lab range: 135-145

> > Renin : .59 Lab range: UPRIGHT 1.31-3.95 (I was upright)

> > SUPINE 0.15-2.33

> > Aldosterone: <1.0 Lab range: 0.0-30.0

> >

> > Was wondering if there is any other cause for renin to be low?

> > At the time test was done I was on Hydrochlorithiazide and

> > Hydralazine.

> > I also take diphenhydramine nightly, for sleep.

> >

> >

>

[Guest guest]

Improper handing of blood also cause for bad test results.

>

> > I guess I will be leaving the group, since my endo does not think

> > this is the cause of my problems. Are tests usually right? Blood was

> > drawn at 10:00 a.m. but no return for blood 4 hours later. and No 24

> > hr. urine was given. Test results were:

> > Potassium: 3.5 Lab range: 3.5-5.2

> > Sodium : 141 Lab range: 135-145

> > Renin : .59 Lab range: UPRIGHT 1.31-3.95 (I was upright)

> > SUPINE 0.15-2.33

> > Aldosterone: <1.0 Lab range: 0.0-30.0

> >

> > Was wondering if there is any other cause for renin to be low?

> > At the time test was done I was on Hydrochlorithiazide and

> > Hydralazine.

> > I also take diphenhydramine nightly, for sleep.

> >

> >

>

[Guest guest]

Here's what you got to ask yourself.

1) Do you think you have Refractory hypertension? or is it just plain old

primary hypertension? Is your hypertension uncontrolled by multiple

medications? I see you've listed 2? without the doses btw. Hydrochlorithiazide

,diuretic, can be causing the hypokalemia. You could have plain vanilla primary

hypertension.

2) If you do believe its Refractory, then yeah you've ruled out

hyperaldsteronism but not all adrenal diseases.

Are you Diabetic? If so, get your Cortisol and ATCH levels tested. Again as

with the Aldo, go early in the morning. If both of these are high, that is

indicative of Cushing's Syndrome. Can cause Hypertension along with hypokalemia

in cases of mineralcorticoid activity this is common with ectopic ACTH

secretion.

While your at it you might as well have the other common causes of refractory

hypertension checked out. Namely, Pheochromocytoma and Renal Vein Stenosis.

Your doctor will order blood tests for free metanephrine and a renal doppler to

measure blood flow through the renal vein.

Here's an interesting article on the causes of Hypertension and Hypokalemia.

http://xnet.kp.org/permanentejournal/winter09/hypertension.html

>

> I guess I will be leaving the group, since my endo does not think this is the

cause of my problems. Are tests usually right? Blood was drawn at 10:00 a.m. but

no return for blood 4 hours later. and No 24 hr. urine was given. Test results

were:

> Potassium: 3.5 Lab range: 3.5-5.2

> Sodium : 141 Lab range: 135-145

> Renin : .59 Lab range: UPRIGHT 1.31-3.95 (I was upright)

> SUPINE 0.15-2.33

> Aldosterone: <1.0 Lab range: 0.0-30.0

>

>

> Was wondering if there is any other cause for renin to be low?

> At the time test was done I was on Hydrochlorithiazide and Hydralazine.

> I also take diphenhydramine nightly, for sleep.

>

[Guest guest]

thanks for the reply. I have never been put on more than 2 meds. at once. Been

on about 10 different ones that have failed to bring bp down. Had hypokalemia

before HCTZ. From what I understand people with cushings have a distinct look

and problems with weight gain. So I do not believe that could be the cause. Have

had test for Pheochromocytoma, it was negative. Havent had kidneys looked at as

of yet.

> >

> > I guess I will be leaving the group, since my endo does not think this is

the cause of my problems. Are tests usually right? Blood was drawn at 10:00 a.m.

but no return for blood 4 hours later. and No 24 hr. urine was given. Test

results were:

> > Potassium: 3.5 Lab range: 3.5-5.2

> > Sodium : 141 Lab range: 135-145

> > Renin : .59 Lab range: UPRIGHT 1.31-3.95 (I was upright)

> > SUPINE 0.15-2.33

> > Aldosterone: <1.0 Lab range: 0.0-30.0

> >

> >

> > Was wondering if there is any other cause for renin to be low?

> > At the time test was done I was on Hydrochlorithiazide and Hydralazine.

