Re: JC at NIC - Is it A/CPA?

[Guest guest]

Before we could measure plasma cortisol we used urine but harder to collect. Saliva is a substitute that can be easily done in OP. But no good way to correct for salivation rate. CE Grim MDOn Apr 23, 2012, at 6:14 AM, wrote: No, but they did no less than 6 cortisol & ACTH tests including two at 11:30 pm & midnight (one of these two was added so they may have been confirming something seen the night before.) They also did 24hr urine tests 9 days straight! > > > > > > Well, well, Well - Look what I just found: > > > http://eje-online.org/content/164/4/447.full.pdf > > > > > . > > > <http://geo./serv?s=97359714/grpId=7299303/grpspId=1705132763/msgId > =42539/stime=1335072741/nc1=5191946/nc2=3848642/nc3=5191951> >

[Guest guest]

Rarely reported in the past. Maybe more often now as we have better ways to test. I am not aware of how one can use adrenal cortisol levels as as a test for excess cortisol without giving Dex before to shut off ACTH and variations during the sampling. This would shut down cortisol release from the adrenal except the tumor unless one had pituitary Cushing's which seems to be the most common cause.Do we have your exact numbers in our files?CE Grim MDOn Apr 22, 2012, at 7:21 PM, lk.barns wrote: The results from both AVS samples showed significantly higher cortisol levels on my right side - higher than would be the normal high cortisol level resulting from poking the adrenal gland with a catheter or the levels indicative of having the catheter in the adrenal vein. The 1st AVS demonstrated that the aldosterone levels were inconsistent with the cortisol readings - it appears that the left and right side samples for aldosterone were mixed up in the lab. On the 2nd AVS the cortisol were consistent with the 1st levels and the aldosterone levels were consistent with both sets of cortisol levels. Since the Cortical tissues of an adrenal gland produces cortisol, aldosterone and androgens - could not a tumor growing in the corticol tissue of an adrenal gland secrete multiple hormones in excess amounts? > > > > > > > > > > > > > > > > > > > > > > > > > > > Well, well, Well - Look what I just found: > > > > > > > > > http://eje-online.org/content/164/4/447.full.pdf > > > > > > > > > <http://eje-online.org/content/164/4/447.full.pdf> > > > > > > > > > > > > > > > > > > "Aldosterone- and cortisol-co-secreting adrenal tumors: the lost subtype > > > > > > > > > of primary aldosteronism." > > > > > > > > > > > > > > > > > > I thought I was wierd and now I find there at least 35 others out there > > > > > > > > > in the world! [] (Pretty soon they will be telling me I'm > > > > > > > > > "Normal" [] ) > > > > > > > > > > > > > > > > > > Dr. Grim, any info/experience with it? I've got to read it a couple > > > > > > > > > times and see if there any muted genes mentioned. Barbara Tatro, where > > > > > > > > > are you when I need you? > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >

[Guest guest]

Suspect you mean measurements. ACTH testing involves giving ACTH. Ah yes I remember the days when we did this in many research studies but in several hundred folks with HTN when you could put people in the hospital to test to detect the cause of difficult HTN. Our 4 day protocol was excellent and cost-effective. Till hosp charges skyrocketed.Before this it would take up to 2 weeks in hosp to test for PA. We've come a long way Babe.See:

1.

Grim

CE, Weinberger MH, Higgins JT Jr, and Kramer NJ. Diagnosis of secondary forms

of hypertension: A comprehensive protocol. JAMA 1977;237: 1331-1335.

On Apr 23, 2012, at 5:44 AM, wrote: No, but they did no less than 6 cortisol & ACTH tests including two at 11:30 pm & midnight (one of these two was added so they may have been confirming something seen the night before.) They also did 24hr urine tests 9 days straight! > > > > > > Well, well, Well - Look what I just found: > > > http://eje-online.org/content/164/4/447.full.pdf > > > > > . > > > <http://geo./serv?s=97359714/grpId=7299303/grpspId=1705132763/msgId > =42539/stime=1335072741/nc1=5191946/nc2=3848642/nc3=5191951> >

[Guest guest]

Had an earlier Dex test which shut down the ACTH but did not suppress cortisol

secretion - indicating an adrenal source for cortisol. The AVS's while

specifically measuring aldosterone with the cortisol readings being only for

confirmation that the catheter was in the correct location -showed significantly

higher cortisol readings from the adrenal with the tumor - I don't believe that

this was coincidental

> > > > > > > > > > >

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> > > > > > > > > > > Well, well, Well - Look what I just found:

> > > > > > > > > > > http://eje-online.org/content/164/4/447.full.pdf

> > > > > > > > > > > <http://eje-online.org/content/164/4/447.full.pdf>

> > > > > > > > > > >

> > > > > > > > > > > " Aldosterone- and cortisol-co-secreting adrenal

> > tumors: the lost subtype

> > > > > > > > > > > of primary aldosteronism. "

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> > > > > > > > > > > I thought I was wierd and now I find there at

> > least 35 others out there

> > > > > > > > > > > in the world! [] (Pretty soon they will be

> > telling me I'm

> > > > > > > > > > > " Normal " [] )

> > > > > > > > > > >

> > > > > > > > > > > Dr. Grim, any info/experience with it? I've got to

> > read it a couple

> > > > > > > > > > > times and see if there any muted genes mentioned.

> > Barbara Tatro, where

> > > > > > > > > > > are you when I need you?

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> > > > > > > > >

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> > > >

> > > >

> > >

> >

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>

[Guest guest]

Ah that is of interest but if on the left side one can almost always get a "cleaner" adrenal blood sample and thus may have higher cortisol. Was more that one taken for each side?This is because the left adrenal vein is usually a single one and quite large. I have watched a number of AVS studies and other our radiologist would be in the left adrenal vein in about 10 seconds after the cath inserted. I think I could prob do the left my self. Has any of the Cushing's signs gotten better?If you did not have an episode of 't after surgery likely the cortisol is coming from other sources as well. CE Grim MDOn May 3, 2012, at 2:56 PM, lk.barns wrote: Had an earlier Dex test which shut down the ACTH but did not suppress cortisol secretion - indicating an adrenal source for cortisol. The AVS's while specifically measuring aldosterone with the cortisol readings being only for confirmation that the catheter was in the correct location -showed significantly higher cortisol readings from the adrenal with the tumor - I don't believe that this was coincidental > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Well, well, Well - Look what I just found: > > > > > > > > > > > http://eje-online.org/content/164/4/447.full.pdf > > > > > > > > > > > <http://eje-online.org/content/164/4/447.full.pdf> > > > > > > > > > > > > > > > > > > > > > > "Aldosterone- and cortisol-co-secreting adrenal > > tumors: the lost subtype > > > > > > > > > > > of primary aldosteronism." > > > > > > > > > > > > > > > > > > > > > > I thought I was wierd and now I find there at > > least 35 others out there > > > > > > > > > > > in the world! [] (Pretty soon they will be > > telling me I'm > > > > > > > > > > > "Normal" [] ) > > > > > > > > > > > > > > > > > > > > > > Dr. Grim, any info/experience with it? I've got to > > read it a couple > > > > > > > > > > > times and see if there any muted genes mentioned. > > Barbara Tatro, where > > > > > > > > > > > are you when I need you? > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >