Re: Re: Makes one wonder.....

March 5, 2011

I was reading through this research article and it discusses a 60ish female who had "years" of high blood pressure that could not be controlled on multiple meds and severe hypokalemia. They seemed to initially attribute the low K to hctz (they just made it worse actually). But It doesn't say which meds she was on prior to finally figuring out what was going on, but if any of us could guess it was likely some combo of an ACEI, a beta blocker, maybe a CCB, and maybe clonodine, and

including the mentioned hctz. http://www.ispub.com/journal/the_internet_journal_of_surgery/volume_24_number_1_1/article/conn-s-syndrome-a-diagnostic-dilemma-case-report.htmlI say in the tag "makes one wonder" because no mention is made of whether she was on or off the medications when they did the actual testing of blood and urine. They state that she had an atypical presentation of PA because while only her serum potassium was off, herurine K

was not, and aldosterone and renin were normal. I kind of suspect, if this lady's story is anything like so many of us on this list, she never stopped her meds and so those particular classes of blood pressure medicines, likely gave her a "net" level that was in the normal range when this wasn't entirely true. If understand correctly these medicines, ACEI, BB's etc, do interfere. So I wonder if she was actually a classic typical case and they just missed it (and sadly LITERALLY a classic case from our experiences here wherein they kept missing it for years, didn't do any tests right, and she went on for so long without the right diagnosis).I

March 5, 2011

They tried me on HCTZ a few times also and each time I ended up in the hospital for low K.....they never put 2 and 2 together though.Subject: Re: Makes one wonder.....To: hyperaldosteronism Date: Saturday,

March 5, 2011, 10:10 AM

I have a feeling this is not an uncommon experience - my low K was overlooked for 4 years, then attributed to HCTZ for the next year after that, while all the while the doctor kept putting me on more and stronger ARBs and CCBs - all of which did nothing except make my BP higher!

-msmith1928

45, female, 5'3", 120 lbs, 1cm left adrenal nodule, aldosterone 42.3, renin 0.5, potassium <2.9 (when not taking supplements); 25mg spiro caused gynecomastia, no HTN meds; other meds are 20MEQ K 2x/day, singulair 10mg, norethindrone .35mg, and cyclobenzaprine 5mg as needed; low sodium, fructose- and grain-free diet

>

> I was reading through this research article and it discusses a 60ish female who had "years" of high blood pressure that could not be controlled on multiple meds and severe hypokalemia. They seemed to initially attribute the low K to hctz (they just made it worse actually).

>

> But It doesn't say which meds she was on prior to finally figuring out what was going on, but if any of us could guess it was likely some combo of an ACEI, a beta blocker, maybe a CCB, and maybe clonodine, and including the mentioned hctz.

>

> http://www.ispub.com/journal/the_internet_journal_of_surgery/volume_24_number_1_1/article/conn-s-syndrome-a-diagnostic-dilemma-case-report.html

>

> I say in the tag "makes one wonder" because no mention is made of whether she was on or off the medications when they did the actual testing of blood and urine. They state that she had an atypical presentation of PA because while only her serum potassium was off, herurine K

> was not, and aldosterone and renin were normal. I kind of suspect, if this lady's story is anything like so many of us on this list, she never stopped her meds and so those particular classes of blood pressure medicines, likely gave her a "net" level that was in the normal range when this wasn't entirely true. If understand correctly these medicines, ACEI, BB's etc, do interfere.

>

> So I wonder if she was actually a classic typical case and they just missed it (and sadly LITERALLY a classic case from our experiences here wherein they kept missing it for years, didn't do any tests right, and she went on for so long without the right diagnosis).

>

> I

>

March 5, 2011

my nephrologist still refuses to believe that hctz caused my renal and k numbers to go crazy and still wants me to look for a kidney donor even though my function improves with every visit.

Pam

They tried me on HCTZ a few times also and each time I ended up in the hospital for low K.....they never put 2 and 2 together though.

Subject: Re: Makes one wonder.....

To: hyperaldosteronism Date: Saturday, March 5, 2011, 10:10 AM

I have a feeling this is not an uncommon experience - my low K was overlooked for 4 years, then attributed to HCTZ for the next year after that, while all the while the doctor kept putting me on more and stronger ARBs and CCBs - all of which did nothing except make my BP higher!

-msmith192845, female, 5'3 " , 120 lbs, 1cm left adrenal nodule, aldosterone 42.3, renin 0.5, potassium <2.9 (when not taking supplements); 25mg spiro caused gynecomastia, no HTN meds; other meds are 20MEQ K 2x/day, singulair 10mg, norethindrone .35mg, and cyclobenzaprine 5mg as needed; low sodium, fructose- and grain-free diet

>> I was reading through this research article and it discusses a 60ish female who had " years " of high blood pressure that could not be controlled on multiple meds and severe hypokalemia. They seemed to initially attribute the low K to hctz (they just made it worse actually).

> > But It doesn't say which meds she was on prior to finally figuring out what was going on, but if any of us could guess it was likely some combo of an ACEI, a beta blocker, maybe a CCB, and maybe clonodine, and including the mentioned hctz.

> > http://www.ispub.com/journal/the_internet_journal_of_surgery/volume_24_number_1_1/article/conn-s-syndrome-a-diagnostic-dilemma-case-report.html

> > I say in the tag " makes one wonder " because no mention is made of whether she was on or off the medications when they did the actual testing of blood and urine. They state that she had an atypical presentation of PA because while only her serum potassium was off, herurine K

> was not, and aldosterone and renin were normal. I kind of suspect, if this lady's story is anything like so many of us on this list, she never stopped her meds and so those particular classes of blood pressure medicines, likely gave her a " net " level that was in the normal range when this wasn't entirely true. If understand correctly these medicines, ACEI, BB's etc, do interfere.

> > So I wonder if she was actually a classic typical case and they just missed it (and sadly LITERALLY a classic case from our experiences here wherein they kept missing it for years, didn't do any tests right, and she went on for so long without the right diagnosis).

