Re: Post-Surgery Care

[Guest guest]

Suggest you go to our files and read the file " Stowasser et al PA Review.pdf "

Lab Investigastion of PA (Stowasser et al) while you wait for Dr. G. to check

in. I think page 12 or 13 tells you what needs to be done after surgery but Dr.

Grim might have more.

I would take Dr. Grim's evolution of PA article to your internist, if you

haven't already, along with this article and get him up to speed.

>

> I am having an adrenalectomy in less that 2 weeks due to finally being

diagnosed with hyperaldosteronism. I am looking for information regarding

post-surgery care. What testing will need to be done and when? And most of all

who do I need to see about this - I have an internist and a cardiologist (my

heart was damaged due to the long period of symptoms requiring surgery 2 years

ago.) Although I saw 3 endocrinologists over 15 years, it was a nephrolgist who

finally diagnosed this in January. The nephrologist is leaving the area and

will not be available for followup care. I live in a rural area and my internist

is generally good at working with other specialists - my cardiologist recognized

the symptoms but was as frustrated as I was about the inability to diagnose the

problem.

> Should I request a referral from the surgeon (in a metropolitan area) for a

referral to someone to follow this after the surgery or hope my internist can

handle this? Who should it be - endocrinologist or nephrologist? And what type

of questions should I ask and what type of treatment should I expect following

surgery?

> Any help and any tips on the recovery process would be appreciated

>

[Guest guest]

Before we can tell you what you need to do we need to know more information. How

old are you? Did they do Adrenal vein sampling? What meds are you on? How did DX

your PA?

>

> I am having an adrenalectomy in less that 2 weeks due to finally being

diagnosed with hyperaldosteronism. I am looking for information regarding

post-surgery care. What testing will need to be done and when? And most of all

who do I need to see about this - I have an internist and a cardiologist (my

heart was damaged due to the long period of symptoms requiring surgery 2 years

ago.) Although I saw 3 endocrinologists over 15 years, it was a nephrolgist who

finally diagnosed this in January. The nephrologist is leaving the area and

will not be available for followup care. I live in a rural area and my internist

is generally good at working with other specialists - my cardiologist recognized

the symptoms but was as frustrated as I was about the inability to diagnose the

problem.

> Should I request a referral from the surgeon (in a metropolitan area) for a

referral to someone to follow this after the surgery or hope my internist can

handle this? Who should it be - endocrinologist or nephrologist? And what type

of questions should I ask and what type of treatment should I expect following

surgery?

> Any help and any tips on the recovery process would be appreciated

>

[Guest guest]

Thank you

[Guest guest]

My post-adrenalectomy care was pretty limited - throughout my diagnosis the main

doctor on my case was a nephrologist. He monitored my BP and potassium weekly

for about 3 weeks after the surgery, but beyond that there wasn't a lot of other

followup. Directly after the adrenalectomy my aldo/renin/K were checked in the

hospital; all were in normal range and I haven't had aldo or renin checked

since. As for monitoring the surgical site itself, the surgeon saw me two weeks

after the surgery, removed the " glue " that held everything together, and

pronounced me both cured and healed.

After all the testing and appointments during the year following my diagnosis,

this seemed pretty anticlimactic! No monitoring, nothing " special " that needs to

be done. When I asked my primary care doctor what, if anything, I needed to do

for follow-up, his response was " Nothing! Just live your life. "

Here's hoping your surgery is as easy as mine was. Best of luck to you!

-msmith1928

Successful left laparoscopic adrenalectomy 10/13/11

>

> I am having an adrenalectomy in less that 2 weeks due to finally being

diagnosed with hyperaldosteronism. I am looking for information regarding

post-surgery care. What testing will need to be done and when? And most of all

who do I need to see about this - I have an internist and a cardiologist (my

heart was damaged due to the long period of symptoms requiring surgery 2 years

ago.) Although I saw 3 endocrinologists over 15 years, it was a nephrolgist who

finally diagnosed this in January. The nephrologist is leaving the area and

will not be available for followup care. I live in a rural area and my internist

is generally good at working with other specialists - my cardiologist recognized

the symptoms but was as frustrated as I was about the inability to diagnose the

problem.

> Should I request a referral from the surgeon (in a metropolitan area) for a

referral to someone to follow this after the surgery or hope my internist can

handle this? Who should it be - endocrinologist or nephrologist? And what type

of questions should I ask and what type of treatment should I expect following

surgery?

> Any help and any tips on the recovery process would be appreciated

>

[Guest guest]

Brief History -

Age 49 - I have been having symptoms for at least 15 years. Began with sudden

on-set hypertension. 1st internist refused to test for PA when I requested

because " we don't need to chase zebras " . Hypertension would alternate between

states of control and episodes of instability. 2 cm Adrenal adenoma discovered

in 2006. Sent to first endo tested for Cushings results inconclusive - treated

with metformin for PCOS despite lack of results to indicate same (I now know).

