aldosterone

[Guest guest]

Val

I just googled this info on aldosterone and I must say I think you may well

have something there!

I have been pleased and surprised that my BP has not shot up again. Hand in

hand with this is some dizziness and quite severe fatigue. I had been putting

both of these symptoms down to the BP med but, as I said, I am off it about 10

days now so the finger of suspicion is beginning to point to another cause.

And you may well have hit the nail on the head.

The other unusual thing that has happened (and I don;t know if this points to

anything) is that i increased my Armour by 1/4 grain four days ago and had NO

palps - I ALWAYS have pals which is why I have been raising by 1/8th

increments. It is a long time since I did a one quarter raise and ZILCH. This is

very

unusual so I am scratching my head trying to put all of this together.

How much more salt do you think I should take.

And the test, is that a saliva one?

Thanks.

Mo

The Importance of the Adrenal Cortex Hormones Cortisol and Aldosterone

By Dr.Ted Friedman, M.D. Ph.D.

The adrenals, small glands located above each kidney, produce a number of

important

hormones. The adrenals' inner medulla produces epinephrine and

norepinephrine (adrenaline). The adrenals also contain an outer cortex, which

produces

hormones such as cortisol, aldosterone, testosterone, DHEA, DHEAS,

androstenedione and estrogens.

Cortisol and aldosterone are two of the most important hormones the body

makes. Excesses or deficiencies of these hormones result in important clinical

problems. Cortisol, a glucocorticoid, is the stress hormone and is involved in

weight control, infection fighting, quality of skin and bones, and heart

function. Its levels are the highest in the morning, and are increased by stress

and

severe illness. Too much cortisol from any cause leads to Cushing's syndrome;

the symptoms and signs of which include redistribution of fat to the face,

upper back and abdomen, weight gain, stretch marks, bruising, extra hair growth,

irregular periods in women, loss of muscle, trouble sleeping and emotional

problems, such as depression. Too little cortisol is part of the syndrome called

's disease, often marked by low energy, joint and abdominal pain,

weight loss, diarrhea, fever, and electrolyte disturbances. If the adrenals are

making too little cortisol, the pituitary compensates and makes more of the

hormone, ACTH. If the pituitary is not working, both ACTH and cortisol levels

may

be low.

Aldosterone is the salt-retaining hormone and is a mineralocorticoid.

Excesses of aldosterone leads to high blood pressure and low potassium.

Deficiencies

of aldosterone are much less appreciated than deficiencies of cortisol, and

lead to low blood pressure and high pulse, especially on standing, the desire

to eat salt (salt-craving), dizziness or lightheadedness on standing, and

palpitations. Severe cases may lead to high potassium and low sodium in blood

tests. When the adrenal is not making aldosterone, renin, a kidney hormone,

increases. Excesses of cortisol and aldosterone may occur independently, that is

a

patient may have only excess aldosterone, only excess cortisol, or excesses of

both. Similarly, deficiencies of cortisol and aldosterone deficiencies may be

independent.

Many patients with symptoms of fatigue and often salt-craving, " cognitive

fuzziness " , dizziness or lightheadedness on standing, or palpitations have low

blood levels of aldosterone. The connection between low aldosterone levels and

fatigue is as follows: with low aldosterone, the kidney loses salt, leading to

low blood volume. This coupled with the idea that the leg veins don't

constrict properly, leads to lower blood volume to the brain and fatigue and

other

symptoms. These patients often have a drop in their

blood pressure and an increase in their pulse when standing. They may also

have decreased blood flow to the brain when measured by SPECT scan. Aldosterone

deficiency may be made worse if patients restrict their salt intake.

Soon-to-be-published research (Friedman, T., et al., in preparation) shows a

few patterns of abnormalities in the renin-aldosterone axis. A little more

than half the patients with fatigue had low blood levels of both renin and

aldosterone. This is called hyporeninemic hypoaldosteronism and is probably due

to

dysfunction of what is called the autonomic nervous system, which sends

messages from the brain to the kidneys. Other aspects of the autonomic nervous

system have been found to be deficient in chronic fatigue syndrome. About

one-third

of the patients studied were found to have low aldosterone and high renin.

This indicates a deficiency in the aldosterone production in the adrenals

themselves, with a compensatory rise in the renin coming from the kidney. The

aldosterone defect can either be an isolated problem, or part of 's

disease

(often early 's disease), in which both cortisol and aldosterone

production are diminished. The remaining patients (about one-sixth) had both

high

renin and high aldosterone. This is likely to be a compensatory rise in both of

these hormones as a reaction to a low blood volume, most likely due to an

inability of the kidney to retain salt.

Treatment of patients with such symptoms requires an individualized

combination of increased salt consumption, a synthetic form of aldosterone

called

Florinef (fludrocortisone), or Midodrine (proamantine), a drug used to raise

blood

pressure. Salt is the most benign of the treatments. Salt tablets can be

purchased in a drug store or a patient can add an extra teaspoon of salt to

their

food per day. Florinef comes in 0.1 mg pills and the usual recommended

starting dose is 1/2 pill in the morning for a week or two. If no side effects

occur, the dose can be increased to 1 pill in the morning if needed. The main

side effects are headache and swelling in legs (edema). Midodrine comes in 5 mg

pills and Dr. Friedman usually starts with one 5 mg pill in the morning and

another at noon. This may be increased up to 2 pills three times a day.

Sometimes both Florinef and Midodrine, as well as extra salt are needed. The

side

effects of Midodrine include high blood pressure, itching, goosebumps, numbness

and the feeling of writing on your skin or scalp. Many of these side effects

go away with use and both drugs are unlikely to cause long term damage. Most

patients taking Florinef and Midodrine, as well as extra salt report an

improvement in their symptoms of palpitations and dizziness/lightheadedness on

standing, and many report an improvement in fatigue and cognitive dysfunction.

Licorice, available as a tea from Alvita, may help with mild cases.

Editor's Note: Dr. Friedman is Associate Professor of Medicine-UCLA,

Endocrinology Division, R. Drew University in Los Angeles, CA. Dr.

Friedman

has ongoing clinical research studies on the renin-aldosterone axis in

chronic fatigue syndrome (CFS) and testosterone replacement in hypopituitary

women.

He also has a private clinic in Los Angeles where he sees patients with

pituitary, adrenal and thyroid disorders. More information about enrolling in

these

studies or seeing Dr. Friedman in clinic can be obtained by visiting Dr.

Friedman's web site (www.goodhormonehealth.com), emailing

mail@..., or calling .

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