> > I>

March 5, 2011

So sad isn't it. Before PA I would literally in just a couple of doses after I would humor them and go back on HCTZ, I would hit rock bottom with my potassium and be in the ER getting it replaced. I refused any more HCTZ long before the PA diagnosis, but still... I always asked and asked anyone who would listen as to "why am I dumping potassium?" and usually they just ignored me. I tried early on, a few years ago when I started hitting 160/120 every day, to do my research and brought it up to those doctors I saw, but they usually shrugged it off so I did too. Not a good excuse but it is the only one I have. I worked back then by myself as a physician assistant in a small rural community where I was the only provider in the county and my doc was 1 1/2 hours away, so I didn't interact, except over the phone, with many other providers to get their take on

it. I do recall a couple of cases of young men I saw who had fairly out of control htn, and while I referred them to cardiologists regarding it, I still ponder if I dropped the ball and are they now one of many out there walking around with PA undiagnosed because we are not getting the tests done and done right? I think now, given how it is so overlooked, I will order the tests, still refer them, but at least I will know we are looking under every stone.

Subject: Re: Makes one wonder.....

To: hyperaldosteronism Date: Saturday, March 5, 2011, 10:10 AM

I have a feeling this is not an uncommon experience - my low K was overlooked for 4 years, then attributed to HCTZ for the next year after that, while all the while the doctor kept putting me on more and stronger ARBs and CCBs - all of which did nothing except make my BP higher!

-msmith192845, female, 5'3", 120 lbs, 1cm left adrenal nodule, aldosterone 42.3, renin 0.5, potassium <2.9 (when not taking supplements); 25mg spiro caused gynecomastia, no HTN meds; other meds are 20MEQ K 2x/day, singulair 10mg, norethindrone .35mg, and cyclobenzaprine 5mg as needed; low sodium, fructose- and grain-free diet

>> I was reading through this research article and it discusses a 60ish female who had "years" of high blood pressure that could not be controlled on multiple meds and severe hypokalemia. They seemed to initially attribute the low K to hctz (they just made it worse actually).

> > But It doesn't say which meds she was on prior to finally figuring out what was going on, but if any of us could guess it was likely some combo of an ACEI, a beta blocker, maybe a CCB, and maybe clonodine, and including the mentioned hctz.

> > http://www.ispub.com/journal/the_internet_journal_of_surgery/volume_24_number_1_1/article/conn-s-syndrome-a-diagnostic-dilemma-case-report.html

> > I say in the tag "makes one wonder" because no mention is made of whether she was on or off the medications when they did the actual testing of blood and urine. They state that she had an atypical presentation of PA because while only her serum potassium was off, herurine K

> was not, and aldosterone and renin were normal. I kind of suspect, if this lady's story is anything like so many of us on this list, she never stopped her meds and so those particular classes of blood pressure medicines, likely gave her a "net" level that was in the normal range when this wasn't entirely true. If understand correctly these medicines, ACEI, BB's etc, do interfere.

> > So I wonder if she was actually a classic typical case and they just missed it (and sadly LITERALLY a classic case from our experiences here wherein they kept missing it for years, didn't do any tests right, and she went on for so long without the right diagnosis).

> > I>

March 5, 2011

What would be a good bp med to use? Do any help?

I have a feeling this is not an uncommon experience - my low K was overlooked for 4 years, then attributed to HCTZ for the next year after that, while all the while the doctor kept putting me on more and stronger ARBs and CCBs - all of which did nothing except make my BP higher!

-msmith1928

45, female, 5'3", 120 lbs, 1cm left adrenal nodule, aldosterone 42.3, renin 0.5, potassium <2.9 (when not taking supplements); 25mg spiro caused gynecomastia, no HTN meds; other meds are 20MEQ K 2x/day, singulair 10mg, norethindrone .35mg, and cyclobenzaprine 5mg as needed; low sodium, fructose- and grain-free diet

>

> I was reading through this research article and it discusses a 60ish female who had "years" of high blood pressure that could not be controlled on multiple meds and severe hypokalemia. They seemed to initially attribute the low K to hctz (they just made it worse actually).

>

> But It doesn't say which meds she was on prior to finally figuring out what was going on, but if any of us could guess it was likely some combo of an ACEI, a beta blocker, maybe a CCB, and maybe clonodine, and including the mentioned hctz.

>

> http://www.ispub.com/journal/the_internet_journal_of_surgery/volume_24_number_1_1/article/conn-s-syndrome-a-diagnostic-dilemma-case-report.html

>

> I say in the tag "makes one wonder" because no mention is made of whether she was on or off the medications when they did the actual testing of blood and urine. They state that she had an atypical presentation of PA because while only her serum potassium was off, herurine K

> was not, and aldosterone and renin were normal. I kind of suspect, if this lady's story is anything like so many of us on this list, she never stopped her meds and so those particular classes of blood pressure medicines, likely gave her a "net" level that was in the normal range when this wasn't entirely true. If understand correctly these medicines, ACEI, BB's etc, do interfere.

>

> So I wonder if she was actually a classic typical case and they just missed it (and sadly LITERALLY a classic case from our experiences here wherein they kept missing it for years, didn't do any tests right, and she went on for so long without the right diagnosis).

>

> I

>

March 5, 2011

Thanks for the info! I'll take it along to Dr appt. It's been 5 years since I had surgery so I forget what all I was taking. I remember the spiro but I was also on bp meds. I think prpanalol. By the end I was on nitroglycerine because of spikes reaching 210/118. The only thing that worked was the nitro. I didn't have the benefit of this list then. Thanks again

-- In hyperaldosteronism , Txsgreen wrote:

>

> What would be a good bp med to use? Do any help?

From what I've gathered here, in order of preference the only meds for secondary HTN from PA are, in order of preference, spironolactone, eplerenone, and, in some cases, amiloride.

March 5, 2011

No!9 the order of preference Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

-- In hyperaldosteronism , Txsgreen wrote:

>

> What would be a good bp med to use? Do any help?

From what I've gathered here, in order of preference the only meds for secondary HTN from PA are, in order of preference, spironolactone, eplerenone, and, in some cases, amiloride.

