Primary aldosteronism

I apologise for continuing to blog on this topic, but I find it fascinating. After all, it is my health.... Not only that, the researcher in me finds the protocols very interesting.

The new web site that I found states that primary aldosteronism (PA) should be considered in cases where

• Blood pressure is above 150/100 mm Hg on three different measurements obtained on different days
• Blood pressure is above 140/90 mm Hg, and does not improve despite combining three conventional antihypertensive drugs
• Blood pressure is below 140/90 mm Hg, but  four or more blood pressure medications are combined
• High blood pressure and sleep apnea

There are other indications, but the above is enough; the fourth might be considered to be the most obvious in my case, but I don't remember the topic of sleep apnea being raised in any consultation. The first stage in diagnosis is the aldosterone/renin ratio; my blood contains almost no renin so the ratio is very high - a good sign of PA. The second step is oral sodium loading that is supposed to suppress aldosterone production; not quite, in my case. 

Once primary aldosteronism has been biochemically established by ARR and confirmatory testing, the next step in diagnosis consists in determining the subtype of the disease. Although it only concerns about a third of patients, the form of primary aldosteronism for which treatment is the most effective is unilateral disease where an adenoma is the source of excess aldosterone.In the third step of the diagnosis process, imaging of the abdomen is obtained by [a] CT scan to assess whether there is an adenoma or the rare adrenal carcinoma on one of the adrenal glands.

One last step is needed in the diagnosis process — adrenal venous sampling. It is the “gold standard” test to distinguish unilateral from bilateral disease, and to determine the best course of treatment.

Reading further, I see that this test measures cortisol, not aldosterone; values from the adrenal veins are compared to a peripheral sample taken from the inferior vena cava that establishes a base value and to which the adrenal values can be compared.

For now, the next step is to obtain an appointment for the test. The PA site stresses that the diagnostic center handles a high enough case volume; the radiologist (or endocrinologist) to which I am being referred performed three such procedures last week. That should suffice.

I'll close this post with a paragraph I found elsewhere on the site, living with PA. Because they are prone to sleep disorders, patients with PA must ensure they get enough rest. Adopting a few simple techniques also helps reducing the anxiety and depression caused by excess aldosterone:

• Accepting events that are beyond our control;
• Asserting our feelings to prevent anger and aggressiveness;
• Setting limits and saying no to requests that create excessive stress;
• Managing our time effectively;
• Making time for hobbies and interests;
• Learning and practicing relaxation techniques;
• Seeking out social support; 
• Seeking counseling in times of crisis and to learn from professionals trained in stress management.

The above provides good reasons why I am still working from home.