Blood pressure continued with periods of instability. Developed periods of

extreme fatigue and muscle pain and weakness along with tachycardia. 2010 heart

attack and flash pulmonary edema during heart cath followed by emergency CABG.

Good recovery for 2 months. Sudden collapse during cardiac rehab and began

episodes of unstable blood pressure, tachycardia, fatigue and muscle weakness.

Since 2010 I have been on at least 10 different BP meds - testing during these

periods has revealed nothing conclusive. As these periods resolved I would

reach a state of over medication. 2nd Endo seen in 2010 screened for PA with

inconclusive results.

January 2011 I was referred to nephrologist during my second bout with Kidney

stones. Revealed a state of acidosis. 6 month follow-up normal aldosterone

levels. 1 year follow-up very high plasma level of aldosterone. AVS revealed

extremely high levels of Aldosterone but did not have good results on one

adrenal. 2nd AVS - successful on both adrenals- shows functioning adenoma.

Will have left adrenalectomy March 23rd.

Have been in a period of unstable blood pressure, tachycardia, extreme fatigue,

weakness since December 2011 - This has been an episodic debilitating problem

that I feel was finally caught by chance.

Current BP meds - Bystolic 10 mg, Digoxin .25 mg, Spironilactone 100 mg

other meds - Byetta 10 mg x2, Cymbalta 120 mg, deplin 7.5 mg

[Guest guest]

Thank you - I hope that live your life is the post-op prescription I get. I

live in such a rural area that there are few specialists even in the nearest

city - I just want to make sure nothing else is missed. - I posted above the

short version of my medical history - I diagnosed myself about 10 years ago but

have just now gotten the DRS to agree - with the exception of my cardiologist

who recognized all the symptoms but could never get the labs to confirm.

[Guest guest]

Let me add that while rural makes the driving distance harder, getting to see specialists is hard no matter where you live and isn't always easy when they're closer. And finding one you like is a plight we all share, rural, urban, suburban, rich or poor.

From: lk.barns <lk.barns@...>Subject: Re: Post-Surgery Carehyperaldosteronism Date: Wednesday, March 14, 2012, 12:29 PM

Thank you - I hope that live your life is the post-op prescription I get. I live in such a rural area that there are few specialists even in the nearest city - I just want to make sure nothing else is missed. - I posted above the short version of my medical history - I diagnosed myself about 10 years ago but have just now gotten the DRS to agree - with the exception of my cardiologist who recognized all the symptoms but could never get the labs to confirm.

[Guest guest]

My post Adx care was limited as well, but my K was still a little low in the

hospital, so I had it checked a few times. It's normal now. I saw the surgeon a

few weeks after my surgery & he gave me a copy of the path report (7 mm

nonmalignant cortical tumor). I saw my endo a week or so later, & she released

from her care, except she wanted my cortisol checked when I had my blood taken

@the end of Nov. (6 weeks after the appt.). I am now under care of nephro, who

had my aldo & renin checked plus 24 hr urine at my request. My BP is still not

ideal, but seems to be lowering. I am tracking BP daily & eating low salt,

which helps. I will repeat the tests in late May & see nephro in early June.

Lucy Sage - 59 yrs old. CT showed 7 mm adenoma in left adrenal. AVS showed aldo

lateralized on left side. Adx on 9/18/11

Please forgive brevity & typos

Sent from my droid

msmith_1928 <janeray1940@...> wrote:

>My post-adrenalectomy care was pretty limited - throughout my diagnosis the

main doctor on my case was a nephrologist. He monitored my BP and potassium

weekly for about 3 weeks after the surgery, but beyond that there wasn't a lot

of other followup. Directly after the adrenalectomy my aldo/renin/K were checked

in the hospital; all were in normal range and I haven't had aldo or renin

checked since. As for monitoring the surgical site itself, the surgeon saw me

two weeks after the surgery, removed the " glue " that held everything together,

and pronounced me both cured and healed.

>

>After all the testing and appointments during the year following my diagnosis,

this seemed pretty anticlimactic! No monitoring, nothing " special " that needs to

be done. When I asked my primary care doctor what, if anything, I needed to do

for follow-up, his response was " Nothing! Just live your life. "

>

>Here's hoping your surgery is as easy as mine was. Best of luck to you!

>

>-msmith1928

>Successful left laparoscopic adrenalectomy 10/13/11

>

>

>>

>> I am having an adrenalectomy in less that 2 weeks due to finally being

diagnosed with hyperaldosteronism. I am looking for information regarding

post-surgery care. What testing will need to be done and when? And most of all

who do I need to see about this - I have an internist and a cardiologist (my

heart was damaged due to the long period of symptoms requiring surgery 2 years

ago.) Although I saw 3 endocrinologists over 15 years, it was a nephrolgist who

finally diagnosed this in January. The nephrologist is leaving the area and

will not be available for followup care. I live in a rural area and my internist

is generally good at working with other specialists - my cardiologist recognized

the symptoms but was as frustrated as I was about the inability to diagnose the

problem.

