Val's story (con't)

[Guest guest]

These are notes from my 2005 excursion into the never, never land of

University of Colorado Endocrinology. At that time, I had exactly the same

symptoms I have had during this most recent episode which began in last

summer - fatigue, HBP, weakness, borderline low K (3.5 - after being on RX K

for two months), borderline low Mg, anxiety, heart irregularities, muscle

pain, insomnia, etc. If essential hypertension has no symptoms, are all of

mine just in my head? If it is essential hypertension, why did my BP fall

20 points on Day 3 of spiro? And 40+ points in less than two months of

spiro? Dr. Grim told me in 2005 that I had PA. Lord, if only I could have

gotten someone to listen! I've had a rough three years. All the following

says to me is that this assistant professor of endocrinology at CU, Leigh

Perreault, was incredibly behind in her reading.

Val

_________________________________________

4/6/05

BP 180/86, HR 96 b/min

Pain location; whole body (muscles)

CU endo's assessment/plan:

The patient has likely endocrine dysfunction with multiple stigmata

consistent with Cushing's disease. Her 24-hour urine free cortisol however

is at the lower limit of normal despite an elevated ACTH level. .. we will

repeat her 24-hour urine test two more times and definitively exclude the

diagnosis of Cushing's disease. We have discussed the possibility of

hyperaldosteronism however her aldosterone to renin ration [abt 21] is not

consistent with this and she also has multiple medical problems that would

not be seen in hyperaldosteronism such as hyperglycemia, insulin resistance,

etc. things that are generally seen in Cushing's disease.

6/17/05

CT scan of the abdomen without contrast

Procedure: A multi-slice axial spiral CT scan of the abdomen was performed

with 5 mm reconstructions.

Impression: Both adrenal glands show normal size and morphology.

7/6/05

BP 160/82, pulse 72

" As she presents to our clinic, she states that she feels like she is

'running at 75%' which she states is typical when she is on LT4. "

Endo assessment/plan

The patient had an ACTH level elevated x1. She also had symptoms consistent

with Cushing's disease. Her Cushing's disease was ruled out by 3 sequential

24-hour urinary free cortisols, all of which were in the normal range. We

also tested her for adrenal insufficiency and she had a very robust ACTH

stimulation test, implying that she also did not have adrenal insufficiency.

She had a borderline aldosterone to renin ratio, which implies she may have

an underlying primary hyperaldosteronism. She had no abnormality identified

on her abdominal CT scan. Thus, together, she has no adrenal pathology.

She simply has primary hypertension, which seems to currently be poorly

controlled on her 1 antihypertensive medication.

2. She has been switched to Vytorin to meet her LDL goal. [groan]

3. The patient has had a relatively stable weight and is unable to tolerate

a higher dose of metformin. She may be a candidate for the addition of a

thiazolidinedione. [groan - been there, done that - 17 lb weight gain]