Re: Week One at NIH

[Guest guest]

Based on your urine volume you have PA.I hope your DASH lapses and not fatal. CE Grim MDOn Jul 21, 2012, at 3:49 PM, ww_engineer wrote:

Hello all:

I've have been in the study at NIH for the past week. I don't have many test results, but thought I would post what I know so far. These are the number the resident discussed with me. I don't have print outs of the results.

They did an IV saline loading test Monday morning. My serum aldosterone went from 5.9 to 4.0 during the test for a normal result. The diurnal cortisol test result was 4.2 (I think that was the midnight sample) which was abnormal. My AVS was canceled until they could do more tests.

The doctors here were a little stumped by this, as the previous testing strongly suggested PA. They team is sure that I have an adrenal tumor, but that it possibly producing glucocorticoids, and that is affecting the aldosterone. They did not have the results of the 24-hr urine samples to review.

Based on the results to date, they asked me to stay another week, which I'm going to do. I started oral salt loading today, and then they are going to more tests for ACTH and dex suppression or something similar. (Dr. Lysikatos called it a "Lills" test or something like that I think). If the oral salt loading test and 24-hour urine collections are positive for PA they will accept that as positive and have me come back for AVS.

Dr. Stratakis went over my CT scan images with me. The original finding form home was a 1 and 1.3 cm adenoma on my left adrenal, with nothing else noted. Dr. Stratakis' interruption of the image is that there was only a one adenoma on the left, and that the second adenoma was misidentified. He also noted: an adenoma on my right adrenal that was missed; that both adrenal were slightly enlarged; and a small calcium deposit the left adrenal.

One nurse thought the results of the saline suppression might be off due to the way the samples were collected. I fell while working in my basement before coming to the NIH, and had a huge bruise and some swelling in my right arm. Because of this they have only used my left arm for BP and IVs. For the Saline Suppression test they normally inject the saline in one arm and draw blood out the other. For me the used the same catheter, and temporally removed the saline line to draw the blood, which may have diluted the samples.

Dr. Grim: I measured urine I produced during the test. From the start to finish of the saline injection it was 1750 cc, then another 300 cc the first time I went after the test, total of 2050 cc.

Thumbnail:

Caucasian, male, 51 years old, 6'- 3" tall, 285 lbs.

Adrenal adenoma both sides by CT scan

Diabetic Type II, OSA on cpap

Verapamil CR 360 mg

Hydralazine, 50 mg x3

Janumet 50/1000 (not taking at NIH)

Simcor 1000/40

Novolog 70/30

Dashing with occasional lapses