March 5, 2011

No! The order of preference is DASH then Spiro then eplere but I suspect if cost is no problem then eplerenone. ITiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

-- In hyperaldosteronism , Txsgreen wrote:

>

> What would be a good bp med to use? Do any help?

From what I've gathered here, in order of preference the only meds for secondary HTN from PA are, in order of preference, spironolactone, eplerenone, and, in some cases, amiloride.

March 6, 2011

sounds like time for a second opinion unless you want to have a kidney transplant. Give us a plot of your Creatinine and eGFG over time so we can tell you when you will need dialysis or kidney transplants. Have you had and CTs or MRIs with contrast in the last 2 yearw?my nephrologist still refuses to believe that hctz caused my renal and k numbers to go crazy and still wants me to look for a kidney donor even though my function improves with every visit.Pam They tried me on HCTZ a few times also and each time I ended up in the hospital for low K.....they never put 2 and 2 together though.Subject: Re: Makes one wonder.....To: hyperaldosteronism Date: Saturday, March 5, 2011, 10:10 AM I have a feeling this is not an uncommon experience - my low K was overlooked for 4 years, then attributed to HCTZ for the next year after that, while all the while the doctor kept putting me on more and stronger ARBs and CCBs - all of which did nothing except make my BP higher!-msmith192845, female, 5'3", 120 lbs, 1cm left adrenal nodule, aldosterone 42.3, renin 0.5, potassium <2.9 (when not taking supplements); 25mg spiro caused gynecomastia, no HTN meds; other meds are 20MEQ K 2x/day, singulair 10mg, norethindrone .35mg, and cyclobenzaprine 5mg as needed; low sodium, fructose- and grain-free diet>> I was reading through this research article and it discusses a 60ish female who had "years" of high blood pressure that could not be controlled on multiple meds and severe hypokalemia. They seemed to initially attribute the low K to hctz (they just made it worse actually). > > But It doesn't say which meds she was on prior to finally figuring out what was going on, but if any of us could guess it was likely some combo of an ACEI, a beta blocker, maybe a CCB, and maybe clonodine, and including the mentioned hctz. > > http://www.ispub.com/journal/the_internet_journal_of_surgery/volume_24_number_1_1/article/conn-s-syndrome-a-diagnostic-dilemma-case-report.html> > I say in the tag "makes one wonder" because no mention is made of whether she was on or off the medications when they did the actual testing of blood and urine. They state that she had an atypical presentation of PA because while only her serum potassium was off, herurine K> was not, and aldosterone and renin were normal. I kind of suspect, if this lady's story is anything like so many of us on this list, she never stopped her meds and so those particular classes of blood pressure medicines, likely gave her a "net" level that was in the normal range when this wasn't entirely true. If understand correctly these medicines, ACEI, BB's etc, do interfere. > > So I wonder if she was actually a classic typical case and they just missed it (and sadly LITERALLY a classic case from our experiences here wherein they kept missing it for years, didn't do any tests right, and she went on for so long without the right diagnosis).> > I>

March 6, 2011

sounds like time for a second opinion unless you want to have a kidney transplant. Give us a plot of your Creatinine and eGFG over time so we can tell you when you will need dialysis or kidney transplants. Have you had and CTs or MRIs with contrast in the last 2 yearw?my nephrologist still refuses to believe that hctz caused my renal and k numbers to go crazy and still wants me to look for a kidney donor even though my function improves with every visit.Pam They tried me on HCTZ a few times also and each time I ended up in the hospital for low K.....they never put 2 and 2 together though.Subject: Re: Makes one wonder.....To: hyperaldosteronism Date: Saturday, March 5, 2011, 10:10 AM I have a feeling this is not an uncommon experience - my low K was overlooked for 4 years, then attributed to HCTZ for the next year after that, while all the while the doctor kept putting me on more and stronger ARBs and CCBs - all of which did nothing except make my BP higher!-msmith192845, female, 5'3", 120 lbs, 1cm left adrenal nodule, aldosterone 42.3, renin 0.5, potassium <2.9 (when not taking supplements); 25mg spiro caused gynecomastia, no HTN meds; other meds are 20MEQ K 2x/day, singulair 10mg, norethindrone .35mg, and cyclobenzaprine 5mg as needed; low sodium, fructose- and grain-free diet>> I was reading through this research article and it discusses a 60ish female who had "years" of high blood pressure that could not be controlled on multiple meds and severe hypokalemia. They seemed to initially attribute the low K to hctz (they just made it worse actually). > > But It doesn't say which meds she was on prior to finally figuring out what was going on, but if any of us could guess it was likely some combo of an ACEI, a beta blocker, maybe a CCB, and maybe clonodine, and including the mentioned hctz. > > http://www.ispub.com/journal/the_internet_journal_of_surgery/volume_24_number_1_1/article/conn-s-syndrome-a-diagnostic-dilemma-case-report.html> > I say in the tag "makes one wonder" because no mention is made of whether she was on or off the medications when they did the actual testing of blood and urine. They state that she had an atypical presentation of PA because while only her serum potassium was off, herurine K> was not, and aldosterone and renin were normal. I kind of suspect, if this lady's story is anything like so many of us on this list, she never stopped her meds and so those particular classes of blood pressure medicines, likely gave her a "net" level that was in the normal range when this wasn't entirely true. If understand correctly these medicines, ACEI, BB's etc, do interfere. > > So I wonder if she was actually a classic typical case and they just missed it (and sadly LITERALLY a classic case from our experiences here wherein they kept missing it for years, didn't do any tests right, and she went on for so long without the right diagnosis).> > I>

