Re: Re: Update (Spiro effect on MDD)

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One concern would be that depressed patients may not eat normal amounts of anything including salt. Without knowing the salt balance off the subjects the Spiro effect is prob not interpretable. Low Na increases also as does even standing vs laying. Must control all aspects of the regulating systems in order to make good interpretations. Not easy and often not done. Can really only be done on a metabolic May your pressure be low unit where diet time position activities can be carefully controlled. I have spent my life doing these sorts of studies. You might want to search Grim C, Kotchen T for information on cortisol and aldo at least in blacks. But even these studies were only on CRC FOR 3 days and not the best controlled. CE Grim MS, MDSpecializing in DifficultHypertensionOn Feb 4, 2012, at 14:06, <jclark24p@...> wrote:

Hi Barb, here is the info in response to your questions 2 and 3. These are the two studies I asked my Psycho Docs to review and tell me what is going on. You might be a better resource for me! Thanks.

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

Mineralocorticoid Receptor Function in Major Depression

In this study I found this: Results Spironolactone treatment resulted in a significant increase in cortisol secretion levels in both groups. Depressed patients demonstrated higher cortisol secretion levels than control subjects. In addition, depressed patients demonstrated a different pattern of increase in cortisol secretion levels after spironolactone administration. Furthermore, a significant effect of spironolactone treatment on corticotropin secretion levels can be observed in depressed patients, whereas controls show no such effect.

Conclusions Despite high baseline cortisol levels, patients with major depression show high functional activity of the MR system. Paired with the body of evidence regarding decreased sensitivity to GR agonists, these data suggest an imbalance in the MR/GR ratio. The balance of MR and GR is known to affect brain serotonin systems and may play an etiologic role in serotonin receptor changes observed in patients with major depression.

This caused me to think I needed to understand something about Cortisol but I'm starting to think I have created a tug-of-war with spironolactone increasing serotonin through the above action while cymbalta is trying to reduce it !

I then went here to see if I could determine the "how" and that is when CYP11B1 and CYP11B2 came into play and I got lost! I think the key is in sections IX and X but I was sort of like puppy chasing his tail trying to figure it out!

Source: http://edrv.endojournals.org/content/29/2/133.long#xref-ref-201-1

A Lifetime of Aldosterone Excess: Long-Term Consequences of Altered Regulation of Aldosterone Production for Cardiovascular Function

All help gretly appreciated so I can keep my psycho docs honest!

- 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

> >

>

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No I was describing how difficult it is to properly study the mineralocorticoid system so you can minimize the variation of the many variables that influence the system so you can be reasonably certain that the results of the study are explained by the intervention(s) that were used. Same for cortisol. I worry that you are reaching for straws but maybe not. Let us know what your team thinks.CE Grim MD On Feb 4, 2012, at 6:36 PM, wrote: Are you stereotyping depressed people? I wonder if they can do a 24h urine collection correctly! I'm not sure that looking up info on cortisol and aldo in blacks would be helpful, I'm little fair skinned for that and there must be reason you were exclusively targetting blacks. Is it possibly the difference in the way they process salt? I simply was reading two studies and saw where spiro affected cortisol and increased cortisol affected depressed ppl differently. I am still expecting an answer from my Psychiatrist. When Barb gave me some other info it was obvious she is knowledgable and she offered to look into it. Who knows, we both might learn something! Although I am off spiro, I'm still wondering why my treatment went awry. I still think there should be a decision tree and maybe we can determine some individuls that would be better off skipping directly to eplerenone, I quoted one the other day - "children". (Maybe a better measure would be age!) Who knows, more might be willing to take the meds/DASH route and have success if we moved it up to the 21st century! .... > > > > > > > > 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 > > > > > > > > > > > > > Reply to sender | Reply to group | Reply via web post | Start a New Topic > > Messages in this topic (110) > > RECENT ACTIVITY: New Files 1 > > Visit Your Group >

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Is there a relationship between cortisol, depression & sleep? I have a friend

who was given cortisol by a naturopath to help her get off an SSRI, which she

takes for panic attacks. She told me that it has helped her sleep much better &

her panic attacks have decreased.

