Re: Re: Update [1 Attachment]

[Guest guest]

It sems more on this list have issues with anxiety and not depression in this regards. I realize that modern medicine erroneously lumps the two together, and even treats anxiety with SSRI's (which is off-label), but they are different emotions that need different treatments (but don't get it of course). But then again in society we are apparently supposed to be smiling and skipping 24/7 and any emotion to the otherwise has a medicine for it. Hell, the psych community now even wants grief listed as a disorder. Grief!!! Should we not be sad at a death in the family. Even the shortest verse in the Bible is "Jesus Wept." Maybe if he was put on prozac he would have been stronger

And while some tend to post on this list daily and much more than others it may appear that depression is a common thread, but it doesn't seem to be all that common. Anxiety seems to have more commonality among us with PA than depression does, but then again if I went to my doc tomorrow and said I was sad because my rabbit died I could get a depression label and a brand new SSRI. So who knows who's really depressed and who isn't.

Just my 2 cents but there are millions upon millions who have suffered abuse, been through war(s), watched people get shot, pulled burned children out of houses, lost family members, and so on, who don't have depression or PTSD. You write like it is an expectation, but millions of us, even when put in situations that are so gruesome and abnormal, and tragic, that defy any and all explanation as to why or how someone could do that to someone else, and while we can still hate it, despise it, cringe at it, cry over it, can still at the days end put it in a box I call perspective. Never to forget it, but also never to let it drive our life. There are horrible sides to life, some that happens directly to us, but some can put in the abnormal perspective box and let it go, and go on. So it is all relative. But when we think we are the only ones who suffered something, or are the island, keep in mind that the person sitting

next to you often has too, they just deal with it differently, keep it tucked away, or are built inherently emotionally different.

From: Barb Tatro <rainbowdayz@...>Subject: Re: Re: Update [1 Attachment]hyperaldosteronism Date: Thursday, February 2, 2012, 9:01 PM

Hey homeboy,

Thanks for the feedback. Right out of the chute, allow me to apologize for hammering you the other day. What appears to be rude and uncalled for, is normal 'speak' in my family and the ICU circles I've called home. We're a brassy lot and filter-free. Sometimes a good thing. Sometimes it came with a security escort to my car. Been fired more than a few times... a Barb-ism I wear with pride. It nearly always had to do with patient or nurse advocacy. Truth be told, you're a good man who is more than willing to educate others as you learn through the wrong that's been done to you. So, , good on you.

At the risk of perhaps offending again, I say this in humor and with caution. You know those smart phones out now that you speak into it in English, it translates into the desired language and speaks it back? So... I was wondering... do they have one that translates , cause sometimes it would be helpful <grin>? Please translate the following:

(are we still smiling?)

1) The postmenopausal women would be ____________________?

2) I do have an outstanding psych question regarding how ____________________ might effect MDD treatment.

3) I'm not sure I'm grasping your commentary/question regarding CYP11B(1/2). So... I will tell you what I know (usually not much). I did teach A & P and Micro labs at Indiana University, adjunct faculty for 12 years. Stopped doing that when I relocated to Houston to work for DeBakey (Google him) in 2001.

Therefore, it is my belief that one can never understand pathophysiology unless one understands normal anatomy/physiology. That said, it is necessary to look at the structure of the adrenal gland to 'get' why and how it goes on the blink.

The adrenal gland, histologically, is divided into 2 general layers: 1) cortex, 2) medulla

The medulla (deepest tissue of the gland) is easy - makes/secretes catecholamines (epi/norepi ---> adrenaline)

The cortex has 3 layers and each makes/secretes a separate type of hormone. From outermost to innermost:

1) zona glomerulosa - mineralcorticoids (aldosterone)

2) zona fasiculata - glucocorticoids (cortisol)

3) zona reticularis - androgens (estrogen, testosterone)

All of the adrenal hormones start out as cholesterol and then are changed into specific layer (zona) hormones through the action of enzymes. Enzymes cause a change in the shape of the molecule and it becomes a different hormone (just like the enzymatic changes in the production of aldosterone---> renin -> angiotensin I -> angiotensin II -> aldosterone). Each of those steps require a specific enzyme to create the new 'shape' of the hormone molecule.

Actually, CYP11B1 and CYP11B2 aren't really genes at all. They are enzymes (B1 = b-hydroxylase, B2 = aldosterone synthase) (Aside - words with 'ase' suffix are generally enzymes). I think they call them genes because they code for these enzymes, but it is confusing. They should call B1 and B2 and say that and are mucking up the hormone factory, but I'm pretty sure that's not gonna' happen.