> > I also take diphenhydramine nightly, for sleep.

> >

>

[Guest guest]

Not likly to be Renal Vein Stenosis based on the low renin.

> > >

> > > I guess I will be leaving the group, since my endo does not think this is

the cause of my problems. Are tests usually right? Blood was drawn at 10:00 a.m.

but no return for blood 4 hours later. and No 24 hr. urine was given. Test

results were:

> > > Potassium: 3.5 Lab range: 3.5-5.2

> > > Sodium : 141 Lab range: 135-145

> > > Renin : .59 Lab range: UPRIGHT 1.31-3.95 (I was upright)

> > > SUPINE 0.15-2.33

> > > Aldosterone: <1.0 Lab range: 0.0-30.0

> > >

> > >

> > > Was wondering if there is any other cause for renin to be low?

> > > At the time test was done I was on Hydrochlorithiazide and Hydralazine.

> > > I also take diphenhydramine nightly, for sleep.

> > >

> >

>

[Guest guest]

There is a even more rare problem that occurs during preg where do u live ?Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

26 years old. Hypertension started during last trimester of pregnancy. was given IV K 4 times while pregnant. Hospitalized wk. after giving birth with BP 240/140. Over last year lowest K recorded was 2.7. BP normally 140-150/100-110 Do not eat licorice. No family history of high Bp and Low K. Family history of high BP in grandfather but not at young age.

>

> > I guess I will be leaving the group, since my endo does not think

> > this is the cause of my problems. Are tests usually right? Blood was

> > drawn at 10:00 a.m. but no return for blood 4 hours later. and No 24

> > hr. urine was given. Test results were:

> > Potassium: 3.5 Lab range: 3.5-5.2

> > Sodium : 141 Lab range: 135-145

> > Renin : .59 Lab range: UPRIGHT 1.31-3.95 (I was upright)

> > SUPINE 0.15-2.33

> > Aldosterone: <1.0 Lab range: 0.0-30.0

> >

> > Was wondering if there is any other cause for renin to be low?

> > At the time test was done I was on Hydrochlorithiazide and

> > Hydralazine.

> > I also take diphenhydramine nightly, for sleep.

> >

> >

>

[Guest guest]

And u expect me to remember all postings for the 600 folks here?Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

In her first posting she states being hospitalized with

blood pressure of 240/140 and has recieved IV potassium. One k test was 2.7.

>

> > I guess I will be leaving the group, since my endo does not think

> > this is the cause of my problems. Are tests usually right? Blood was

> > drawn at 10:00 a.m. but no return for blood 4 hours later. and No 24

> > hr. urine was given. Test results were:

> > Potassium: 3.5 Lab range: 3.5-5.2

> > Sodium : 141 Lab range: 135-145

> > Renin : .59 Lab range: UPRIGHT 1.31-3.95 (I was upright)

> > SUPINE 0.15-2.33

> > Aldosterone: <1.0 Lab range: 0.0-30.0

> >

> > Was wondering if there is any other cause for renin to be low?

> > At the time test was done I was on Hydrochlorithiazide and

> > Hydralazine.

> > I also take diphenhydramine nightly, for sleep.

> >

> >

>

[Guest guest]

Renal vein stenosis does not cause HTN THAT I know of. If her lab tests are correct she has a rare problem. I think it may be better for me to handle this so she does not go down too many false paths. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

Here's what you got to ask yourself.

1) Do you think you have Refractory hypertension? or is it just plain old primary hypertension? Is your hypertension uncontrolled by multiple medications? I see you've listed 2? without the doses btw. Hydrochlorithiazide ,diuretic, can be causing the hypokalemia. You could have plain vanilla primary hypertension.

2) If you do believe its Refractory, then yeah you've ruled out hyperaldsteronism but not all adrenal diseases.

Are you Diabetic? If so, get your Cortisol and ATCH levels tested. Again as with the Aldo, go early in the morning. If both of these are high, that is indicative of Cushing's Syndrome. Can cause Hypertension along with hypokalemia in cases of mineralcorticoid activity this is common with ectopic ACTH secretion.

While your at it you might as well have the other common causes of refractory hypertension checked out. Namely, Pheochromocytoma and Renal Vein Stenosis. Your doctor will order blood tests for free metanephrine and a renal doppler to measure blood flow through the renal vein.