>> Should I request a referral from the surgeon (in a metropolitan area) for a

referral to someone to follow this after the surgery or hope my internist can

handle this? Who should it be - endocrinologist or nephrologist? And what type

of questions should I ask and what type of treatment should I expect following

surgery?

>> Any help and any tips on the recovery process would be appreciated

>>

>

>

[Guest guest]

Ah yes and I would print it out and take to your team. I am still available for one on one help which may be better that a published one if there are problems a day or two after surgery. Remind us how your team knows that ADX will help?CE GrimOn Mar 13, 2012, at 8:53 PM, wrote: Suggest you go to our files and read the file "Stowasser et al PA Review.pdf" Lab Investigastion of PA (Stowasser et al) while you wait for Dr. G. to check in. I think page 12 or 13 tells you what needs to be done after surgery but Dr. Grim might have more. I would take Dr. Grim's evolution of PA article to your internist, if you haven't already, along with this article and get him up to speed. > > I am having an adrenalectomy in less that 2 weeks due to finally being diagnosed with hyperaldosteronism. I am looking for information regarding post-surgery care. What testing will need to be done and when? And most of all who do I need to see about this - I have an internist and a cardiologist (my heart was damaged due to the long period of symptoms requiring surgery 2 years ago.) Although I saw 3 endocrinologists over 15 years, it was a nephrolgist who finally diagnosed this in January. The nephrologist is leaving the area and will not be available for followup care. I live in a rural area and my internist is generally good at working with other specialists - my cardiologist recognized the symptoms but was as frustrated as I was about the inability to diagnose the problem. > Should I request a referral from the surgeon (in a metropolitan area) for a referral to someone to follow this after the surgery or hope my internist can handle this? Who should it be - endocrinologist or nephrologist? And what type of questions should I ask and what type of treatment should I expect following surgery? > Any help and any tips on the recovery process would be appreciated >

[Guest guest]

On Mar 14, 2012, at 9:43 AM, msmith_1928 wrote: My post-adrenalectomy care was pretty limited - throughout my diagnosis the main doctor on my case was a nephrologist. He monitored my BP and potassium weekly for about 3 weeks after the surgery, but beyond that there wasn't a lot of other followup. Directly after the adrenalectomy my aldo/renin/K were checked in the hospital; all were in normal range and I haven't had aldo or renin checked since. As for monitoring the surgical site itself, the surgeon saw me two weeks after the surgery, removed the "glue" that held everything together, and pronounced me both cured and healed.And we wonder why surgery cure rates are so high. But other long term studies are not so high.But my hunch is that ms is a cure.Only time will tell.In the old days we always covered everyone with cortisol before and after the surgery as we did not know if we were only going to take out one or two till we looked at them both.Also the surgery was much bigger at that time. Went in thru the back below both ribs to "look" at each adrenal. Or thru the front depending on the surgeon.CE Grim MD After all the testing and appointments during the year following my diagnosis, this seemed pretty anticlimactic! No monitoring, nothing "special" that needs to be done. When I asked my primary care doctor what, if anything, I needed to do for follow-up, his response was "Nothing! Just live your life." Here's hoping your surgery is as easy as mine was. Best of luck to you! -msmith1928 Successful left laparoscopic adrenalectomy 10/13/11 > > I am having an adrenalectomy in less that 2 weeks due to finally being diagnosed with hyperaldosteronism. I am looking for information regarding post-surgery care. What testing will need to be done and when? And most of all who do I need to see about this - I have an internist and a cardiologist (my heart was damaged due to the long period of symptoms requiring surgery 2 years ago.) Although I saw 3 endocrinologists over 15 years, it was a nephrolgist who finally diagnosed this in January. The nephrologist is leaving the area and will not be available for followup care. I live in a rural area and my internist is generally good at working with other specialists - my cardiologist recognized the symptoms but was as frustrated as I was about the inability to diagnose the problem. > Should I request a referral from the surgeon (in a metropolitan area) for a referral to someone to follow this after the surgery or hope my internist can handle this? Who should it be - endocrinologist or nephrologist? And what type of questions should I ask and what type of treatment should I expect following surgery? > Any help and any tips on the recovery process would be appreciated >

[Guest guest]

Dr. Grimm - copied history from another post and have listed lab results

plasma aldosterone - 103.0

1st avs left adrenal - 1398.4

2nd avs left adrenal - over 1300 (do not have exact number)

1st avs right adrenal - invalid result

2nd avs right adrenal - within normal limits

Brief History -

Age 49 - I have been having symptoms for at least 15 years. Began with sudden

on-set hypertension. 1st internist refused to test for PA when I requested

because " we don't need to chase zebras " . Hypertension would alternate between

states of control and episodes of instability. 2 cm Adrenal adenoma discovered

in 2006. Sent to first endo tested for Cushings results inconclusive - treated

with metformin for PCOS despite lack of results to indicate same (I now know).