March 6, 2011

Best is called DASH.CE Grim MDWhat would be a good bp med to use? Do any help? I have a feeling this is not an uncommon experience - my low K was overlooked for 4 years, then attributed to HCTZ for the next year after that, while all the while the doctor kept putting me on more and stronger ARBs and CCBs - all of which did nothing except make my BP higher!-msmith192845, female, 5'3", 120 lbs, 1cm left adrenal nodule, aldosterone 42.3, renin 0.5, potassium <2.9 (when not taking supplements); 25mg spiro caused gynecomastia, no HTN meds; other meds are 20MEQ K 2x/day, singulair 10mg, norethindrone .35mg, and cyclobenzaprine 5mg as needed; low sodium, fructose- and grain-free diet>> I was reading through this research article and it discusses a 60ish female who had "years" of high blood pressure that could not be controlled on multiple meds and severe hypokalemia. They seemed to initially attribute the low K to hctz (they just made it worse actually). > > But It doesn't say which meds she was on prior to finally figuring out what was going on, but if any of us could guess it was likely some combo of an ACEI, a beta blocker, maybe a CCB, and maybe clonodine, and including the mentioned hctz. > > http://www.ispub.com/journal/the_internet_journal_of_surgery/volume_24_number_1_1/article/conn-s-syndrome-a-diagnostic-dilemma-case-report.html> > I say in the tag "makes one wonder" because no mention is made of whether she was on or off the medications when they did the actual testing of blood and urine. They state that she had an atypical presentation of PA because while only her serum potassium was off, herurine K> was not, and aldosterone and renin were normal. I kind of suspect, if this lady's story is anything like so many of us on this list, she never stopped her meds and so those particular classes of blood pressure medicines, likely gave her a "net" level that was in the normal range when this wasn't entirely true. If understand correctly these medicines, ACEI, BB's etc, do interfere. > > So I wonder if she was actually a classic typical case and they just missed it (and sadly LITERALLY a classic case from our experiences here wherein they kept missing it for years, didn't do any tests right, and she went on for so long without the right diagnosis).> > I>

March 6, 2011

Classic clue to PA.Low K on HTZ or there diuretics. CE Grim MDThey tried me on HCTZ a few times also and each time I ended up in the hospital for low K.....they never put 2 and 2 together though.Subject: Re: Makes one wonder.....To: hyperaldosteronism Date: Saturday, March 5, 2011, 10:10 AM I have a feeling this is not an uncommon experience - my low K was overlooked for 4 years, then attributed to HCTZ for the next year after that, while all the while the doctor kept putting me on more and stronger ARBs and CCBs - all of which did nothing except make my BP higher!-msmith192845, female, 5'3", 120 lbs, 1cm left adrenal nodule, aldosterone 42.3, renin 0.5, potassium <2.9 (when not taking supplements); 25mg spiro caused gynecomastia, no HTN meds; other meds are 20MEQ K 2x/day, singulair 10mg, norethindrone .35mg, and cyclobenzaprine 5mg as needed; low sodium, fructose- and grain-free diet>> I was reading through this research article and it discusses a 60ish female who had "years" of high blood pressure that could not be controlled on multiple meds and severe hypokalemia. They seemed to initially attribute the low K to hctz (they just made it worse actually). > > But It doesn't say which meds she was on prior to finally figuring out what was going on, but if any of us could guess it was likely some combo of an ACEI, a beta blocker, maybe a CCB, and maybe clonodine, and including the mentioned hctz. > > http://www.ispub.com/journal/the_internet_journal_of_surgery/volume_24_number_1_1/article/conn-s-syndrome-a-diagnostic-dilemma-case-report.html> > I say in the tag "makes one wonder" because no mention is made of whether she was on or off the medications when they did the actual testing of blood and urine. They state that she had an atypical presentation of PA because while only her serum potassium was off, herurine K> was not, and aldosterone and renin were normal. I kind of suspect, if this lady's story is anything like so many of us on this list, she never stopped her meds and so those particular classes of blood pressure medicines, likely gave her a "net" level that was in the normal range when this wasn't entirely true. If understand correctly these medicines, ACEI, BB's etc, do interfere. > > So I wonder if she was actually a classic typical case and they just missed it (and sadly LITERALLY a classic case from our experiences here wherein they kept missing it for years, didn't do any tests right, and she went on for so long without the right diagnosis).> > I>

March 6, 2011

how do we get to all the folks who missed you as well as all PAs now in practice. I suggest you and I write a paper for the leading PA mag with your story and my comments.CE Grim MDSo sad isn't it. Before PA I would literally in just a couple of doses after I would humor them and go back on HCTZ, I would hit rock bottom with my potassium and be in the ER getting it replaced. I refused any more HCTZ long before the PA diagnosis, but still... I always asked and asked anyone who would listen as to "why am I dumping potassium?" and usually they just ignored me. I tried early on, a few years ago when I started hitting 160/120 every day, to do my research and brought it up to those doctors I saw, but they usually shrugged it off so I did too. Not a good excuse but it is the only one I have. I worked back then by myself as a physician assistant in a small rural community where I was the only provider in the county and my doc was 1 1/2 hours away, so I didn't interact, except over the phone, with many other providers to get their take on it. I do recall a couple of cases of young men I saw who had fairly out of control htn, and while I referred them to cardiologists regarding it, I still ponder if I dropped the ball and are they now one of many out there walking around with PA undiagnosed because we are not getting the tests done and done right? I think now, given how it is so overlooked, I will order the tests, still refer them, but at least I will know we are looking under every stone.Subject: Re: Makes one wonder.....To: hyperaldosteronism Date: Saturday, March 5, 2011, 10:10 AM I have a feeling this is not an uncommon experience - my low K was overlooked for 4 years, then attributed to HCTZ for the next year after that, while all the while the doctor kept putting me on more and stronger ARBs and CCBs - all of which did nothing except make my BP higher!-msmith192845, female, 5'3", 120 lbs, 1cm left adrenal nodule, aldosterone 42.3, renin 0.5, potassium <2.9 (when not taking supplements); 25mg spiro caused gynecomastia, no HTN meds; other meds are 20MEQ K 2x/day, singulair 10mg, norethindrone .35mg, and cyclobenzaprine 5mg as needed; low sodium, fructose- and grain-free diet>> I was reading through this research article and it discusses a 60ish female who had "years" of high blood pressure that could not be controlled on multiple meds and severe hypokalemia. They seemed to initially attribute the low K to hctz (they just made it worse actually). > > But It doesn't say which meds she was on prior to finally figuring out what was going on, but if any of us could guess it was likely some combo of an ACEI, a beta blocker, maybe a CCB, and maybe clonodine, and including the mentioned hctz. > > http://www.ispub.com/journal/the_internet_journal_of_surgery/volume_24_number_1_1/article/conn-s-syndrome-a-diagnostic-dilemma-case-report.html> > I say in the tag "makes one wonder" because no mention is made of whether she was on or off the medications when they did the actual testing of blood and urine. They state that she had an atypical presentation of PA because while only her serum potassium was off, herurine K> was not, and aldosterone and renin were normal. I kind of suspect, if this lady's story is anything like so many of us on this list, she never stopped her meds and so those particular classes of blood pressure medicines, likely gave her a "net" level that was in the normal range when this wasn't entirely true. If understand correctly these medicines, ACEI, BB's etc, do interfere. > > So I wonder if she was actually a classic typical case and they just missed it (and sadly LITERALLY a classic case from our experiences here wherein they kept missing it for years, didn't do any tests right, and she went on for so long without the right diagnosis).> > I>