I was curious because I had an Adx last September & my cortisol was low in

November. I had an ACTH stimulation test in early December, which I " passed. "

I still wake up 2 to 5 times a night, need 10 hours sleep a night & struggle

with fatigue & HAs. I was hoping these symtoms would diminish after my Adx. The

only meds I take are Cymbalta & Omeprazole. My BP is still decreasing

(averaging around 125/70), but the systolic still goes over 140 occaisionally

when I go out to eat.

Lucy Sage

Please forgive brevity & typos

Sent from my droid

Clarence Grim <lowerbp2@...> wrote:

>No I was describing how difficult it is to properly study the

>mineralocorticoid system so you can minimize the variation of the many

>variables that influence the system so you can be reasonably certain

>that the results of the study are explained by the intervention(s)

>that were used.

>

>Same for cortisol.

>

>I worry that you are reaching for straws but maybe not. Let us know

>what your team thinks.

>

>CE Grim MD

>

>

>

>

>On Feb 4, 2012, at 6:36 PM, wrote:

>

>> Are you stereotyping depressed people? I wonder if they can do a 24h

>> urine collection correctly! I'm not sure that looking up info on

>> cortisol and aldo in blacks would be helpful, I'm little fair

>> skinned for that and there must be reason you were exclusively

>> targetting blacks. Is it possibly the difference in the way they

>> process salt?

>>

>> I simply was reading two studies and saw where spiro affected

>> cortisol and increased cortisol affected depressed ppl differently.

>> I am still expecting an answer from my Psychiatrist. When Barb gave

>> me some other info it was obvious she is knowledgable and she

>> offered to look into it. Who knows, we both might learn something!

>>

>> Although I am off spiro, I'm still wondering why my treatment went

>> awry. I still think there should be a decision tree and maybe we can

>> determine some individuls that would be better off skipping directly

>> to eplerenone, I quoted one the other day - " children " . (Maybe a

>> better measure would be age!) Who knows, more might be willing to

>> take the meds/DASH route and have success if we moved it up to the

>> 21st century!

>>

>> ....

>>

>>

>> > > > >

>> > > > > 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

>> > > > >

>> > > >

>> > >

>> > >

>> > > Reply to sender | Reply to group | Reply via web post | Start a

>> New Topic

>> > > Messages in this topic (110)

>> > > RECENT ACTIVITY: New Files 1

>> > > Visit Your Group

>> >

>>

>>

>

[Guest guest]

