Any good Medical Doctors in Dallas Tx that specializes in this?
Does anyone have moon faces as a result of Primary aldosterone?
I have almost every symptom but no evidence in testing.
This is actually a well known cause of secondary hypertension, and in young patients otherwise healthy with high blood pressure not responding to blood pressure medication we always check for it… this article is misinformation. I am a primary care nurse practitioner
I have heart failure. I’ve been to four cardiologists at three different health systems. They didn’t check for this until I DEMANDED it. Your comment is BS
No money in a cure.
I WILL SAY IT AGAIN. DOCTORS WANT “MONEY” NOT A “CURE”
I was fortunate to have a PCP streer me in the right direction when I went to him to treat my hypertension as well as high sodium/low potassium. After losing 2 pounds a week through calorie deficit and exercise we were able to rule out weight and diet after 3 months a 30 pounds shed. I joked i can eat all the bananas I want to increase potassium, which would cause me to gain back the weight 😀. Luckily I was referred to an endocrinologist (shoutouts to Dr Grady at PDEC!), and after multiple months of tests, pills, 2 adrenal vein sample procedures, they finally identified the mass and scheduled an adrenalectomy. 13 month process, and thankful for my PCP, Endocrinologist, and Surgeon who got my BP back to normal and cure my hypertension caused by Primary Aldosteronism.
I know this has to be why my blood pressure is high because it has been high since I had my son and I was very active. I was in marching band and after school I would walk and work out. When I tried to explain it to my doctor he was unwilling to listen. My son is 19 now and because of uncontrolled blood pressure my left ventricle is now enlarged. I only have one kidney and now my levels are high, but thank the Creator Im not on dialysis and I pray I won’t have to be.
The article is titled “Doctors Overlook a Curable Cause of High Blood Pressure”. It mentions one patient with a particular tumor which was removed and thereby restored balance in her system and “normal BP”. It goes on to mention two pharmacuticals with highly undesireable side effects. So how is this curable?
I had high blood pressure for 4uy
Years.i had cancer that why my was so high. I don’t take any medication
My husband was diagnosed with this very same thing after his cardiologist recommended seeing a kidney specialist. After 30 years on b/p medication he had surgery to remove malfunctioning adrenal gland and miraculously no more b/p and feeling 100% better.
Thank you for this article!! I went through this 16 years ago. I can still remember my disbelief and frustration when I had a doctor tell me I was just tired and stressed. I believe those are valid conditions for some but knew it was not for me. I still have PTSD when I go to the doctor because of the two years it took of pleading to get anyone to listen. Know this will help so many people!
Yes they do. The PA Foundation’s website offers a directory of specialists and centers of excellence. You can contact us any time, we respond to inquiries within 24 hours.
Incredibly informative/ my BP is all over the map but this article may help shed lite on a direction to explore..
Everyone’s quick to criticize the medical field but in reality it’s not entirely their fault.
It’s extremely rare to have this condition. 99% of people won’t have it.
Doctors goals are to save lives and medication saves lives. Patients don’t want to address their lifestyles and doctors have no other tools except for medication, they’re going to go to the only tool they have.
Patients have responsibilities too. Always get a second opinion, a third opinion. Remember that medicine is designed to treat the masses not the few.
Primary aldosteronism is so very rare. I almost feel this article is giving people hope like they found the magic bullet to their problem. Unfortunately, the chances are extremely low this is the cause of your hypertension
So you didn’t read the article then? 1 in 5 patients is not 99%.
Well let me just tell you this. I’ve been to 3 different Drs and neither is treating me with medication for hypertension or for high blood pressure and high cholesterol. And I am tired of ending in the Hospital every time I feel sick, palpitations etc and then sent back home referring me to cardiologist that has cleared me and continue to refer me to a Endocronologist that don’t want to treat me because of my palpitations when I was refer to Endocronologist in the first place because of hypertension. So yeah I’m one of those patients that criticize some Drs because they like the money more then the patients now a days. They are quick to diagnose something else then finding the WHY. I’m going on 4 yrs with this condition. I tried dieting like Endocronologist and primary dr said to and if that does not help then we will have to give you treatment and guess what still waiting on that treatment. Lost only 15 pounds 1 pound here 2 there. When you have hypertension without treatment it is hard to loose weight. Not sure as my Endocronologist she knows or acts like she doesn’t.