Here's an interesting article on the causes of Hypertension and Hypokalemia.

http://xnet.kp.org/permanentejournal/winter09/hypertension.html

>

> I guess I will be leaving the group, since my endo does not think this is the cause of my problems. Are tests usually right? Blood was drawn at 10:00 a.m. but no return for blood 4 hours later. and No 24 hr. urine was given. Test results were:

> Potassium: 3.5 Lab range: 3.5-5.2

> Sodium : 141 Lab range: 135-145

> Renin : .59 Lab range: UPRIGHT 1.31-3.95 (I was upright)

> SUPINE 0.15-2.33

> Aldosterone: <1.0 Lab range: 0.0-30.0

>

>

> Was wondering if there is any other cause for renin to be low?

> At the time test was done I was on Hydrochlorithiazide and Hydralazine.

> I also take diphenhydramine nightly, for sleep.

>

[Guest guest]

Did HTN MARKEDLY improve after PG?Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

thanks for the reply. I have never been put on more than 2 meds. at once. Been on about 10 different ones that have failed to bring bp down. Had hypokalemia before HCTZ. From what I understand people with cushings have a distinct look and problems with weight gain. So I do not believe that could be the cause. Have had test for Pheochromocytoma, it was negative. Havent had kidneys looked at as of yet.

> >

> > I guess I will be leaving the group, since my endo does not think this is the cause of my problems. Are tests usually right? Blood was drawn at 10:00 a.m. but no return for blood 4 hours later. and No 24 hr. urine was given. Test results were:

> > Potassium: 3.5 Lab range: 3.5-5.2

> > Sodium : 141 Lab range: 135-145

> > Renin : .59 Lab range: UPRIGHT 1.31-3.95 (I was upright)

> > SUPINE 0.15-2.33

> > Aldosterone: <1.0 Lab range: 0.0-30.0

> >

> >

> > Was wondering if there is any other cause for renin to be low?

> > At the time test was done I was on Hydrochlorithiazide and Hydralazine.

> > I also take diphenhydramine nightly, for sleep.

> >

>

[Guest guest]

What combos have u been on? See my file on difficult HTN AND TAke to your team. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

thanks for the reply. I have never been put on more than 2 meds. at once. Been on about 10 different ones that have failed to bring bp down. Had hypokalemia before HCTZ. From what I understand people with cushings have a distinct look and problems with weight gain. So I do not believe that could be the cause. Have had test for Pheochromocytoma, it was negative. Havent had kidneys looked at as of yet.

> >

> > I guess I will be leaving the group, since my endo does not think this is the cause of my problems. Are tests usually right? Blood was drawn at 10:00 a.m. but no return for blood 4 hours later. and No 24 hr. urine was given. Test results were:

> > Potassium: 3.5 Lab range: 3.5-5.2

> > Sodium : 141 Lab range: 135-145

> > Renin : .59 Lab range: UPRIGHT 1.31-3.95 (I was upright)

> > SUPINE 0.15-2.33

> > Aldosterone: <1.0 Lab range: 0.0-30.0

> >

> >

> > Was wondering if there is any other cause for renin to be low?

> > At the time test was done I was on Hydrochlorithiazide and Hydralazine.

> > I also take diphenhydramine nightly, for sleep.

> >

>

[Guest guest]

Dr. Grimm,

I live in North Carolina, between Winston-Salem and Greensboro. BP has actually

been worse after pregnancy. during PG it was just 140/90 at highest, and no HTN

before that. I have been on Nifedipine, Labetelol, Atenolol, Amlodipine,

Losartan,Hydralazine, Chlorithalidone, and HCTZ. and I may be forgetting some...

BP has actually gotten better (but not normal) after coming off of HCTZ, and

most symptoms have dissapeared. Dont know if that is significant or not. My endo

has pretty much written me off, did not make follow up appt. I live near Wake

Forest school of medicine, Do you think it would be worth while to get an appt

there?

