Re: weight and my adrenal tumor

[Guest guest]

Perhaps I am the first woman in history to GAIN weight on a 1000-1200

calorie/day diet? Somehow I doubt it though, it sounds like there are several of

us on this board who did so while we had tumors.

I'm not a midget but I am just under 5'3 " . When I first became sick with what I

now know was the tumor, I went from 89 pounds (I had never weighed over 100, and

usually kept my weight down around the low 90s) to 139 pounds within less than a

year, EVEN THOUGH MY DIET DID NOT EVER CHANGE.

I've watched my weight obsessively since childhood. At the time of the weight

gain, I was vegetarian - mostly vegan, really - and most of my calories came

from grains, rice, beans, legumes, and fresh fruits veggies. I tracked my

portions and calories and rarely topped 1000/day. (NB: I did not know it at the

time, but I was soon to learn that I was celiac and fructose intolerant.)

Yet I managed to gain 50 pounds and become insulin resistant while eating this

way. And the weight gain continued, until I hit 173 and stopped stepping on the

scales.

What saved me was being diagnosed with celiac disease and fructose intolerance -

I dropped all grains except for rice from my diet, all beans and legumes, and

most fruits and sweet/starchy veggies. This left me with not much to eat, so I

added in chicken, fish, and nuts.

I dropped those 50 pounds within 90 days by doing this. I still didn't go over

1200 calories a day (and I still don't, to this day) but what the calories were

MADE OF had changed. Eventually I dropped rice from my diet as well, because I

found that it made me gain weight easily. Still, as long as I had the tumor, I

never was able to get below 120-125 pounds - which at my height always felt just

a bit too heavy.

Fast forward to now, 4 months after the tumor was taken out. My labs no longer

show me as insulin-resistant. I eat rice to my heart's content, and I'm actually

finding it hard to keep my weight from dropping below 110 (I find 110-115 to be

the perfect range for me).

So - this was my longwinded way of saying that our adrenal tumors certainly do

some strange stuff to us when it comes to weight, and as long as I still had the

tumor, it was VERY possible for me to gain weight on 1000 calories a day!

-msmith1928

Successful left laparoscopic adrenalectomy 10/13/11

> Each time a med change was made I would gain at least ten pounds that could

never be lost. As a result, by 1995 I carried 70 extra pounds.

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[Guest guest]

I'm not saying that I gained weight from " nothing " - I'm saying that all the

excess stuff put out by the tumor made me susceptible to weight gain in an

abnormal way. My weight gain/loss story shows that for whatever reason, while I

had the tumor my metabolism slowed way down, and something happened that made a

carb-based diet (my vegetarian diet) promote weight gain, and made a

protein-based diet (my post-celiac and -fructose intolerance diet) promote

weight loss/maintenance, and that regardless of diet, pre-adrenalectomy I gained

weight really easily and now I don't. I wish there was a simple explanation of

what the tumor had been doing to me weight-wise, but there doesn't seem to be.

I'm kind of an odd case since I don't have family pressures or food issues to

deal with at all - eating is an inconvenience rather than a pleasure, and if I

could take a " food pill " and be done with it I would! I have no problem refusing

food and am not afraid to say " no thank you " to anybody offering it. Even though

medical professionals can safely assume that *most* people take in more calories

than they realize, I certainly am not " most people " in this regard. I don't

snack, I don't eat mindlessly, I don't derive ANY pleasure from food other than

it makes me un-hungry when the stomach starts to growl. I'm also incredibly

obsessive and self-controlling about weight and have been my whole life - I feel

so uncomfortable the minute I begin to put on any extra that I've always been

willing to starve if I have to in order to prevent it. So I am confident that my

" experiment " was pretty well controlled.

I only wish I knew what my experiment proved!

> > Each time a med change was made I would gain at least ten pounds that could

never be lost. As a result, by 1995 I carried 70 extra pounds.

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[Guest guest]

I have tried to stay out of this discussion but can resist no longer. As I have reported, I stopped Spironolctone on Dec. 22. At that point I had lost ~25lbs since starting Spiro. In the first 3 weeks I gained about 15lbs of which I managed to loose about 5lbs. Fast forward to yesterday. I had gained 9 more lbs from when I was weighed at the VA on Feb. 9th. Do I measure the input? No! Do I measure the output? No. Has my exersize changed? No. Has my addition of salt changed? No, we don't even have a salt shaker. We very seldom add any salt in cooking, zero, zilch, none! My wife is still the shopper and cook and is very sensitive to the salt issue. I use the same size plate, no it is a sandwich plate and my right elbow makes the same number of bends every day. The deck of cards is the same size as it was last year! I have not had "S-T-U-P-I-D" tatooed on my forehead, yet!