Up to 50% of hypertensives have PA, 30% of them can potentially be cured, 60% of them can be treated medically. See the Anals of Internal Medicine: https://www.acpjournals.org/doi/10.7326/M20-0065
100% of your comment is wrong congrats
Yes, also in medical, your correct Rob
Evidence-based practices are theoretically self-correcting. New research replaces old assumptions, however hard it may be for us humans. I am not a medical specialist yet I am trained to look for scientific literature updates in my field. It took me all of 5 minutes to find several prevalence reviews and studies, published since 2010 in medical journals. Key take-away? It was thought to be very rare (~1%), yet recent studies indicate this assumption is likely wrong and prevalence estimates have ranged between 5% and 20% of hypertensive patients. So, although we do not yet have enough information to state with confidence how common it is, it’s way more than 1%, and therefore, many people are under-diagnosed and under-treated in practice. If you truly are a medical professional, please review more recent research than what you were originally trained in.
For example, “Once thought to be rare, PA is now known to be the most common cause of secondary hypertension, with a prevalence of 20% among patients with resistant hypertension,1,2 10% in those with severe hypertension (systolic blood pressure [SBP] ≥180, diastolic blood pressure ≥110 mm Hg),3,4 and 6% in those with otherwise uncomplicated hypertension.4 Only a small fraction of the patients with PA are diagnosed and treated.5 ” from Byrd JB, Turcu AF, Auchus RJ. Primary Aldosteronism: Practical Approach to Diagnosis and Management. Circulation. 2018 Aug 21;138(8):823-835. doi: 10.1161/CIRCULATIONAHA.118.033597
Fifteen years ago Dr Samuel Mann, Weill Cornell, NYC, diagnosed me with this after three years of unsuccessful treatment with three blood pressure pills that did not lower my high blood pressure. I’ve been on Spironolactone and Accupril for all these years, opting not to have the surgery and my blood pressure is controlled, thanks toDr Mann, an excellent caring doctor.
Nina, your comment is likely what’s happening with me.
3 years on unsuccessful treatment for my hypertension.
Taking drugs,but it’s even getting worse.
It has affected my renal.
Feeling inflammation,heat on one of my lower back (Kidneys desease at this time).
Please refer me to your doctor or just provide me with contact info.
I’m in the West Coast,but did spend 20 years in New York.
Thanks.
I’ve been aware of a growth on my adrenal gland around 20 yrs around the same time my blood pressure was elevating slowly. My average bp all my life was 115/72 started moving up and started being prescribed medication and slowly raising the dose. I’ve been taking bp meds for 15 yrs.
Weight loss? Who knew.
I spent a decade being poked, pumped full of useless meds, blamed for not making changes; it nearly killed me. One simple adrenal test saved me.
Would my thyroid condition cause high blood pressure
What did you do and who did you see to get this done and what actions were taken to save you
who did you see to get this done . what actions were taken to save you
Yes, sometimes once your thyroid levels are normalized it can improve your BP. I wish you success.
This article provided a wealth of information
The information in the article is completely false.Please DO NOT take any recommendations from this article.
Friend, I lived this for 10 long, painful years. You can’t imagine the cramps caused by high octane diuretics & 180meq of potassium a day. My hands would lock up & I couldn’t open them, my entire body (even my eyes), would vibrate as though they fell asleep. That’s only the tip of the iceberg. This is a life- threatening illness and does not deserve to be trolled by your ignorance.