Blood pressure continued with periods of instability. Developed periods of

extreme fatigue and muscle pain and weakness along with tachycardia. 2010 heart

attack and flash pulmonary edema during heart cath followed by emergency CABG.

Good recovery for 2 months. Sudden collapse during cardiac rehab and began

episodes of unstable blood pressure, tachycardia, fatigue and muscle weakness.

Since 2010 I have been on at least 10 different BP meds - testing during these

periods has revealed nothing conclusive. As these periods resolved I would

reach a state of over medication. 2nd Endo seen in 2010 screened for PA with

inconclusive results.

January 2011 I was referred to nephrologist during my second bout with Kidney

stones. Revealed a state of acidosis. 6 month follow-up normal aldosterone

levels. 1 year follow-up very high plasma level of aldosterone. AVS revealed

extremely high levels of Aldosterone but did not have good results on one

adrenal. 2nd AVS - successful on both adrenals- shows functioning adenoma.

Will have left adrenalectomy March 23rd.

Have been in a period of unstable blood pressure, tachycardia, extreme fatigue,

weakness since December 2011 - This has been an episodic debilitating problem

that I feel was finally caught by chance.

Current BP meds - Bystolic 10 mg, Digoxin .25 mg, Spironilactone 100 mg

other meds - Byetta 10 mg x2, Cymbalta 120 mg, deplin 7.5 mg

[Guest guest]

Dr. Grim

Apparently I've been finding information from the " old days " regarding cortisol

pre/post op. My surgeon indicated that I would not need cortisol replacement if

all goes as planned. Happy to see your post above that automatic cortisol dosing

is not the standard now.

[Guest guest]

My husband had right adrenalectomy last Wednesday following a conclusive AVS which indicated extremely high aldosterone levels. Following surgery his BP immediately returned to the normal range. In the hospital everything was in the normal range. However, two days later it shot back up again to pre-surgery hypertensive levels. It has been fluctuating only a little bit. The post-surgery pathology revealed a functioning adenoma on the gland removed and the blood work revealed normal aldosterone levels.

Has anyone experienced a period of adjustment following the adrenalectomy before BP returns to a normal range?Thanks.-- Cate Roman, MFAArtistwww.cateroman.com

“It's not what you look at that matters, it's what you see.”                                                                                Henry Thoreau

[Guest guest]

Thanks for your LK's story: I have some comments. On Mar 14, 2012, at 10:20 AM, lk.barns wrote: Brief History - Age 49 - I have been having symptoms for at least 15 years. Began with sudden on-set hypertension. 1st internist refused to test for PA when I requested because "we don't need to chase zebras". Curious as to why you wanted to be tested early on? Sudden onset itself is a good reason. Low K is a dead (in your case nearly) give away.Sudden onset HTN is almost a Zebra. HTN and low K is a zebra. I would send all of your prior team your "story" and my article on the evolution of PA and why it is so common in drug resistant HTN.Hypertension would alternate between states of control and episodes of instability. 2 cm Adrenal adenoma discovered in 2006. Adrenal adenomas causing Cushing's are zebras and really rare in the HTN population. Unless you look Cushingoid. Even then they are prob 1000 times less common that Conn's. Sent to first endo tested for Cushings results inconclusive - treated with metformin for PCOS despite lack of results to indicate same (I now know). Blood pressure continued with periods of instability. Developed periods of extreme fatigue and muscle pain and weakness along with tachycardia. 2010 heart attack and flash pulmonary edema during heart cath followed by emergency CABG. Flash pulmonary edema is usually due to severe uncontrolled HTN-can be in PA but more common in Renal Artery Stenosis.Good recovery for 2 months. Sudden collapse during cardiac rehab and began episodes of unstable blood pressure, tachycardia, fatigue and muscle weakness. Since 2010 I have been on at least 10 different BP meds - testing during these periods has revealed nothing conclusive. As these periods resolved I would reach a state of over medication. 2nd Endo seen in 2010 screened for PA with inconclusive results. Bet they tested you on drugs and did not do a 24 hr urine on the same day. January 2011 I was referred to nephrologist during my second bout with Kidney stones. Revealed a state of acidosis. 6 month follow-up normal aldosterone levels. 1 year follow-up very high plasma level of aldosterone. Fiddling for 1 year? Shame on them. AVS revealed extremely high levels of Aldosterone but did not have good results on one adrenal. 2nd AVS - successful on both adrenals- shows functioning adenoma. Will have left adrenalectomy March 23rd.Recommend you send us the numbers for the AVS as some do not interpret them correctly. We have a form in our files that you can put them in to standardize presentation and analysis. Have been in a period of unstable blood pressure, tachycardia, extreme fatigue, weakness since December 2011 - This has been an episodic debilitating problem that I feel was finally caught by chance.Has no one suggested a low sodium diet or DASH???What is K doing? low K and digoxin is a dangerous combo. Most do not use dig much anymore but your team knows you best. Bystolic will not work well in PA if given for BP. Current BP meds - Bystolic 10 mg, Digoxin .25 mg, Spironilactone 100 mg other meds - Byetta 10 mg x2, Cymbalta 120 mg, deplin 7.5 mgneed for Byetta will prob go away as K is corrected after surgery but should be better now if K and spiro working. Any episodes of low blood sugar? If not test whenn you are feeling weak. If low call team now and ask about stopping Byetta. CE Grim MD

[Guest guest]

Thanks for your input. So you had HTN and low K for 5 years before your own self Dx?Please go to our database and enter as much info as you have.See below.On Mar 14, 2012, at 10:29 AM, lk.barns wrote: Thank you - I hope that live your life is the post-op prescription I get. I live in such a rural area that there are few specialists even in the nearest city - I just want to make sure nothing else is missed. - I posted above the short version of my medical history - I diagnosed myself about 10 years ago but have just now gotten the DRS to agree - with the exception of my cardiologist who recognized all the symptoms but could never get the labs to confirm.If one cannot get the blood tests I recommend a trial of the measuring home BP, DASHing and/or spironolactone (but better both) and stepping down other meds. If all becomes normal again then no good reason to test further IMHO unless side effects appear. Then do eplerenone.

[Guest guest]

Thanks for your input. So you had HTN and low K for 5 years before your own self Dx?Please go to our database and enter as much info as you have.See below.On Mar 14, 2012, at 10:29 AM, lk.barns wrote: Thank you - I hope that live your life is the post-op prescription I get. I live in such a rural area that there are few specialists even in the nearest city - I just want to make sure nothing else is missed. - I posted above the short version of my medical history - I diagnosed myself about 10 years ago but have just now gotten the DRS to agree - with the exception of my cardiologist who recognized all the symptoms but could never get the labs to confirm.If one cannot get the blood tests I recommend a trial of the measuring home BP, DASHing and/or spironolactone (but better both) and stepping down other meds. If all becomes normal again then no good reason to test further IMHO unless side effects appear. Then do eplerenone.

[Guest guest]

Thanks for the excellent update Lucy.When you have time please send the 24 hr urine Na, K and renin and aldo numbers and the normal values for your lab. How and with what are you taking your BP at home?As this is the best guide to Dx and Rx what is going on for the BP it is critical to be sure it is being done with the best standardization and accuracy.Keep DASHing for now.CE Grim MDOn Mar 14, 2012, at 12:52 PM, Lucy Sage wrote: My post Adx care was limited as well, but my K was still a little low in the hospital, so I had it checked a few times. It's normal now. I saw the surgeon a few weeks after my surgery & he gave me a copy of the path report (7 mm nonmalignant cortical tumor). I saw my endo a week or so later, & she released from her care, except she wanted my cortisol checked when I had my blood taken @the end of Nov. (6 weeks after the appt.). I am now under care of nephro, who had my aldo & renin checked plus 24 hr urine at my request. My BP is still not ideal, but seems to be lowering. I am tracking BP daily & eating low salt, which helps. I will repeat the tests in late May & see nephro in early June. Lucy Sage - 59 yrs old. CT showed 7 mm adenoma in left adrenal. AVS showed aldo lateralized on left side. Adx on 9/18/11 Please forgive brevity & typos Sent from my droid msmith_1928 <janeray1940@...> wrote: >My post-adrenalectomy care was pretty limited - throughout my diagnosis the main doctor on my case was a nephrologist. He monitored my BP and potassium weekly for about 3 weeks after the surgery, but beyond that there wasn't a lot of other followup. Directly after the adrenalectomy my aldo/renin/K were checked in the hospital; all were in normal range and I haven't had aldo or renin checked since. As for monitoring the surgical site itself, the surgeon saw me two weeks after the surgery, removed the "glue" that held everything together, and pronounced me both cured and healed. > >After all the testing and appointments during the year following my diagnosis, this seemed pretty anticlimactic! No monitoring, nothing "special" that needs to be done. When I asked my primary care doctor what, if anything, I needed to do for follow-up, his response was "Nothing! Just live your life." > >Here's hoping your surgery is as easy as mine was. Best of luck to you! > >-msmith1928 >Successful left laparoscopic adrenalectomy 10/13/11 > > >> >> I am having an adrenalectomy in less that 2 weeks due to finally being diagnosed with hyperaldosteronism. I am looking for information regarding post-surgery care. What testing will need to be done and when? And most of all who do I need to see about this - I have an internist and a cardiologist (my heart was damaged due to the long period of symptoms requiring surgery 2 years ago.) Although I saw 3 endocrinologists over 15 years, it was a nephrolgist who finally diagnosed this in January. The nephrologist is leaving the area and will not be available for followup care. I live in a rural area and my internist is generally good at working with other specialists - my cardiologist recognized the symptoms but was as frustrated as I was about the inability to diagnose the problem. >> Should I request a referral from the surgeon (in a metropolitan area) for a referral to someone to follow this after the surgery or hope my internist can handle this? Who should it be - endocrinologist or nephrologist? And what type of questions should I ask and what type of treatment should I expect following surgery? >> Any help and any tips on the recovery process would be appreciated >> > >

