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

[Guest guest]

I am not sure. jamie will know.CE Grim MDWhat 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> > >> >> >> >> >> >> >>

[Guest guest]

Stupid shits.CE Grim MDI 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>

[Guest guest]

Would be an important project.How can I help.CE Grim MDAnd 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>

[Guest guest]

Seems to me we need to tell 's story in all of them. I think I told you I was involved in training/using some of the first PAs when I was at Duke 64-67. Knew Dr.Stead well. The father of PA concept as I recall.CE Grim MDThe 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> > >> >> >> >> >> >> >>

[Guest guest]

I may have said that myself a time or two, or was I called that a time or two.....oh heck if the shoe fits....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>

[Guest guest]

Me to. Like a pt 55 y/p biker with Cushing's I missed with bad HTN and Low K. I assumed he had Conn's (you see only what you are looking for) but did not look at his striae below his roles of belly fat and missed the purple ones. A good intern did. I called myself SS.CE Grim MDI may have said that myself a time or two, or was I called that a time or two.....oh heck if the shoe fits....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>

[Guest guest]

Pretty damn hard to be perfect. Now if we could convince everyone else. I am learning more valuable HTN lessons on this site than anywhere else. That's okay with me as I needed to get my head around. Glad I found ya'llSubject: 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>

[Guest guest]

A good case study would be awesome to start with. Maybe one that is done and gone (found and treated)...meaning for my case they are still looking for the pheo and the hyperthyroid in the middle of it all sure ran every symptom in every book together so I may be a bit over the top. As far as Conn's, he is convinced of without a doubt and the DX is a done deal, but he's still gonna redo the adrenal CT to be certain and make sure nothing to dramatic is seen. But I can do the outline to an article, you can clean it up and add the most pertinent info, and I can query and submit to the mags and specialty organizations.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> > >> >> >> >> >> >> >>

[Guest guest]

Purple marks? WhT does that change about dx?

Me to. Like a pt 55 y/p biker with Cushing's I missed with bad HTN and Low K. I assumed he had Conn's (you see only what you are looking for) but did not look at his striae below his roles of belly fat and missed the purple ones. A good intern did. I called myself SS.CE Grim MDI may have said that myself a time or two, or was I called that a time or two.....oh heck if the shoe fits....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>

[Guest guest]

Only about 5 years ago I had my l-adrenalectomy at mass general. I think every student came by my bed . Over and over asking me if it was ok to talk to me since this was such a rare catch. Hopefully those students don't see it as rare anymore.

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

> > > >

> > >

> >

> >

> >

>

[Guest guest]

I bet you did a great job teaching them. Mass Jesus is prob the best Hosp in the world.CE Grim MDOnly about 5 years ago I had my l-adrenalectomy at mass general. I think every student came by my bed . Over and over asking me if it was ok to talk to me since this was such a rare catch. Hopefully those students don't see it as rare anymore. 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> > > >> > >> >> >> >>

[Guest guest]

Cushing's classically have purple straie (stretch marks) lower abd and around knees sometimes even.CE Grim MDPurple marks? WhT does that change about dx? Me to. Like a pt 55 y/p biker with Cushing's I missed with bad HTN and Low K. I assumed he had Conn's (you see only what you are looking for) but did not look at his striae below his roles of belly fat and missed the purple ones. A good intern did. I called myself SS.CE Grim MDI may have said that myself a time or two, or was I called that a time or two.....oh heck if the shoe fits....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>

[Guest guest]

We need the name of your Endo team leader? Dr. G ?Who did your AVS?Who did your sugery?Only about 5 years ago I had my l-adrenalectomy at mass general. I think every student came by my bed . Over and over asking me if it was ok to talk to me since this was such a rare catch. Hopefully those students don't see it as rare anymore. 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> > > >> > >> >> >> >>

[Guest guest]

Purple

striae are common in Cushings - also with Bartonella, generally on the back.

Val

From: hyperaldosteronism

[mailto:hyperaldosteronism ] On Behalf Of Txsgreen

Purple marks? WhT does that change about dx?

On 7 Mar 2011, at 23:30, Clarence Grim

wrote:

Me to. Like a pt 55 y/p biker with Cushing's I missed with bad HTN

and Low K. I assumed he had Conn's (you see only what you are looking for) but

did not look at his striae below his roles of belly fat and missed the purple

ones. A good intern did. I called myself SS.

CE

Grim MD

[Guest guest]

Wow! Such a loving atmosphere in a hospital with so many kind young students! That's non-heard of! If I were you, I would have asked them to remove the one on the other side too!

Max.

Only about 5 years ago I had my l-adrenalectomy at mass general. I think every student came by my bed . Over and over asking me if it was ok to talk to me since this was such a rare catch. Hopefully those students don't see it as rare anymore.