I hope you are not a medical professional because if you are, you’re a prime example of this problem. For over four long years I was showing up at my doctor’s office with blood pressure readings in excess of 160/120. His solution was to just keep adding more blood pressure meds and diuretics to my ever growing cocktail. Do you have any idea of what it does to someone when you have them take 8 or 9 blood pressure meds EACH DAY? Obviously you don’t, so I’ll tell you. It becomes almost impossible to even get out of bed, among other things. This ignorance helped to destroy my successful business of 22 years, and my marriage. The heart specialist was stumped, a 2nd specialist was stumped. Finally after almost 5 years of this, I decided on my own to consult a kidney specialist. In ONE visit he had a pretty good idea of what the problem was. He wrote me a $5.00 script for Spironolactone, told me to go home and take a dose, then take my blood pressure in 30 minutes. I did, and for the first time in about 7 years, my blood pressure was COMPLETELY NORMAL. I will NEVER forget that moment. Please don’t be PART of the problem. Be part of the solution and STOP telling people that this is not going on, because lives are being ruined — and you are denying that.
“The information in the article is completely false.Please DO NOT take any recommendations from this article.”
– Paid for by the Multi-Billion Dollar Healthcare Lobby.
They literally pay hospitals, healthcare groups and all medical entities to ignore these studies, some of whom were referenced in this article. This is an intentional suppression of science to generate trillions of dollars from the US public. This article should go viral.
Agreed, this article should be pulled, spreading misinformation, this condition is rare and we have protocols when it is appropriate to test for… giving people false hope and wasting time and stress and energy
I’m a male I worked pushed my body all my life I believe this is what pushed me into poor health from 15 to now 52 I’m going to look into this
What does that say about healthcare in this country when one has to fight, because of burned out &/or egotistical doctors, to get a diagnosis. It happens far too often so what is the AMA doing abt it? Not much. Please write, email, fax to put a fire under them to make changes! No excuses!
I have had all these same problems for just about 40 years now! Where should I go for help? I’m 57 now and having severe memory loss, confusion and fibromyalgia! My legs go numb constantly and I have “nodules “ on my thyroid,low potassium constantly, if anyone has any advice or help for me, please contact me asap! Suffering in Riverside/San Diego area!
I know for a fact it is hard to diagnose as I was on just about every Hypertension medication with limited results Finally a Doctor took the time and did the tests and I was diagnosed with Primary Aldosteronism and was prescribed Spironolactone as well as other hypertension medications which caused side effects but hey my BP was normal. Fast forward 20 years I found an article online about this disease and a surgeon that does minimally invasive surgery to remove the adrenal gland if needed. I scheduled an appointment with him and after a few test he and his colleagues determine that I indeed had a very small tumor on my left adrenal gland. Surgery was done now I no longer require Spironolactone or any hypertension medications.
Glad to hear your rid of that scourge blood pressure. Who is the surgeon?
I am grateful for this article. Simply because I know anything can raise your blood pressure whether it be a cold, the flu, going to see your doctor. And nobody wants to know why your blood pressure is raised. They simply Go off your history from every time that you have gone into there office and see that your blood pressure is raised. But instead of doing further research as to why your blood pressure is raised, they just want to give you medication to fix the symptom not the problem. So they can keep you coming back and keep putting money in their pockets. All the while they are ruining your kidneys, and God knows what else. So I am grateful for this article. For someone to actually stand up and speak the truth. And now I am going to dig deeper as well. Especially since my family has had kidney issues and high blood pressure. Think it’s coincidental? I don’t. So again, thank you for this article.
I agree especially with finding out why your blood pressure is being elevated.
It is SAD NO OWADAYS ONLY THE OLD SCHOOL DOCS STILL AROUND ARE ETHICALLY ENOUGH TO UH PHILD THEIR MORAL!!! TODAYS DICTORS ARE A SAD CASE OF A FAILED AND 💔 SYSTEM PURPOSELY DAMAGED IN THE NAME 📛 OF ABSOLUTE PURE MONEY NOT HEALTH!!! THE SICKER THEY KEEP YOU THE MORE MM ONEY TO HEY MAKE!!! ONLY TRUE 💕 DOCTORS FEW AMD FAR IN BEFWEEN!!! ONE XAY SOON IT WILL BE CORRECTED PERMANENTLY UT FOR NOW GOD HAVE MERCY ON OUR SOULS!!! GS DA ZIM AMEN
I believe I am a patient who may very well have this problem and it’s the first time I hear of it. I am very much interested in obtaining more information regarding this.