[Guest guest]

Yes. But do not have enough infor to comment on.Such as age, ethnicity, renal function, type of surgery, blood loss with surgery, is the device they are using accurate on him. Is BP the same in both arms?What meds is he on? What was he on before surgery and how were the stopped?Was he on low salt diet before surgery.How is K?Is his pain being controlled adequately?To mention a few.CE Grim MD On Mar 14, 2012, at 5:26 PM, cate roman wrote: My husband had right adrenalectomy last Wednesday following a conclusive AVS which indicated extremely high aldosterone levels. Following surgery his BP immediately returned to the normal range. In the hospital everything was in the normal range. However, two days later it shot back up again to pre-surgery hypertensive levels. It has been fluctuating only a little bit. The post-surgery pathology revealed a functioning adenoma on the gland removed and the blood work revealed normal aldosterone levels. Has anyone experienced a period of adjustment following the adrenalectomy before BP returns to a normal range?Thanks.-- Cate Roman, MFAArtistwww.cateroman.com “It's not what you look at that matters, it's what you see.” Henry Thoreau

[Guest guest]

Hi Cate - yes, this happened to me the first few days home from the

hospital. Pre-adrenalectomy my BP averaged low 140s/90s (unmedicated);

in the hospital almost immediately after surgery my BP dropped to

110s/70s IIRC. Then when I came home I started getting readings of high

130s/80s. I checked my BP pretty obsessively during those first few days

and found that it fluctuated quite a bit throughout the day. After about

a week had passed I started getting more consistent low 120s/high 70s

readings, and that's where I've remained ever since.

-msmith1928

Successful left laparoscopic adrenalectomy 10/13/11

>

> My husband had right adrenalectomy last Wednesday following a

conclusive

> AVS which indicated extremely high aldosterone levels. Following

surgery

> his BP immediately returned to the normal range. In the hospital

everything

> was in the normal range. However, two days later it shot back up again

to

> pre-surgery hypertensive levels. It has been fluctuating only a little

bit.

> The post-surgery pathology revealed a functioning adenoma on the gland

> removed and the blood work revealed normal aldosterone levels.

>

> Has anyone experienced a period of adjustment following the

adrenalectomy

> before BP returns to a normal range?

>

> Thanks.

>

>

> --

> Cate Roman, MFA

> Artist

>

> www.cateroman.com

>

> " It's not what you look at that matters, it's what you see. "

> Henry Thoreau

>

[Guest guest]

Thanks for responding so quickly.Here are the answers to your questions:He is a 57 year old, 12-year colon cancer survivor with a permanent ileostomy and a post-cancer Ironman triathlete.Armenian decent. Born in Los Angeles CA.

Normal and healthy renal function.Pre-surgery CT scan indicated a 13mm nodule on left adrenal. However, AVS determined high aldosterone levels ONLY on the right adrenal. Docs concluded left adrenal nodule was none functioning as all levels where in the normal range.

Laproscopic right adrenalectomy with minor blood loss. Pathology confirmed a microscopic aldostronoma.BP cuff is accurate to +/- 3 points.BP varies less than 5 points between arms.He is currently on no medications, but prior to surgery was taking 5 mg Bystolic per day.

He took his final Bystolic the day before surgery and medication was not restarted.While on Bystolic pre-surgery BP range between 150-160/90-100.For two days, immediately post surgery BP was around 120/65.Then it suddenly (within a few hours) went to 160/100. The nurses began to monitor it every two hours where it consistently stayed above 150/90 until discharge later that evening.

Surgery was March 7th. He came home on March 9th. We take his BP in the afternoon, resting, left arm, same cuff. Here's are the readings:March 10th 154/95March 11th 148/90March 12th 133/92March 13th 137/87

March 14th 148/91Low-salt diet had been observed for 4 months prior. He is a healthy weight.We don't have K values.His pain is now low and he manages it with 400 mg Advil 2 x a day.Would love to hear your thoughts about whether this could be an adjustment period or ?

Thanks again,CateOn Wed, Mar 14, 2012 at 7:47 PM, Clarence Grim <lowerbp2@...> wrote:

 

Yes. But do not have enough infor to comment on.Such as age, ethnicity, renal function, type of surgery, blood loss with surgery, is the device they are using accurate on him.  Is BP the same in both arms?

