JC at NIH - Attending Physician

[Guest guest]

I thought you might like to see my doctor's position on PA.

Dr Moriatis is my attending physician, Dr, Stratikas is the big boss at NIH. (I

read section 14 a couple times!)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3057029/pdf/IJHT2011-624691.pdf

[Guest guest]

Thanks and should be uploaded to our file on PA reviews. Nice review but strange that low sodium/high K diet (DASH) in not mentioned in the management of PA-the classic form of Aldo-Salt Hypertension which has been well studied in rats at NIH. But article was about diagnosis-mostly. Indeed I will communicate with them about this issue to see if they are exploring this way to improve management of PA.The review also seems to forget the article by Conn's group published in 1967 that led most HTNologists (as it did me after reading the article at that time) to drop low K as a necessary condition for the Dx of PA. I consider this a long time ago "in the past". So a better statement would be "despite the first report of normokalemic primary aldosteronism 44 years ago most practicing physicians have been taught that a low K is needed to make the Dx. Only recently has this major teaching error begun to be corrected. But would be good to review some medical curriculums to see if this is still being taught. I stopped teaching it in 1967. " In the past, clinicians would not consider the diagnosisof primary hyperaldosteronism unless the patient presentedwith spontaneous hypokalemia, and then the diagnosticevaluation would require discontinuation of antihypertensivemedications for at least 2 weeks. The spontaneoushypokalemia/no antihypertensive drug approach resulted inpredicted prevalence rates of less than 0.5% of hypertensivepatients."Diagnosis of normokalemic primary aldosteronism, a new form of curable hypertension.Conn JW.Science. 1967 Oct 27;158(3800):525-6. No abstract available. We also noted adrenal abnormalities in HTN pts with ONLY low PRA and difficult HTN who we operated on at Duke starting when I was a Renal Fellow there in 1965-6 and published in 1970. I then spent a year in Dr. Conn's lab in 1969. 1.Hypertension, adrenal abnormalities, and alterations in plasma renin activity.Gunnells JC Jr, McGuffin WL Jr, RR, Grim CE, Wells S, Silver D, Glenn JF.Ann Intern Med. 1970 Dec;73(6):901-11. No abstract available.As the first author of the report of the first family with normokalemic GRA in 1977 I am a bit miffed that this was not mentioned but then again their article was a review.

Grim

CE, Weinberger MH, and Anand S. Familial, dexamethasone suppressible,

normokalemic hyperaldosteronism. In Hypertension in Childhood, (M. New ed),

Raven Press, New York, 1977;109-122 Grim

CE, Weinberger MH. Familial dexamethasone suppressible normokalemic

hyperaldosteronism. Pediatrics, 1980;65:597-604.CE Grim MD

On Apr 20, 2012, at 10:03 PM, wrote: I thought you might like to see my doctor's position on PA. Dr Moriatis is my attending physician, Dr, Stratikas is the big boss at NIH. (I read section 14 a couple times!) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3057029/pdf/IJHT2011-624691.pdf

[Guest guest]

Thanks and should be uploaded to our file on PA reviews. Nice review but strange that low sodium/high K diet (DASH) in not mentioned in the management of PA-the classic form of Aldo-Salt Hypertension which has been well studied in rats at NIH. But article was about diagnosis-mostly. Indeed I will communicate with them about this issue to see if they are exploring this way to improve management of PA.The review also seems to forget the article by Conn's group published in 1967 that led most HTNologists (as it did me after reading the article at that time) to drop low K as a necessary condition for the Dx of PA. I consider this a long time ago "in the past". So a better statement would be "despite the first report of normokalemic primary aldosteronism 44 years ago most practicing physicians have been taught that a low K is needed to make the Dx. Only recently has this major teaching error begun to be corrected. But would be good to review some medical curriculums to see if this is still being taught. I stopped teaching it in 1967. " In the past, clinicians would not consider the diagnosisof primary hyperaldosteronism unless the patient presentedwith spontaneous hypokalemia, and then the diagnosticevaluation would require discontinuation of antihypertensivemedications for at least 2 weeks. The spontaneoushypokalemia/no antihypertensive drug approach resulted inpredicted prevalence rates of less than 0.5% of hypertensivepatients."Diagnosis of normokalemic primary aldosteronism, a new form of curable hypertension.Conn JW.Science. 1967 Oct 27;158(3800):525-6. No abstract available. We also noted adrenal abnormalities in HTN pts with ONLY low PRA and difficult HTN who we operated on at Duke starting when I was a Renal Fellow there in 1965-6 and published in 1970. I then spent a year in Dr. Conn's lab in 1969. 1.Hypertension, adrenal abnormalities, and alterations in plasma renin activity.Gunnells JC Jr, McGuffin WL Jr, RR, Grim CE, Wells S, Silver D, Glenn JF.Ann Intern Med. 1970 Dec;73(6):901-11. No abstract available.As the first author of the report of the first family with normokalemic GRA in 1977 I am a bit miffed that this was not mentioned but then again their article was a review.

Grim

CE, Weinberger MH, and Anand S. Familial, dexamethasone suppressible,

normokalemic hyperaldosteronism. In Hypertension in Childhood, (M. New ed),

Raven Press, New York, 1977;109-122 Grim

CE, Weinberger MH. Familial dexamethasone suppressible normokalemic

hyperaldosteronism. Pediatrics, 1980;65:597-604.CE Grim MD

On Apr 20, 2012, at 10:03 PM, wrote: I thought you might like to see my doctor's position on PA. Dr Moriatis is my attending physician, Dr, Stratikas is the big boss at NIH. (I read section 14 a couple times!) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3057029/pdf/IJHT2011-624691.pdf

[Guest guest]

Thanks and I just sent her a note re the article. Esp on the failure to mention the requirement of excess diet salt for aldo to do its damage. Mentioned our site but no names.CE Grim MDOn Apr 20, 2012, at 10:03 PM, wrote: I thought you might like to see my doctor's position on PA. Dr Moriatis is my attending physician, Dr, Stratikas is the big boss at NIH. (I read section 14 a couple times!) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3057029/pdf/IJHT2011-624691.pdf