Us Endocrinologists are frequently accused of mental masturbation when we link observations based only on sort of random articles or even wishful thinking. See the last sentence in the abstract below. Some would use this as an example but our team thinks not. So if you search PUBMED for any two items you will come up with many "matchs" that make no sense. Deciding which ones do and do not is not always an easy task. Hypertension. 2007 Mar;49(3):704-11. Epub 2006 Dec 11.Association of adrenal steroids with hypertension and the metabolic syndrome in blacks.Kidambi S, Kotchen JM, Grim CE, Raff H, Mao J, Singh RJ, Kotchen TA.SourceMedical College of Wisconsin, Milwaukee, USA.Erratum inHypertension. 2007 Mar;49(3):e20.AbstractBlacks have a high prevalence of hypertension and adrenal cortical adenomas/hyperplasia. We evaluated the hypothesis that adrenal steroids are associated with hypertension and the metabolic syndrome in blacks. Ambulatory blood pressures, anthropometric measurements, and measurements of plasma renin activity (PRA), aldosterone, fasting lipids, glucose, and insulin were obtained in 397 subjects (46% hypertensive and 50% female) after discontinuing antihypertensive and lipid-lowering medications. Hypertension was defined as average ambulatory blood pressure >130/85 mm Hg. Late-night and early morning salivary cortisol, 24-hour urine-free cortisol, and cortisone excretion were measured in a consecutive subsample of 97 subjects (40% hypertensive and 52% female). Compared with normotensive subjects, hypertensive subjects had greater waist circumference and unfavorable lipid profiles, were more insulin resistant, and had lower PRA and higher plasma aldosterone and both late-night and early morning salivary cortisol concentrations. Twenty-four-hour urine-free cortisol and cortisone did not differ. Overall, ambulatory blood pressure was positively correlated with plasma aldosterone (r=0.22; P<0.0001) and late-night salivary cortisol (r=0.23; P=0.03) and inversely correlated with PRA (r=-0.21; P<0.001). Plasma aldosterone correlated significantly with waist circumference, total cholesterol, triglycerides, insulin, and the insulin-resistance index. Based on Adult Treatment Panel III criteria, 17% of all of the subjects were classified as having the metabolic syndrome. Plasma aldosterone levels, but not PRA, were elevated in subjects with the metabolic syndrome (P=0.0002). The association of aldosterone with blood pressure, waist circumference, and insulin resistance suggests that aldosterone may contribute to obesity-related hypertension in blacks. In addition, we speculate that relatively high aldosterone and low PRA in these hypertensive individuals may reflect a mild variant of primary aldosteronism. On Feb 5, 2012, at 3:23 AM, wrote: I didn't know that I had to validate the study too, I thought that was why we used Pubmed. The article I quoted was published in "Arch Gen Psychiatry. 2003;60:24-28" so it has had 9 years to be reviewed and challenged by professionls, I doubt I could add anything! To validate it I referred it to my treating professionls. Dr. Bolton has professor status at the University of Vermont (UVM) and she was going to the library to see if there was any more info in the last 9 years. I expect to hear back later this month. I simply found a study that indicated that treatment with spironolactone caused an increase in cortisol. Then I found another study that while the increase was not a problem in "normals", it increased serotonin in PTNs with MDD. Wouldn't it be nice to know this in advance? Maybe there is another medicine, on either side of the conflict, that would eliminte this problem. If not, maybe we need to increase the SSRI or find something that reduces cortisol. (And at the minimum the left hand should know what the right hand is doing!) Don't worry about me, I eliminated the potential problem on Dec. 20th and hope I don't have to see how it works with epleremone! :>) ... > > > > > > > > > > > > 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 > > > > > > > > > > > > > > > > > > > > > > > Reply to sender | Reply to group | Reply via web post | Start a > > New Topic > > > > Messages in this topic (110) > > > > RECENT ACTIVITY: New Files 1 > > > > Visit Your Group > > > > > > > >

[Guest guest]

Depressed folks tend to have high cortisol and a disturbed rhythm of ACTH. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Feb 5, 2012, at 17:47, Francis Bill SUSPECTED PA <georgewbill@...> wrote:

I would think a increase in cortisol would decrease stress. If this is the case does decreasing stress increase depression?

> > > > > > > > >

> > > > > > > > > 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

> > > > > > > > >

> > > > > > > >

> > > > > > >

> > > > > > >

> > > > > > > Reply to sender | Reply to group | Reply via web post |

> > > Start a

> > > > > New Topic

> > > > > > > Messages in this topic (110)

> > > > > > > RECENT ACTIVITY: New Files 1

> > > > > > > Visit Your Group

> > > > > >

> > > > >

> > > > >

> > > >

> > >

> > >

> >

>

[Guest guest]

Cortisol is released by the body during a 'fight or flight' (stress) response. The release produces: a burst of survival energy, increased memory function, increased immunity, decreased pain response and so forth. Part of the stress response is returning to normal cortisol levels (relaxation response) once the threat is removed. If that doesn't happen and the cortisol levels remain elevated (constant stress) or if the response is activated repeatedly, you end up in a chronic state of stress (chronically high cortisol levels). High or prolonged blood levels of cortisol cause: impaired thinking, suppressed thyroid function, blood sugar imbalances, decreased bone density, decreased muscle tissue, high blood pressure, decreased immunity, etc.