What meds is he on? What was he on before surgery and how were the stopped?Was he on low salt diet before surgery.How is K?

Is his pain being controlled adequately?To mention a few.CE Grim MD On Mar 14, 2012, at 5:26 PM, cate roman wrote:

  My husband had right adrenalectomy last Wednesday following a conclusive AVS which indicated extremely high aldosterone levels. Following surgery his BP immediately returned to the normal range. In the hospital everything was in the normal range. However, two days later it shot back up again to pre-surgery hypertensive levels. It has been fluctuating only a little bit. The post-surgery pathology revealed a functioning adenoma on the gland removed and the blood work revealed normal aldosterone levels.

Has anyone experienced a period of adjustment following the adrenalectomy before BP returns to a normal range?Thanks.-- Cate Roman, MFAArtistwww.cateroman.com

“It's not what you look at that matters, it's what you see.”                                                                                Henry Thoreau

-- Cate Roman, MFAArtistwww.cateroman.com“It's not what you look at that matters, it's what you see.”

                                                                                Henry Thoreau

[Guest guest]

Thank you that is very encouraging.

[Guest guest]

Most will not need. But team needs to be aware of the remote possibility.CE Grim MDOn Mar 14, 2012, at 3:35 PM, lk.barns wrote: Dr. Grim Apparently I've been finding information from the "old days" regarding cortisol pre/post op. My surgeon indicated that I would not need cortisol replacement if all goes as planned. Happy to see your post above that automatic cortisol dosing is not the standard now.

[Guest guest]

They should have gotten cortisol levels done on each AVS sample. Ask for these as well. Without them one cannot be certain the R sample is actually from the R adrenal. Also looks like they did not use ACTH as a way to insure steady background ACTH levels. But not sure. So ask the team.CE Grim MDOn Mar 14, 2012, at 3:24 PM, lk.barns wrote: Dr. Grimm - copied history from another post and have listed lab results plasma aldosterone - 103.0 1st avs left adrenal - 1398.4 2nd avs left adrenal - over 1300 (do not have exact number) 1st avs right adrenal - invalid result 2nd avs right adrenal - within normal limits Brief History - Age 49 - I have been having symptoms for at least 15 years. Began with sudden on-set hypertension. 1st internist refused to test for PA when I requested because "we don't need to chase zebras". Hypertension would alternate between states of control and episodes of instability. 2 cm Adrenal adenoma discovered in 2006. Sent to first endo tested for Cushings results inconclusive - treated with metformin for PCOS despite lack of results to indicate same (I now know). Blood pressure continued with periods of instability. Developed periods of extreme fatigue and muscle pain and weakness along with tachycardia. 2010 heart attack and flash pulmonary edema during heart cath followed by emergency CABG. Good recovery for 2 months. Sudden collapse during cardiac rehab and began episodes of unstable blood pressure, tachycardia, fatigue and muscle weakness. Since 2010 I have been on at least 10 different BP meds - testing during these periods has revealed nothing conclusive. As these periods resolved I would reach a state of over medication. 2nd Endo seen in 2010 screened for PA with inconclusive results. January 2011 I was referred to nephrologist during my second bout with Kidney stones. Revealed a state of acidosis. 6 month follow-up normal aldosterone levels. 1 year follow-up very high plasma level of aldosterone. AVS revealed extremely high levels of Aldosterone but did not have good results on one adrenal. 2nd AVS - successful on both adrenals- shows functioning adenoma. Will have left adrenalectomy March 23rd. Have been in a period of unstable blood pressure, tachycardia, extreme fatigue, weakness since December 2011 - This has been an episodic debilitating problem that I feel was finally caught by chance. Current BP meds - Bystolic 10 mg, Digoxin .25 mg, Spironilactone 100 mg other meds - Byetta 10 mg x2, Cymbalta 120 mg, deplin 7.5 mg

[Guest guest]

Dr Grim if you were her Dr would you do the surgery based on information on this

information?

>

> > Dr. Grimm - copied history from another post and have listed lab

> > results

> >

> > plasma aldosterone - 103.0

> > 1st avs left adrenal - 1398.4

> > 2nd avs left adrenal - over 1300 (do not have exact number)

> > 1st avs right adrenal - invalid result

> > 2nd avs right adrenal - within normal limits

> >

> > Brief History -

> >

> > Age 49 - I have been having symptoms for at least 15 years. Began

> > with sudden

> > on-set hypertension. 1st internist refused to test for PA when I

> > requested

> > because " we don't need to chase zebras " . Hypertension would

> > alternate between

> > states of control and episodes of instability. 2 cm Adrenal adenoma

> > discovered

> > in 2006. Sent to first endo tested for Cushings results inconclusive

> > - treated

> > with metformin for PCOS despite lack of results to indicate same (I

> > now know).

> > Blood pressure continued with periods of instability. Developed

> > periods of

> > extreme fatigue and muscle pain and weakness along with tachycardia.