Now let's look at some of the known issues:

T2DM Insulin/Glucosse - "Daily sticks" are bouncing and on an upward trend, does this have any bearing?

OSA - I have been told that is affected by PA and should get better when PA is corrected.

Quality of sleep - Waking ~2 times/night. Sleeping 2-3 hours at a time. Remember what I told you about REM sleep?

Depression - Markedly worse according to phsyco testing. If the action of Spironolactone increases cortisol which increases seratonin in MDD, what happens when you take it away? What if you are already on medication, Cymbalta, to increase seratonin?

I detailed this out because if the input remains the same but the output changes is that a reason for weight gain or has logic failed me again? Let me rephrase that, If I take a bath towel and weigh it completely dry and then soak it in water and weigh it again, which will be heaver? (You didn't ask but while mt endema was completely resolved while on Spiro, I now loose my ankle bone as the day progresses.)

I may have ranged outside the actual subject area but you got me started! At least I didn't get into "Man Boobs" and no labedio! Testosterone test next week and I start weekly RTC until we get a handle on some of this.

A status update from one PTN who has been there/done that! Stay tuned for what happens after an ADX (I hope!)

> > > Each time a med change was made I would gain at least ten pounds that could never be lost. As a result, by 1995 I carried 70 extra pounds. > > > .> > > <http://geo./serv?s=97359714/grpId=7299303/grpspId=1705132763/msgId=41551/stime=1331872149/nc1=5191951/nc2=5191946/nc3=3848640>> > >> >>

[Guest guest]

Depression - Markedly worse according to phsyco testing. If the action of

Spironolactone increases cortisol which increases seratonin in MDD, what happens

when you take it away?

Don't know data that Spiro increases cortisol chronically.

We talked about it a month ago or more. Antagonizing cyp11b2 (androgen) causes

an increase in cyp11b1 (Cortisol) and what that does to serotonin and Barb Tatro

explained the shortened loop in MDD. I believe it started with this study:

http://archpsyc.ama-assn.org/cgi/content/full/60/1/24 - Mineralocorticoid

Receptor Function in Major Depression

> > > > > Each time a med change was made I would gain at least ten pounds that

could never be lost. As a result, by 1995 I carried 70 extra pounds.

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[Guest guest]

So, does this explain how weight could go up w/o a change in diet? I do not

drink excess water and that has not changed.

That is where the retained salt is going and your weight is going up. Or u are

drinking heavy water?

Let's say you are ding the DASH EXACTLY and are in sodium balance, no edema, and

stop Spiro the following would be expected.

Your sodium reabsorbing effect should go up remarkably. So lets say you now

begin to reabsorb 1/2 of the 1500 mg of sodium a day. So 750 mg is about 33 mM a

day. You will also retain more water. So every day your weight will go up about

1/4 kilogram (about 1/2 a pound) a day until your BP increases enough to over

come the salt retention from unantagonised aldo (previously blocked by spiro)

thru pressure natriuresis. The pressure will continue to rise until sodium

balance is restored or the pressure blows out a Blood vessel or the heart can no

longer keep up with the pressure load and fluid begins to back up in your feet

and lungs, and you start to get tired rhen begin to wake up short of breath and

cant sleep lying down. THEN AKA CHF DEVELOPS.

So if u plot your your weight, which must be due to salt retention as you are

not eating enough to gain weight I would predict your BP will be trending up.

Peeing at night will increase.

Keep us posted as this evolves.

> > > > > Each time a med change was made I would gain at least ten pounds that

could never be lost. As a result, by 1995 I carried 70 extra pounds.

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[Guest guest]

If excess aldosterone worsens OSA wouldn't it be safe to assume that getting rid

of the excess would improve the OSA? Looks like Dr. Calhoun has been studying

this for 10 years or more.

OSA - I have been told that is affected by PA and should get better when PA is

corrected.