March 6, 2011

No that is the old story. If you gave her my article it will be a once a year or more diagnosis. I suspect I know who taught her HTN if she was in Boston. Ask her. We need to correct them also.CE Grim MDThe sad part is something is missing in what Dr are learning in med schools. From 's information. I finally got back to see my Primary Care Physician, Dr. Webster, last week. We had a long conversation regarding what had been going on in the last 4 months and the direction I saw thing going. She indicated Conn's Syndrome was a "once in a lifetime experience" for general practice internists. On the VA web site I looked up Dr Webster information. She has been A Dr for about 12 years. She went to Dartmouth Med school. If I remember this right. From information my nephew told me from him working at the VA she spent a lot of time making sure all her patients were taking care of. many times spending 3 or 4 hours after office closed doing call backs. This may be the reason she didn't keep up to date on new information. Had she keep up to date she should have see that one out of ten with high blood pressure have PA. Far from the once in a lifetime experience. > >> > I was reading through this research article and it discusses a 60ish female who had "years" of high blood pressure that could not be controlled on multiple meds and severe hypokalemia. They seemed to initially attribute the low K to hctz (they just made it worse actually).> > > > > But It doesn't say which meds she was on prior to finally figuring out what was going on, but if any of us could guess it was likely some combo of an ACEI, a beta blocker, maybe a CCB, and maybe clonodine, and including the mentioned hctz. > > > > > http://www.ispub.com/journal/the_internet_journal_of_surgery/volume_24_number_1_1/article/conn-s-syndrome-a-diagnostic-dilemma-case-report.html> > > > > I say in the tag "makes one wonder" because no mention is made of whether she was on or off the medications when they did the actual testing of blood and urine. They state that she had an atypical presentation of PA because while only her serum potassium was off, herurine K> > > was not, and aldosterone and renin were normal. I kind of suspect, if this lady's story is anything like so many of us on this list, she never stopped her meds and so those particular classes of blood pressure medicines, likely gave her a "net" level that was in the normal range when this wasn't entirely true. If understand correctly these medicines, ACEI, BB's etc, do interfere. > > > > > So I wonder if she was actually a classic typical case and they just missed it (and sadly LITERALLY a classic case from our experiences here wherein they kept missing it for years, didn't do any tests right, and she went on for so long without the right diagnosis).> > > > > I> >>

March 6, 2011

That is what the JNCs have said for many years. If you look at the bottom of the algo you will seeConsider referring to a HTN specialist.Unfor there are not a lot of us around.CE grim MDOh I don't deny you pumped he up before you slamed her, It was your final statement that got me upset. I quote, " Had she keep up to date she should have see that one out of ten with high bloodpressure have PA. Far from the once in a lifetime experience." I read that as "Every doctor should read enough so they will know everything that pertains to the medical profession!" Impossible I say, they need to know when to seek professional help and she got an A+ in my book. My BP was being controlled but she didn't like the way. As soon as she saw an opportunity she jumped.I don't know if she needs to become a Conn's specialist as much as she needs to know one and when to call for help! I read somewhere that if it took 3 or more meds to control your BP you should suspect Conn's. Maybe the rule of thumb should be: "If it takes 3 or more meds to control BP you should contact someone with HTN in their area of expertise".> > > > >> > > > > I was reading through this research article and it discusses a 60ish female who had "years" of high blood pressure that could not be controlled on multiple meds and severe hypokalemia. They seemed to initially attribute the low K to hctz (they just made it worse actually). > > > > > > > > > > > > > > But It doesn't say which meds she was on prior to finally figuring out what was going on, but if any of us could guess it was likely some combo of an ACEI, a beta blocker, maybe a CCB, and maybe clonodine, and including the mentioned hctz. > > > > > > > > > > > > > > http://www.ispub.com/journal/the_internet_journal_of_surgery/volume_24_number_1_1/article/conn-s-syndrome-a-diagnostic-dilemma-case-report.html> > > > > > > > > > > > > > I say in the tag "makes one wonder" because no mention is made of whether she was on or off the medications when they did the actual testing of blood and urine. They state that she had an atypical presentation of PA because while only her serum potassium was off, herurine K> > > > > > > > > was not, and aldosterone and renin were normal. I kind of suspect, if this lady's story is anything like so many of us on this list, she never stopped her meds and so those particular classes of blood pressure medicines, likely gave her a "net" level that was in the normal range when this wasn't entirely true. If understand correctly these medicines, ACEI, BB's etc, do interfere. > > > > > > > > > > > > > > So I wonder if she was actually a classic typical case and they just missed it (and sadly LITERALLY a classic case from our experiences here wherein they kept missing it for years, didn't do any tests right, and she went on for so long without the right diagnosis).> > > > > > > > > > > > > > I> > > > >> > > >> > >> >>