I suppose the way to view this is by looking at steroids a person takes orally (prescribed, athletes, body building, etc.). Decreased stress behaviors is not what comes to mind when thinking about the somatic, cognitive, or emotional effects of taking them. I'm pretty sure steroids wouldn't be as popular in the world of sports if they relaxed the body and increased depression. If it did, they'd have to start shooting Smackdown v. Raw at a Spa with a therapist stage right.

Barb

Re: Update (Spiro effect on MDD)

I would think a increase in cortisol would decrease stress. If this is the case does decreasing stress increase depression?> > > > > > > > >> > > > > > > > > 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> > > > > > > > >> > > > > > > >> > > > > > >> > > > > > >> > > > > > > Reply to sender | Reply to group | Reply via web post | > > > Start a> > > > > New Topic> > > > > > > Messages in this topic (110)> > > > > > > RECENT ACTIVITY: New Files 1> > > > > > > Visit Your Group> > > > > >> > > > >> > > > >> > > >> > >> > >> >>

[Guest guest]



The elevation in cortisol must be related to the anxiety that is coupled with depression... in a constant state of worry (rumination to the nth). So which came first, the chicken or the egg? Did the disturbed rhythm of ACTH cause the depression or did the anxiety of depression cause the altered ACTH?

Also, if ACTH is part of the hormonal feedback system, how can it be controlled by rhythm (intervals/time)?

Barb

Re: Re: Update (Spiro effect on MDD)

Depressed folks tend to have high cortisol and a disturbed rhythm of ACTH.

May your pressure be low!

CE Grim MS, MD

Specializing in Difficult

Hypertension

On Feb 5, 2012, at 17:47, Francis Bill SUSPECTED PA <georgewbill@...> wrote:

I would think a increase in cortisol would decrease stress. If this is the case does decreasing stress increase depression?> > > > > > > > >> > > > > > > > > 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> > > > > > > > >> > > > > > > >> > > > > > >> > > > > > >> > > > > > > Reply to sender | Reply to group | Reply via web post | > > > Start a> > > > > New Topic> > > > > > > Messages in this topic (110)> > > > > > > RECENT ACTIVITY: New Files 1> > > > > > > Visit Your Group> > > > > >> > > > >> > > > >> > > >> > >> > >> >>

[Guest guest]

This is the funniest thing I've read in a long time. However, I don't think Endocrinologists should start feeling special just yet. ICU nurses are known for an inordinate amount of mental masturbation. Just ask any doc who wants to be left alone at 3 am. It goes something like this, "Dr. Grim. This is Barb from ICU. I've been looking at the labs and the patient's numbers and the amount of drainage from the left leg incision and I remember an article I read recently regarding these symptoms and what I am seeing".

His response, "$#%-5* & $!!@$?".

Nurse's response, "Hello... doctor... hello... are you there"?

Barb

Re: Re: Update (Spiro effect on MDD)

Us Endocrinologists are frequently accused of mental masturbation when we link observations based only on sort of random articles or even wishful thinking.

See the last sentence in the abstract below. Some would use this as an example but our team thinks not.

So if you search PUBMED for any two items you will come up with many "matchs" that make no sense. Deciding which ones do and do not is not always an easy task.

Hypertension. 2007 Mar;49(3):704-11. Epub 2006 Dec 11.

Association of adrenal steroids with hypertension and the metabolic syndrome in blacks.

Kidambi S, Kotchen JM, Grim CE, Raff H, Mao J, Singh RJ, Kotchen TA.

Source

Medical College of Wisconsin, Milwaukee, USA.

Erratum in

Hypertension. 2007 Mar;49(3):e20.