> > > >

> > > > I guess I will be leaving the group, since my endo does not think this

is the cause of my problems. Are tests usually right? Blood was drawn at 10:00

a.m. but no return for blood 4 hours later. and No 24 hr. urine was given. Test

results were:

> > > > Potassium: 3.5 Lab range: 3.5-5.2

> > > > Sodium : 141 Lab range: 135-145

> > > > Renin : .59 Lab range: UPRIGHT 1.31-3.95 (I was upright)

> > > > SUPINE 0.15-2.33

> > > > Aldosterone: <1.0 Lab range: 0.0-30.0

> > > >

> > > >

> > > > Was wondering if there is any other cause for renin to be low?

> > > > At the time test was done I was on Hydrochlorithiazide and Hydralazine.

> > > > I also take diphenhydramine nightly, for sleep.

> > > >

> > >

> >

> >

>

[Guest guest]

What I was trying to show is her K and B/P were worse then was intercated by

your reply. of But you have not only borderline low K in some labs would be

called low K.

Seems she was posting her replay at the same time as well. Would agree you need

to be the only one give her advice as she dosen't seem have normal PA.

a

> > >

> > > > I guess I will be leaving the group, since my endo does not think

> > > > this is the cause of my problems. Are tests usually right? Blood was

> > > > drawn at 10:00 a.m. but no return for blood 4 hours later. and No 24

> > > > hr. urine was given. Test results were:

> > > > Potassium: 3.5 Lab range: 3.5-5.2

> > > > Sodium : 141 Lab range: 135-145

> > > > Renin : .59 Lab range: UPRIGHT 1.31-3.95 (I was upright)

> > > > SUPINE 0.15-2.33

> > > > Aldosterone: <1.0 Lab range: 0.0-30.0

> > > >

> > > > Was wondering if there is any other cause for renin to be low?

> > > > At the time test was done I was on Hydrochlorithiazide and

> > > > Hydralazine.

> > > > I also take diphenhydramine nightly, for sleep.

> > > >

> > > >

> > >

> >

> >

>

[Guest guest]

Good and I had forgotten the older posts. Thanks for reminding me.CE Grim MDOn Oct 13, 2011, at 9:00 PM, Francis Bill SUSPECTED PA wrote: What I was trying to show is her K and B/P were worse then was intercated by your reply. of But you have not only borderline low K in some labs would be called low K. Seems she was posting her replay at the same time as well. Would agree you need to be the only one give her advice as she dosen't seem have normal PA. a > > > > > > > I guess I will be leaving the group, since my endo does not think > > > > this is the cause of my problems. Are tests usually right? Blood was > > > > drawn at 10:00 a.m. but no return for blood 4 hours later. and No 24 > > > > hr. urine was given. Test results were: > > > > Potassium: 3.5 Lab range: 3.5-5.2 > > > > Sodium : 141 Lab range: 135-145 > > > > Renin : .59 Lab range: UPRIGHT 1.31-3.95 (I was upright) > > > > SUPINE 0.15-2.33 > > > > Aldosterone: <1.0 Lab range: 0.0-30.0 > > > > > > > > Was wondering if there is any other cause for renin to be low? > > > > At the time test was done I was on Hydrochlorithiazide and > > > > Hydralazine. > > > > I also take diphenhydramine nightly, for sleep. > > > > > > > > > > > > > > > >

[Guest guest]

I think it would best is only Dr Grim and use the heading DIFF.

> > > > > > >

> > > > > > > I guess I will be leaving the group, since my endo does not

> > > think this is the cause of my problems. Are tests usually right?

> > > Blood was drawn at 10:00 a.m. but no return for blood 4 hours later.

> > > and No 24 hr. urine was given. Test results were:

> > > > > > > Potassium: 3.5 Lab range: 3.5-5.2

> > > > > > > Sodium : 141 Lab range: 135-145

> > > > > > > Renin : .59 Lab range: UPRIGHT 1.31-3.95 (I was upright)

> > > > > > > SUPINE 0.15-2.33

> > > > > > > Aldosterone: <1.0 Lab range: 0.0-30.0

> > > > > > >

> > > > > > >

> > > > > > > Was wondering if there is any other cause for renin to be low?

> > > > > > > At the time test was done I was on Hydrochlorithiazide and

> > > Hydralazine.

> > > > > > > I also take diphenhydramine nightly, for sleep.

> > > > > > >

> > > > > >

> > > > >

> > > > >

> > > >

> > >

> > >

> >

>