No data that correcting PA will help OSA but could if breathing muscles are

weakened by low K and get better.

http://www.ncbi.nlm.nih.gov/pubmed/21654850 - Resistant hypertension,

obstructive sleep apnoea and aldosterone.

Dudenbostel T, Calhoun DA.

We hypothesize that aldosterone excess worsens OSA by promoting accumulation of

fluid within the neck, which then contributes to increased upper airway

resistance.Journal of Human Hypertension advance online publication, 9 June

2011; doi:10.1038/jhh.2011.47.

http://www.ncbi.nlm.nih.gov/pubmed/20726285 - Severity of obstructive sleep

apnea is related to aldosterone status in subjects with resistant hypertension.

Gonzaga CC, Gaddam KK, Ahmed MI, Pimenta E, SJ, Harding SM, Oparil S,

Cofield SS, Calhoun DA.

CONCLUSIONS:

Our analysis of patients with resistant hypertension confirms a markedly high

prevalence of OSA in this group. Furthermore, severity of OSA was greater in

those patients with hyperaldosteronism and related to the degree of aldosterone

excess. The correlation between OSA severity and aldosterone supports the

hypothesis that aldosterone excess contributes to greater severity of OSA.

> > > > > Each time a med change was made I would gain at least ten pounds that

could never be lost. As a result, by 1995 I carried 70 extra pounds.

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51/stime=1331872149/nc1=5191951/nc2=5191946/nc3=3848640>

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[Guest guest]

Calories in/calories out may be that simple in someone with a NORMAL endocrine

system. I cannot believe this one-size-fits-all approach can be applied to those

of us with adrenal tumors.

I've read a lot of posts from others on this board who, like myself, went from

normal weight to overweight really rapidly after the onset of their PA. I do not

believe that it's a lack of self-control; instead, I am certain that there is

something going on metabolically that causes us to store fat. Even though my

pre-adrenalectomy weight/BMI were " normal, " my weight distribution followed a

pattern similar to Cushing's patients - skinny legs with lots of abdominal fat,

and fat around the shoulders and upper arms. I knew this wasn't normal.

Before the tumor was removed, there was no amount of calorie

restriction/exercise/salt restriction that allowed me to get my weight down

below 120. And keeping it at 120, which I felt was the top end of " healthy " for

my small frame, was a struggle, but I figured out what worked and stuck with it.

Post-surgery, I've had no trouble at all keeping my weight to a more healthy

range of 110-115, even though I'm eating more (and eating more salt!) than I did

while I had the tumor.

If calories in/calories out was all there was to it, then I should be GAINING

weight, as I am eating more than I did before the surgery.

> > > Each time a med change was made I would gain at least ten pounds

> > that could never be lost. As a result, by 1995 I carried 70 extra

> > pounds.

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[Guest guest]

The key statements in your post that really struck home with me all dealt with

frustration.

I'm sure I was the umpteenth woman who walked into each of my specialists

offices complaining about weight gain and the inability to lose weight. Unlike

my small town GP, they did not have the pleasure of waiving to me as he passed

me on my daily walk. I was dismissed as yet another overweight woman looking for

something to blame or a quick fix.

However, the purpose of the the consultation was never to seek the quick fix -

the weight fluctuation was just one symptom and one part of the overall

condition - an evaluation of an adrenal adenoma and uncontrolled hypertension.

Complicating this was sporadic appearance and disappearance of symptoms.

It was not until medically monitored and controlled rehabilitation that any of

the specialist began to observe what was happening. My ability to quickly gain

muscular strength and endurance clearly demonstrated my prior physical

conditioning. Then symptoms began during rehab and I quickly began to decline.

Suddenly, I no longer received a smirk from medical professionals when the

numbers on the scale rose dramatically or praise when the numbers fell just as

dramatically. This was finally seen as one of my symptoms.

Over the past year my weight has ranged from a low of 192 in February 2011 to a

high of 226 in November 2011. As of this morning, I am back down to 209. By

following these fluctuations and scheduling tests when symptoms were their

worst, I have finally been able to get a clear diagnosis.

Most of the stories here regarding dramatic weigh gain and loss are from women.

Women are cyclical creatures. Healthy women experience minor fluctuations in

weight depending on the level of hormones available during a particular part of

her cycle - that's normal. Add to the mix an abnormal level of aldosternone and

what happens then? Since most medical research until recently has been conducted

on male subjects, the answers may yet to be established.