Who would test for this, primary doctor or cardiologist? I’ve suffer from hypertension for over 40 years, and I exercise and watch what I eat.
On its website, the PA Foundation offers step-by-step information on diagnosis and treatment. We also offer a directory of specialists and centers of excellence. You can contact us any time, we respond to inquiries within 24 hours.
Kidney specialist
Her symptoms were absoluteiy typical of thiamine (vitamin B1) deficiency, reminding us of the genius of Hans Selye, who proposed, on the evidence, that human diseases are diseases of adaptation to some form of stress (infection, trauma, genetics). He described the General Adaptation Syndrome in the animals he studied and found that his lab studies showed the same changes as those seen in chronic disease of humans. Skelton,one of Selyes students pfoduced the General Adaptation Syndrome in an animal by making it thiamine deficienf. Thiamine presides over energy metabolism and pregnancy requires energy for the survival of the mother and her yet unborn child. An American Ob Gyn has shown that thiamine deficiency is common in ptegnancy and was able to prevent the common complications of ptegnancy by giving the mother a supplement of thiamime.
I experienced this during my first pregnancy. My oldest is now 25. I have had my hormones checked many times and always came out normal. I’ve suffered with all these symptoms since I was 26, this is so eye opening! This info is priceless. My journey has been many years of high blood pressure but I fought to not take meds. Then when I did it was not pleasant. Had a terrible experience fir a couple years. So I decided to not take them at all. They made me feel worse. Four years ago ended up in the hospitol and almost died from congestive heart failure. Thank God I had two doctors that got me on the right combination of BP meds to get me out the crisis and feeling gradually better. But I’ve always had unexplainable pain in that area and noone could ever figure it out. Thank you, this gives me hope!!
I take blood pressure prescription. It never helps or lowers my pressure down. I also take cholesterol prescription, it works okay. But both prescription can cause to rise blood sugar level. So be aware. That’s the way Big Pharmas make so much money from patients’ expenses, they’re not serious about anything.
My mom is on 5 different bp medications, and kidney problems, I’ve told doctors that they are killing my mom, money is all the want, not trying to get to the root of the problem. Thanks for the article.
I’m doing good about
I was diagnosed by an Endocrinologist in 2011 with Primary Hyperaldosteronism and had a heck of a time finding a doctor to do the necessary tests and surgery. I finally had the adenoma and most of my left adrenal gland removed and my high BP and extremely low K went back to normal. It is good to hear that this is getting some attention. I was miserable when I had it.
Letting who did you see to get this done.
Took my doctor SEVEN YEARS of no success with putting me on every blood pressure lowering chemical known to medicine, all and all AT THE SAME TIME (except of course, spironolactone) to send me to a kidney specialist who knew that I had this condition in ONE VISIT. It was confirmed with ONE DOSE of spironolactone, then reconfirmed with an MRI which found a tumor on my adrenal gland that was causing the aldosterone to constantly leak into my system . The tumor was zapped off, my adrenal gland was stapled closed and in one day my blood pressure went from medical emergency high to NORMAL. Unfortunately, the damage had been done after almost 7 years of walking around like a zombie from all the meds — my business and my marriage were both casualties. Primary care physicians REALLY need to be made aware of this! Kudos to the author of the article. It’s the FIRST one I have ever seen on the subject since I was finally diagnosed about 17 years ago.
I do believe this discussion on blood pressure problem. My blood pressure being like this since I was 34 yes old and now am much older, and its remains the same, something is badly needed to change, I hope the specialty find a cure soon. Thanks
Yes I believe this information on high blood pressure is correct.
Have been taking several medications for HBP for 35
yrs and was always told
there is no cure, yet here is one
instance where there is a cure when
1 adrenal gland is secreting excess
aldosterone.The fact is if the cause
is known a cure can be found.The
Medical Profession must simply
admit they just do not know what
to do.My HBP was diagnosed as
Primary Hypertension and Nocturnal Hypertension so the
question is what is the cause?