March 6, 2011

My Endocrinologist is alright. Like I said lose a little personality that I can live with it seems with decent care, but he knew Conn's and he made the PA dx based on history and my long history of hypokalemia and the no doubt response to spiro. He is really worried about a pheo too because Norepi is pretty high (plasma) and other metanepherines are not (I have done the urine a few times, but that was before I knew how to do it right from this site, and they didn't instruct me right and I think it was normal - I didn't get those labs with my other records). I also have these runs of tach that never had happened prior to the thyroid issue and a sudden peak in blood pressure spike occasionally especially when I roll over at night on my belly (I tend to put my hands under me and I am pressing on SOMETHING I think). So MIGB and a better specific

adrenal CT is scheduled. They scheduled it a while ago, but I have so many CT's with dye lately I had to put some mileage between them since I already had such a malignant HTN for so long and I want to keep my kidneys.But when the spiro worked in just 2 doses of 25mg (does it work THAT good in alot of you?) when I was already on 5 other meds, he said there was no doubt, and he calls it Conn's, not PA - so Dr Conn's legacy is reaching a few!,And he mentioned DASH too. That damn sodium.......the first time I actually say him was when I very very ill with hyperthyroidism and I was at his visit with a BP 160ish over 130ish. He sent me to cardiology who actually started the spiro.and what got me THAT dx of hyperthyroid was a good ER doc when I finally said to him, after so many visits, that "something is wrong!" I told the ER doc that Sunday morning that I "was not depressed. I am not stressed more than the average guy is right

now, and I can't exercise because I can barely walk!" I had been getting progressively worse with this weakness (among a million other things)I couldn't explain and woke up that Sunday feeling like I was paralyzed almost. Heatrt was 140 that am too. What are the chances of PA, hyperthyroid, and pheo all in one? Would I be a "case for the ages"......okay anyone who's read my posts and those who know me know I am at least a "basket case for the ages"........Subject: Re: Makes one wonder.....To: hyperaldosteronism Date: Saturday, March 5, 2011, 10:10 AM I have a feeling this is not an uncommon experience - my low K was overlooked for 4 years, then attributed to HCTZ for

the next year after that, while all the while the doctor kept putting me on more and stronger ARBs and CCBs - all of which did nothing except make my BP higher!-msmith192845, female, 5'3", 120 lbs, 1cm left adrenal nodule, aldosterone 42.3, renin 0.5, potassium <2.9 (when not taking supplements); 25mg spiro caused gynecomastia, no HTN meds; other meds are 20MEQ K 2x/day, singulair 10mg, norethindrone .35mg, and cyclobenzaprine 5mg as needed; low sodium, fructose- and grain-free diet>> I was reading through this research article and it discusses a 60ish female who had "years" of high blood pressure that could not be controlled on multiple meds and severe hypokalemia. They seemed to initially

attribute the low K to hctz (they just made it worse actually). > > But It doesn't say which meds she was on prior to finally figuring out what was going on, but if any of us could guess it was likely some combo of an ACEI, a beta blocker, maybe a CCB, and maybe clonodine, and including the mentioned hctz. > > http://www.ispub.com/journal/the_internet_journal_of_surgery/volume_24_number_1_1/article/conn-s-syndrome-a-diagnostic-dilemma-case-report.html> > I say in the tag "makes one wonder" because no mention is made of whether she was on or off the medications when they did the actual testing of blood and urine. They state that she had an atypical presentation of PA because while only her serum potassium was off, herurine K> was not, and aldosterone and renin were normal. I kind of suspect, if this lady's story is anything like so many of us on this list, she never stopped her meds and so those particular classes of blood pressure medicines, likely gave her a "net" level that was in the normal range when this wasn't entirely true. If understand correctly these medicines, ACEI, BB's etc, do interfere. > > So I wonder if she was actually a classic typical case and they just missed it (and sadly LITERALLY a classic case from our experiences here wherein they kept missing it for years, didn't do any tests right, and she went on for so long without the right diagnosis).> > I>

March 6, 2011

And I also was nearly done with my PhD in Human Services, but I stopped early 2009 when the economy tanked and I got sicker and sicker. But nothing to preclude me from finishing it when I can afford it again (I had to quit working full-time when it hit the fan illness wise) and we can do something based on PA. I was studying influenza, but since years have passed I will need to refocus my research and I think PA would be a great idea in some manner. It would be interesting to research and document analytically all the different Aldosteronites on this list. Subject: Re: Makes one wonder.....To: hyperaldosteronism Date: Saturday, March 5, 2011, 10:10 AM I have a feeling this is not an uncommon experience - my low K was overlooked for 4 years, then attributed to HCTZ for the next year after that, while all the while the doctor kept putting me on more and stronger ARBs and CCBs - all of which did nothing except make my BP higher!-msmith192845, female, 5'3", 120 lbs, 1cm left adrenal nodule, aldosterone 42.3, renin 0.5, potassium <2.9 (when not taking supplements); 25mg spiro caused gynecomastia, no HTN meds; other meds are 20MEQ K 2x/day, singulair 10mg, norethindrone .35mg, and cyclobenzaprine 5mg as needed; low sodium, fructose- and grain-free diet>> I was reading through this research article and it discusses a 60ish female who had "years" of high blood pressure that could not be controlled on multiple meds and severe hypokalemia. They seemed to initially attribute the low K to hctz (they just made it worse actually). > > But It doesn't say which meds she was on prior to finally figuring out what was going on, but if any of us could guess it was likely some combo of an ACEI, a beta blocker, maybe a CCB, and maybe clonodine, and including the mentioned hctz. > > http://www.ispub.com/journal/the_internet_journal_of_surgery/volume_24_number_1_1/article/conn-s-syndrome-a-diagnostic-dilemma-case-report.html> > I say in the tag "makes one wonder" because no mention is made of whether she was on or off the medications when they did the actual testing of blood and urine. They state that she had an atypical presentation of PA because while only her serum potassium was off, herurine K> was not, and aldosterone and renin were normal. I kind of suspect, if this lady's story is anything like so many of us on this list, she never stopped her meds and so those particular classes of blood pressure medicines, likely gave her a "net" level

that was in the normal range when this wasn't entirely true. If understand correctly these medicines, ACEI, BB's etc, do interfere. > > So I wonder if she was actually a classic typical case and they just missed it (and sadly LITERALLY a classic case from our experiences here wherein they kept missing it for years, didn't do any tests right, and she went on for so long without the right diagnosis).> > I>