So... the CYP11B1 acts on the zona fasiculata and impacts the enzyme action on glucocorticoids. CYP11B2 acts on the cells of the zona glomerulosa and impacts the enzyme action on mineralcorticoids. Because both are mutants, what comes out the other end are hormones that secrete and behave inappropriately.

The mutant enzymatic changes end up chronically resetting the relationship between the pituitary gland secretion of ACTH (adreocorticotropic hormone, which stimulates the adrenal cortex to secrete), creating upregulation (excessive mineral and glucocorticoids).

So... back to your question... what you are saying is that CYP11B1/2 can also alter enzymatic changes in the zona reticularis androgens? I don't see the correlation, because that's a whole different set of enzymes. Because enzymes are target tissue specific, it's not likely that enzymes that are mineral/glucocorticoid specific are capable of causing changes in androgens. I'll attach a picture here if it will let me to show you the different layers, hormones and enzymes. If not I'll post it to the group with a call out. You know what they say a picture is worth.

Finally, I find your MDD interesting. I have the same diagnosis for likely the same reason - PTSD. I have never been diagnosed with PTSD but you can't spend your childhood being molested and abused and not come out like a returning vet. Also, many on this site admit to a life filled with depression. Perhaps we're assigning the MDD to events that are unrelated. Perhaps the relationship has everything to do with adrenal abnormalities and nothing at all to do with the hardships of our life. I find that more plausible because you and I are both survivors, stuffed full of piss and vinegar. I'm thinkin' that maybe and are f-ing with my mood ring too.

Hugs,

Barb

Re: Update

Barb, I totally agree with your assessment and decision as long as you keep a close eye on adverse side effects! I was well controlled on 25mg bid but developed gynecomastia early. No recommendation from anyone to change because it "was not painful". My PCP was estatic and not willing to change anything until I developed 6 bumps in my rt. breast and she had to convince me that I was going to Boston (400+ miles R/T) for a mammogram! I considered Eplerenone but it took 3 trys to get it approved by the VA. I did a lot of research and found enough unanswered questions and the fact that there was limited research and finlly decided now was the time to persue an AVS and know all my options! As a postmenopusal female many of my concerns will not apply. I do have an outstanding question with my Psyco Staff regarding how it might affect MDD treatment. (There is apprently an effect on gene CYP11B1 and CYP11B2, cortisol and androgen, because they are

neighbors on the channel. You surely know more about it than I!) - 65 yo super ob., fastidious male - 12mm X 13mm rt. a.adnoma with previous rt. flank pain. Treating with DASH. Stats w/o meds = BP 175/90 HR 59 BS 125. D/C Spironolactone 12/20/2011 due to adverse SX.Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, Gynecomastia, MDD and PTSD.Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, AmlodipineBesylate 5mg, 81mg aspirin and Metformin 2000MG. Started washing Spironolactone 12/20/11 to prepare for AVS.>> Briefly, my adrenal history includes a right adenoma dx'd in 2000 and a

left adenoma dx'd in 2009 and drug-resistant HTN for 25 years. My right renal artery is 70% stenosed (US dx) and the right kidney is atrophic. I had some basic lab work done 2 weeks ago. Aldosterone was 25 (high). Renin 9.3 (high normal). Started Spiro 25mg daily after labs were drawn. I have been on the Spiro for 2 weeks now. After one dose, the brain fog lifted, my lungs were much more clear, the trace LE peripheral edema started to diminish and my blood pressure began to decrease. > > The second week on Spiro, I felt generally horrible and my BPs were improving but not good. At the end of the second week, BP normalizing and K+ maintained on 20mEq BID (had been taking 40 BID and supplementing when the low K+ PVCs cycled in - usually 160mEq over 24 hrs). The sum: I am feeling much better.> > I was referred to endo. Saw him today. Super doc with a great big brain. He says there is so much going on with me, now and

historically, he is not sure if it is primary or secondary aldosteronism because of the renal artery stenosis or the long-term NSAID therapy (800mg BID for the issues with my lumbar vertebrae and left hip). Based on the numbers and diagnostics, he is leaning toward secondary. He ordered labs to check for Pheo, Cushing's, etc., and I will see him in one month. He also wants a repeat CT because the last one was 3 years ago. I won't do that until Medicare kicks in July 1. He's okay with that.> > He said it was up to me if I wanted to purge the drugs, do a salt loading and then retest. He also said he would refer me to a university setting for an AVS if I wanted a definitive diagnosis. The way I view it... I am 65, retired, and Spiro is working. Kind of a no brainer. > > Any thoughts?> > Barb>