Abstract

Blacks have a high prevalence of hypertension and adrenal cortical adenomas/hyperplasia. We evaluated the hypothesis that adrenal steroids are associated with hypertension and the metabolic syndrome in blacks. Ambulatory blood pressures, anthropometric measurements, and measurements of plasma renin activity (PRA), aldosterone, fasting lipids, glucose, and insulin were obtained in 397 subjects (46% hypertensive and 50% female) after discontinuing antihypertensive and lipid-lowering medications. Hypertension was defined as average ambulatory blood pressure >130/85 mm Hg. Late-night and early morning salivary cortisol, 24-hour urine-free cortisol, and cortisone excretion were measured in a consecutive subsample of 97 subjects (40% hypertensive and 52% female). Compared with normotensive subjects, hypertensive subjects had greater waist circumference and unfavorable lipid profiles, were more insulin resistant, and had lower PRA and higher plasma aldosterone and both late-night and early morning salivary cortisol concentrations. Twenty-four-hour urine-free cortisol and cortisone did not differ. Overall, ambulatory blood pressure was positively correlated with plasma aldosterone (r=0.22; P<0.0001) and late-night salivary cortisol (r=0.23; P=0.03) and inversely correlated with PRA (r=-0.21; P<0.001). Plasma aldosterone correlated significantly with waist circumference, total cholesterol, triglycerides, insulin, and the insulin-resistance index. Based on Adult Treatment Panel III criteria, 17% of all of the subjects were classified as having the metabolic syndrome. Plasma aldosterone levels, but not PRA, were elevated in subjects with the metabolic syndrome (P=0.0002). The association of aldosterone with blood pressure, waist circumference, and insulin resistance suggests that aldosterone may contribute to obesity-related hypertension in blacks. In addition, we speculate that relatively high aldosterone and low PRA in these hypertensive individuals may reflect a mild variant of primary aldosteronism.

On Feb 5, 2012, at 3:23 AM, wrote:

I didn't know that I had to validate the study too, I thought that was why we used Pubmed. The article I quoted was published in "Arch Gen Psychiatry. 2003;60:24-28" so it has had 9 years to be reviewed and challenged by professionls, I doubt I could add anything!To validate it I referred it to my treating professionls. Dr. Bolton has professor status at the University of Vermont (UVM) and she was going to the library to see if there was any more info in the last 9 years. I expect to hear back later this month.I simply found a study that indicated that treatment with spironolactone caused an increase in cortisol. Then I found another study that while the increase was not a problem in "normals", it increased serotonin in PTNs with MDD. Wouldn't it be nice to know this in advance? Maybe there is another medicine, on either side of the conflict, that would eliminte this problem. If not, maybe we need to increase the SSRI or find something that reduces cortisol. (And at the minimum the left hand should know what the right hand is doing!)Don't worry about me, I eliminated the potential problem on Dec. 20th and hope I don't have to see how it works with epleremone! :>)...> > > > > >> > > > > > 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> > > > > >> > > > >> > > >> > > >> > > > Reply to sender | Reply to group | Reply via web post | Start a > > New Topic> > > > Messages in this topic (110)> > > > RECENT ACTIVITY: New Files 1> > > > Visit Your Group> > >> >> >>

[Guest guest]

Ah if only more were like this. Nurses I mean. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Feb 5, 2012, at 18:45, Barb Tatro <rainbowdayz@...> wrote:

This is the funniest thing I've read in a long time. However, I don't think Endocrinologists should start feeling special just yet. ICU nurses are known for an inordinate amount of mental masturbation. Just ask any doc who wants to be left alone at 3 am. It goes something like this, "Dr. Grim. This is Barb from ICU. I've been looking at the labs and the patient's numbers and the amount of drainage from the left leg incision and I remember an article I read recently regarding these symptoms and what I am seeing".

His response, "$#%-5* & $!!@$?".

Nurse's response, "Hello... doctor... hello... are you there"?

Barb

Re: Re: Update (Spiro effect on MDD)

Us Endocrinologists are frequently accused of mental masturbation when we link observations based only on sort of random articles or even wishful thinking.