[Guest guest]

Haha. I figured the more they learn the better. My bp post surgery was so low that I couldn't get up. Then I developed glaucoma . Luckily the eye hospital was next door. I kept saying I couldn't see well and they ignored me so I reduced to sign discharge papers. Then they listened. My endo, dr godine, was a jerk but my surgeon , dr Ratner, was stellar.

Wow! Such a loving atmosphere in a hospital with so many kind young students! That's non-heard of! If I were you, I would have asked them to remove the one on the other side too!

Max.

Only about 5 years ago I had my l-adrenalectomy at mass general. I think every student came by my bed . Over and over asking me if it was ok to talk to me since this was such a rare catch. Hopefully those students don't see it as rare anymore.

[Guest guest]

Makes me wonder what I really had. I've requested the labs from 5 years ago and they are starting to come in. Moving , I lost a lot and what I do find is jumbled in boxes. I haven't had the energy and clear head to sort it all.

Cushing's classically have purple straie (stretch marks) lower abd and around knees sometimes even.CE Grim MDPurple marks? WhT does that change about dx? Me to. Like a pt 55 y/p biker with Cushing's I missed with bad HTN and Low K. I assumed he had Conn's (you see only what you are looking for) but did not look at his striae below his roles of belly fat and missed the purple ones. A good intern did. I called myself SS.CE Grim MDI may have said that myself a time or two, or was I called that a time or two.....oh heck if the shoe fits....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>

[Guest guest]

Your doc obviously didn't know what he's talking about.  If you've not been treated for Bartonella,

you still have it.  I have the two volume

set from Dr. Schaller

http://www.personalconsult.com/articles/activestriations.html

Scroll down to see pictures.

Val

From:

hyperaldosteronism [mailto:hyperaldosteronism ] On

Behalf Of Txsgreen

 I had what looked like purple stretch marks

and the dr said I must have just put on weight too fast. The marks are almost

gone now. I also was positive for bartonella and cat scratch on the genex labs.

Tho when I took those labs to a dr he said he didn't get why I had them and was

so awful to me I ran out.

On 8

Mar 2011, at 09:34, " Valarie " wrote:

Purple striae are common in Cushings - also with Bartonella,

generally on the back.

From: hyperaldosteronism

[mailto:hyperaldosteronism ] On Behalf Of Txsgreen

Purple marks? WhT does that change about dx?

On 7 Mar 2011, at 23:30, Clarence Grim

wrote:

Me to. Like a pt 55 y/p biker with Cushing's I

missed with bad HTN and Low K. I assumed he had Conn's (you see only what you

are looking for) but did not look at his striae below his roles of belly fat

and missed the purple ones. A good intern did. I called myself SS.

CE Grim MD

..

[Guest guest]

Thank you so much Val. I can't read it from the tiny iPod but am looking forward to the info. I really appreciate it. When I was first diagnosed with lymes the dr ordered all those labs from genex. I may have the name wrong. It said I had cat scratch and Lyme and other stuff. Well I was leaving the next week for Belfast so the dr gave me 3 months of antibiotics. I ended up loving Belfast so stayed two years- til I felt I was gettingtoo I'll. By then the lymes dr quit seeing patients and only does research now.I saw 4 diff docs and each said my lymes has to be gone. Only a cardiologist believed me but then I started needing blood transfusions and other medical issues so I gave up on getting a dr to believe I had late stage lymes. My brother and mother go naturopath and colloidal silver route. So I'm a bit stuck on finding a lymes doc. I need to get over it and start looking again

Your doc obviously didn't know what he's talking about. If you've not been treated for Bartonella,

you still have it. I have the two volume

set from Dr. Schaller

http://www.personalconsult.com/articles/activestriations.html

Scroll down to see pictures.

Val

From:

hyperaldosteronism [mailto:hyperaldosteronism ] On

Behalf Of Txsgreen

I had what looked like purple stretch marks

and the dr said I must have just put on weight too fast. The marks are almost

gone now. I also was positive for bartonella and cat scratch on the genex labs.

Tho when I took those labs to a dr he said he didn't get why I had them and was

so awful to me I ran out.

On 8

Mar 2011, at 09:34, "Valarie " wrote:

Purple striae are common in Cushings - also with Bartonella,

generally on the back.

From: hyperaldosteronism

[mailto:hyperaldosteronism ] On Behalf Of Txsgreen

Purple marks? WhT does that change about dx?

On 7 Mar 2011, at 23:30, Clarence Grim

wrote:

Me to. Like a pt 55 y/p biker with Cushing's I

missed with bad HTN and Low K. I assumed he had Conn's (you see only what you

are looking for) but did not look at his striae below his roles of belly fat

and missed the purple ones. A good intern did. I called myself SS.

CE Grim MD

..