March 6, 2011

I got to 2.1 once and felt VERY ominous one time (almost passing out) on my way home from work and pulled into a local ER. BP was at critical levels then too. Still nothing....tanked me up with K and then said they didn't know.....Subject: Re: Makes one wonder.....To: hyperaldosteronism Date: Saturday, March 5, 2011, 10:10 AM I have a feeling this is not an uncommon experience - my low K was overlooked for 4 years, then attributed to HCTZ for the

next year after that, while all the while the doctor kept putting me on more and stronger ARBs and CCBs - all of which did nothing except make my BP higher!-msmith192845, female, 5'3", 120 lbs, 1cm left adrenal nodule, aldosterone 42.3, renin 0.5, potassium <2.9 (when not taking supplements); 25mg spiro caused gynecomastia, no HTN meds; other meds are 20MEQ K 2x/day, singulair 10mg, norethindrone .35mg, and cyclobenzaprine 5mg as needed; low sodium, fructose- and grain-free diet>> I was reading through this research article and it discusses a 60ish female who had "years" of high blood pressure that could not be controlled on multiple meds and severe hypokalemia. They seemed to initially attribute

the low K to hctz (they just made it worse actually). > > But It doesn't say which meds she was on prior to finally figuring out what was going on, but if any of us could guess it was likely some combo of an ACEI, a beta blocker, maybe a CCB, and maybe clonodine, and including the mentioned hctz. > > http://www.ispub.com/journal/the_internet_journal_of_surgery/volume_24_number_1_1/article/conn-s-syndrome-a-diagnostic-dilemma-case-report.html> > I say in the tag "makes one wonder" because no mention is made of whether she was on or off the medications when they did the actual testing of blood and urine. They state that she had an atypical presentation of PA because while only her serum potassium was off, herurine K> was not, and aldosterone and renin were normal. I kind of suspect, if this lady's story is anything like so many of us on this list, she never stopped her meds and so those particular classes of blood pressure medicines, likely gave her a "net" level that was in the normal range when this wasn't entirely true. If understand correctly these medicines, ACEI, BB's etc, do interfere. > > So I wonder if she was actually a classic typical case and they just missed it (and sadly LITERALLY a classic case from our experiences here wherein they kept missing it for years, didn't do any tests right, and she went on for so long without the right diagnosis).> > I>

March 6, 2011

The two in circulation, the Journal of the American Academy of Physician Assistants (JAAPA) which is the main journal, and then ADVANCE for PA's and NP's (they combined us though we really have very different paths in our training) is free so it is heavy in circulation. But there is also some specialty journals that have their own magazines or journals. Here are some links to PA specialty organizations:http://www.endocrine-pa.com/http://www.afppa.org/http://www.cardiologypa.org/http://www.gipas.org/http://www.uapanet.org/BTW just FYI starting this year there is now new specialty designations with the extra board exams for PA's, and also now some PA residency's for them. I am fortunate as I will be grandfathered into emergency medicine and family practice and I took the NCCPA's board exam for special recognition

for surgery years ago, so I lucked out.Subject: Re: Makes one wonder.....To: hyperaldosteronism Date: Sunday, March 6, 2011, 9:33 PM

What is the leading PA magazine? Thanks.

> > >

> > > I was reading through this research article and it discusses a

> > 60ish female who had "years" of high blood pressure that could not

> > be controlled on multiple meds and severe hypokalemia. They seemed

> > to initially attribute the low K to hctz (they just made it worse

> > actually).

> > >

> > > But It doesn't say which meds she was on prior to finally figuring

> > out what was going on, but if any of us could guess it was likely

> > some combo of an ACEI, a beta blocker, maybe a CCB, and maybe

> > clonodine, and including the mentioned hctz.

> > >

> > > http://www.ispub.com/journal/the_internet_journal_of_surgery/volume_24_number_1_1/article/conn-s-syndrome-a-diagnostic-dilemma-case-report.html

> > >

> > > I say in the tag "makes one wonder" because no mention is made of

> > whether she was on or off the medications when they did the actual

> > testing of blood and urine. They state that she had an atypical

> > presentation of PA because while only her serum potassium was off,

> > herurine K

> > > was not, and aldosterone and renin were normal. I kind of suspect,

> > if this lady's story is anything like so many of us on this list,

> > she never stopped her meds and so those particular classes of blood

> > pressure medicines, likely gave her a "net" level that was in the

> > normal range when this wasn't entirely true. If understand correctly

> > these medicines, ACEI, BB's etc, do interfere.

> > >

> > > So I wonder if she was actually a classic typical case and they

> > just missed it (and sadly LITERALLY a classic case from our

> > experiences here wherein they kept missing it for years, didn't do

> > any tests right, and she went on for so long without the right

> > diagnosis).

> > >

> > > I

> > >

> >

>

March 6, 2011

The two in circulation, the Journal of the American Academy of Physician Assistants (JAAPA) which is the main journal, and then ADVANCE for PA's and NP's (they combined us though we really have very different paths in our training) is free so it is heavy in circulation. But there is also some specialty journals that have their own magazines or journals. Here are some links to PA specialty organizations:http://www.endocrine-pa.com/http://www.afppa.org/http://www.cardiologypa.org/http://www.gipas.org/http://www.uapanet.org/BTW just FYI starting this year there is now new specialty designations with the extra board exams for PA's, and also now some PA residency's for them. I am fortunate as I will be grandfathered into emergency medicine and family practice and I took the NCCPA's board exam for special recognition

for surgery years ago, so I lucked out.Subject: Re: Makes one wonder.....To: hyperaldosteronism Date: Sunday, March 6, 2011, 9:33 PM

What is the leading PA magazine? Thanks.

> > >

> > > I was reading through this research article and it discusses a

> > 60ish female who had "years" of high blood pressure that could not

> > be controlled on multiple meds and severe hypokalemia. They seemed

> > to initially attribute the low K to hctz (they just made it worse

> > actually).