> > 2010 heart

> > attack and flash pulmonary edema during heart cath followed by

> > emergency CABG.

> > Good recovery for 2 months. Sudden collapse during cardiac rehab and

> > began

> > episodes of unstable blood pressure, tachycardia, fatigue and muscle

> > weakness.

> > Since 2010 I have been on at least 10 different BP meds - testing

> > during these

> > periods has revealed nothing conclusive. As these periods resolved I

> > would

> > reach a state of over medication. 2nd Endo seen in 2010 screened for

> > PA with

> > inconclusive results.

> > January 2011 I was referred to nephrologist during my second bout

> > with Kidney

> > stones. Revealed a state of acidosis. 6 month follow-up normal

> > aldosterone

> > levels. 1 year follow-up very high plasma level of aldosterone. AVS

> > revealed

> > extremely high levels of Aldosterone but did not have good results

> > on one

> > adrenal. 2nd AVS - successful on both adrenals- shows functioning

> > adenoma.

> > Will have left adrenalectomy March 23rd.

> >

> > Have been in a period of unstable blood pressure, tachycardia,

> > extreme fatigue,

> > weakness since December 2011 - This has been an episodic

> > debilitating problem

> > that I feel was finally caught by chance.

> > Current BP meds - Bystolic 10 mg, Digoxin .25 mg, Spironilactone 100

> > mg

> > other meds - Byetta 10 mg x2, Cymbalta 120 mg, deplin 7.5 mg

> >

> >

>

[Guest guest]

I posted these in December, but here they are again:

 

24 hour urine:

 

creatine

On Wed, Mar 14, 2012 at 10:32 PM, Clarence Grim <lowerbp2@...> wrote:

 

Thanks for the excellent update Lucy.

When you have time please send the 24 hr urine Na, K and renin and aldo numbers and the normal values for your lab.  

How and with what are you taking your BP at home?

As this is the best guide to Dx and Rx what is going on for the BP it is critical to be sure it is being done with the best standardization and accuracy.

Keep DASHing for now.

CE Grim MD

On Mar 14, 2012, at 12:52 PM, Lucy Sage wrote:

 

My post Adx care was limited as well, but my K was still a little low in the hospital, so I had it checked a few times. It's normal now. I saw the surgeon a few weeks after my surgery & he gave me a copy of the path report (7 mm nonmalignant cortical tumor). I saw my endo a week or so later, & she released from her care, except she wanted my cortisol checked when I had my blood taken @the end of Nov. (6 weeks after the appt.). I am now under care of nephro, who had my aldo & renin checked plus 24 hr urine at my request. My BP is still not ideal, but seems to be lowering. I am tracking BP daily & eating low salt, which helps. I will repeat the tests in late May & see nephro in early June.

Lucy Sage - 59 yrs old. CT showed 7 mm adenoma in left adrenal. AVS showed aldo lateralized on left side. Adx on 9/18/11Please forgive brevity & typosSent from my droidmsmith_1928 <janeray1940@...> wrote:

>My post-adrenalectomy care was pretty limited - throughout my diagnosis the main doctor on my case was a nephrologist. He monitored my BP and potassium weekly for about 3 weeks after the surgery, but beyond that there wasn't a lot of other followup. Directly after the adrenalectomy my aldo/renin/K were checked in the hospital; all were in normal range and I haven't had aldo or renin checked since. As for monitoring the surgical site itself, the surgeon saw me two weeks after the surgery, removed the " glue " that held everything together, and pronounced me both cured and healed.

>>After all the testing and appointments during the year following my diagnosis, this seemed pretty anticlimactic! No monitoring, nothing " special " that needs to be done. When I asked my primary care doctor what, if anything, I needed to do for follow-up, his response was " Nothing! Just live your life. "

>>Here's hoping your surgery is as easy as mine was. Best of luck to you!>>-msmith1928>Successful left laparoscopic adrenalectomy 10/13/11>>

>>>> I am having an adrenalectomy in less that 2 weeks due to finally being diagnosed with hyperaldosteronism. I am looking for information regarding post-surgery care. What testing will need to be done and when? And most of all who do I need to see about this - I have an internist and a cardiologist (my heart was damaged due to the long period of symptoms requiring surgery 2 years ago.) Although I saw 3 endocrinologists over 15 years, it was a nephrolgist who finally diagnosed this in January. The nephrologist is leaving the area and will not be available for followup care. I live in a rural area and my internist is generally good at working with other specialists - my cardiologist recognized the symptoms but was as frustrated as I was about the inability to diagnose the problem.

>> Should I request a referral from the surgeon (in a metropolitan area) for a referral to someone to follow this after the surgery or hope my internist can handle this? Who should it be - endocrinologist or nephrologist? And what type of questions should I ask and what type of treatment should I expect following surgery?

>> Any help and any tips on the recovery process would be appreciated>>>>