See the last sentence in the abstract below. Some would use this as an example but our team thinks not.

So if you search PUBMED for any two items you will come up with many "matchs" that make no sense. Deciding which ones do and do not is not always an easy task.

Hypertension. 2007 Mar;49(3):704-11. Epub 2006 Dec 11.

Association of adrenal steroids with hypertension and the metabolic syndrome in blacks.

Kidambi S, Kotchen JM, Grim CE, Raff H, Mao J, Singh RJ, Kotchen TA.

Source

Medical College of Wisconsin, Milwaukee, USA.

Erratum in

Hypertension. 2007 Mar;49(3):e20.

Abstract

Blacks have a high prevalence of hypertension and adrenal cortical adenomas/hyperplasia. We evaluated the hypothesis that adrenal steroids are associated with hypertension and the metabolic syndrome in blacks. Ambulatory blood pressures, anthropometric measurements, and measurements of plasma renin activity (PRA), aldosterone, fasting lipids, glucose, and insulin were obtained in 397 subjects (46% hypertensive and 50% female) after discontinuing antihypertensive and lipid-lowering medications. Hypertension was defined as average ambulatory blood pressure >130/85 mm Hg. Late-night and early morning salivary cortisol, 24-hour urine-free cortisol, and cortisone excretion were measured in a consecutive subsample of 97 subjects (40% hypertensive and 52% female). Compared with normotensive subjects, hypertensive subjects had greater waist circumference and unfavorable lipid profiles, were more insulin resistant, and had lower PRA and higher plasma aldosterone and both late-night and early morning salivary cortisol concentrations. Twenty-four-hour urine-free cortisol and cortisone did not differ. Overall, ambulatory blood pressure was positively correlated with plasma aldosterone (r=0.22; P<0.0001) and late-night salivary cortisol (r=0.23; P=0.03) and inversely correlated with PRA (r=-0.21; P<0.001). Plasma aldosterone correlated significantly with waist circumference, total cholesterol, triglycerides, insulin, and the insulin-resistance index. Based on Adult Treatment Panel III criteria, 17% of all of the subjects were classified as having the metabolic syndrome. Plasma aldosterone levels, but not PRA, were elevated in subjects with the metabolic syndrome (P=0.0002). The association of aldosterone with blood pressure, waist circumference, and insulin resistance suggests that aldosterone may contribute to obesity-related hypertension in blacks. In addition, we speculate that relatively high aldosterone and low PRA in these hypertensive individuals may reflect a mild variant of primary aldosteronism.

On Feb 5, 2012, at 3:23 AM, wrote:

I didn't know that I had to validate the study too, I thought that was why we used Pubmed. The article I quoted was published in "Arch Gen Psychiatry. 2003;60:24-28" so it has had 9 years to be reviewed and challenged by professionls, I doubt I could add anything!To validate it I referred it to my treating professionls. Dr. Bolton has professor status at the University of Vermont (UVM) and she was going to the library to see if there was any more info in the last 9 years. I expect to hear back later this month.I simply found a study that indicated that treatment with spironolactone caused an increase in cortisol. Then I found another study that while the increase was not a problem in "normals", it increased serotonin in PTNs with MDD. Wouldn't it be nice to know this in advance? Maybe there is another medicine, on either side of the conflict, that would eliminte this problem. If not, maybe we need to increase the SSRI or find something that reduces cortisol. (And at the minimum the left hand should know what the right hand is doing!)Don't worry about me, I eliminated the potential problem on Dec. 20th and hope I don't have to see how it works with epleremone! :>)...> > > > > >> > > > > > 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> > > > > >> > > > >> > > >> > > >> > > > Reply to sender | Reply to group | Reply via web post | Start a > > New Topic> > > > Messages in this topic (110)> > > > RECENT ACTIVITY: New Files 1> > > > Visit Your Group> > >> >> >>