> > >

> > > But It doesn't say which meds she was on prior to finally figuring

> > out what was going on, but if any of us could guess it was likely

> > some combo of an ACEI, a beta blocker, maybe a CCB, and maybe

> > clonodine, and including the mentioned hctz.

> > >

> > > http://www.ispub.com/journal/the_internet_journal_of_surgery/volume_24_number_1_1/article/conn-s-syndrome-a-diagnostic-dilemma-case-report.html

> > >

> > > I say in the tag "makes one wonder" because no mention is made of

> > whether she was on or off the medications when they did the actual

> > testing of blood and urine. They state that she had an atypical

> > presentation of PA because while only her serum potassium was off,

> > herurine K

> > > was not, and aldosterone and renin were normal. I kind of suspect,

> > if this lady's story is anything like so many of us on this list,

> > she never stopped her meds and so those particular classes of blood

> > pressure medicines, likely gave her a "net" level that was in the

> > normal range when this wasn't entirely true. If understand correctly

> > these medicines, ACEI, BB's etc, do interfere.

> > >

> > > So I wonder if she was actually a classic typical case and they

> > just missed it (and sadly LITERALLY a classic case from our

> > experiences here wherein they kept missing it for years, didn't do

> > any tests right, and she went on for so long without the right

> > diagnosis).

> > >

> > > I

> > >

> >

>

March 6, 2011

Medicine's ONLY WAYS sometimes completely fade away...it is amazing as I have been in medicine a mere 25 years this year, but so many things have changed some pretty darn dramatic in that short period. One was CPR. We were taught, like may of you too, AIRWAY AIRWAY AIRWAY and without mouth to mouth no one would survive. Well, now it doesn't even have to be done and just doing chest compressions has the same or better outcomes. Love it.Subject: Re: Makes one wonder.....To: hyperaldosteronism Date: Sunday, March 6, 2011, 9:28 PM

Dr. G., Aren't you applying todays knowledge to the history books? At one time they taught that the world was flat - you KNEW the world was flat until you or sombody discovered differently. Then somebody had to take responsbility to correct the erronious information and make sure all interested parties were informed!

Can't we apply the same to PA? The way I understand it they once, not too long ago, thought PA was a very rare anomaly. As I remember it didn't even exist by name prior to 1954 when Dr. Conn identified it and his name got tacked onto it. It got into the manuals and student guides as a "Once in a Lifetime" for the average doctor.

Ms. Webster, a young student, comes along in the mid 1990's, at Darmouth I might add not Boston. Being an astute student she files this in the "could happen but extremely unlikely file" in her brain. She graduates, becomes Dr. Webster and 12 years later becomes a very successful, underpaid PCP at the Veterans Hospital in WRJ, Vt. Along comes this handsome young patient, yours truely, with extremely hard to manage HTN (7 different BP meds plus a Pottassium Suppl if I recall!) She refers him to a HTN specialist and he comes back and announces, "They tell me it's CONN'S Syndrome."

She thinks, I read something about that and it is extremely rare, what are the odds of that happening in my practice! Her response is, "That's very rare, a once in a lifetime for a PCP!" Mr. thinks, not so fast, I'm going to burst her bubble. Mr. hands her a paper and says, "Maybe not as rare as you think, read Dr. Grim's position paper". She thinks, "Who is this Grim guy and what makes him such an expert" but promises she will read it and will know alot more before their next meeting. She sits down after dinner,the children are in bed and while almost nodding off after a hectic day pulls out the position paper.

Suddenly she bolts upright and exclaims, "Holy Shit, this guy worked directly with Dr. Conn., I'd better pay attention!" She reads and rereads the paper. She is still thinking, if this is true why haven't I heard about it. Wide awake now she goes to the computer and Googles "Primary Aldosteronism" and immediately up comes the website for eMedicine which opens with the statement, "Although initially considered a rarity, primary hyperaldosteronism (PH) now is considered one of the more common causes of secondary hypertension (HTN)."

She relaxes a little and thinks, "it looks like this is changing!" How lucky can you get to have a patient with it and a specialist who knows about it. Finding out about it was sure lucky on my part. I wonder when they are going to announce it. I'll have to remember to check on Mr. 's file in the morning, I think he is on 5 meds! And the "midnight oil" burns one more night at the Webster household!

How has the "New Story" been disseminated? It's going to take a very long time if we use this model!

> > > >

> > > > I was reading through this research article and it discusses a

> > 60ish female who had "years" of high blood pressure that could not

> > be controlled on multiple meds and severe hypokalemia. They seemed

> > to initially attribute the low K to hctz (they just made it worse

> > actually).

> > >

> > > >

> > > > But It doesn't say which meds she was on prior to finally

> > figuring out what was going on, but if any of us could guess it was

> > likely some combo of an ACEI, a beta blocker, maybe a CCB, and maybe

> > clonodine, and including the mentioned hctz.

> > >

> > > >

> > > > http://www.ispub.com/journal/the_internet_journal_of_surgery/volume_24_number_1_1/article/conn-s-syndrome-a-diagnostic-dilemma-case-report.html

> > >

> > > >

> > > > I say in the tag "makes one wonder" because no mention is made

> > of whether she was on or off the medications when they did the

> > actual testing of blood and urine. They state that she had an

> > atypical presentation of PA because while only her serum potassium

> > was off, herurine K

> > >

> > > > was not, and aldosterone and renin were normal. I kind of

> > suspect, if this lady's story is anything like so many of us on this

> > list, she never stopped her meds and so those particular classes of

> > blood pressure medicines, likely gave her a "net" level that was in

> > the normal range when this wasn't entirely true. If understand

> > correctly these medicines, ACEI, BB's etc, do interfere.

> > >

> > > >

> > > > So I wonder if she was actually a classic typical case and they

> > just missed it (and sadly LITERALLY a classic case from our

> > experiences here wherein they kept missing it for years, didn't do

> > any tests right, and she went on for so long without the right

> > diagnosis).

> > >

> > > >

> > > > I

> > > >

> > >

> >

>

March 6, 2011