Of course taking 6 different medications enriches the Pharmaceuticals and keeps them in business so there in no incentive
to find the causes and eliminate these diseases.
Join the club. On Medicare now but told my PC years ago. But I Don’t Have A Medical Degree
Does the Mayo Clinic or John’s Hopkins have specialist knowledgeable in Aldosterone?
I had primary aldosterone it took 8 years for a diagnosis. Started age 21 in 1962 surgery at Wilford Hall. Of course I was a research patient. Left adrenal gland removed. Small benign tumor. I was written up in medical history. I could not maintain potassium no matter how much I drink. Yes I was drink almost a 8 oz twice daily and I felt good. I’m now 80 years old with afib and high blood pressure. Not sick I’m in a fittness program and feel good. Take my meds as prescribed I’m sharing this to help someone else. I never had a weight problem.
High
Will pass this information on to two other people, very valuable information.
This just proves to me that doctors are narcissists.
I Love this article. Thanks.
Best CORRECT NARRATIVE I’ve read.
Thank you for writing this Article.
Thanks for the update and it will definitely change my way of dealing with hypertensive patients
Thank goodness I just saw this, I have a heart appointment Monday, I am talking to my doc about this.
Thank you for this information!
It explains everything!!
Trash and misleading
The normals are not well defined.Rarely is hyperaldosteronism “the only” cause if hypertension in an individual patient.
Oh, and try to convince a patient to have surgery because “maybe” it will help their blood pressure.
And patients in my experience, never even mention this pathology-the story related of a patient promoting the diagnosis is, politely, “unheard of” .
Just another author, who knows nothing about clinical medicine, bad mouthing the profession.
Well K, I hate to bust your bubble but my PCP completely failed me over 7 years of climbing blood pressure that did not respond to diuretics OR blood pressure meds. I trusted him, and he just kept putting me on more. Both specialists he sent me to were stumped. THANK GOD I decided on my own to see a kidney specialist because it took him ONE VISIT to pinpoint the problem, and was able to verify that with one dose of one $5.00 script – Spironolactone. If the pressure drops like a rock with spironalactone, it’s confirmed! There’s no guesswork involved in whether or not surgery will lower the patients pressure, the Spironolactone will tell you whether it will or not. Please stop being part of the problem — become part of the solution instead because this is ruining lives.
Wow, glad I read this. Thank gawd for women who don’t take no for an answer.
This is a very informative article. I have high blood pressure and take 3 meds to control it which I hate. I am always reading and researching ways to get off the blood pressure meds. When asked, the doctors quickly tell you its genetics. I want to know the cause so hopefully it can be fixed therfore I can get off the meds. I will continue to research this technique and pray it will help many of us that suffer with high blood pressure.
Great article. I also have hypertension. I’ve been taking pills for 15 years and for 15 years I’ve had a cough. I’ve been tested and retested to find out why. Would this test possibly help me.
Dianne
Are you taking lisinopril?
Known for giving a nasty cough
Aldesterone is something that can cause hypertension issues. I have experienced this. It is something to pay attention to and ask your doctor about. My doctors did pay attention to this. Not all doctors do apparently. Thanks for informing me about this.
I recently had the same symptoms and I was rushed to the hospital because my heart was racing 10x fast. I am also 12 weeks pregnant. They did a lot of tests and found nothing. They said it was stress on my heart. And wrote it off as hypertension.
Article is absolutely correct that most of the doctors can’t detect this aldosteronism as a cause of high blood pressure!I I had suffered for long ten years with fluctuation of blood pressure! All kinds of test results came out to be normal and my weight was with in normal range of my height but BP was uncontrollable! Doctors prescribed all sort of BP medications & anxiety and stress pills along with Ambien for sleep without any improvement of my BP condition! Side effects from all these medications was driving me to death. Fortunately for me, a doctor, who was specialist for kidney disease, did an MRI of my kidneys and detected a tiny benign growth on my right adrenaline gland which he suspected the root cause of high blood pressure! Imbalanced secretion hormones in blood stream from adrenaline gland was the culprit! I was completely cured of the BP issue for a long time but last few years it went up a little bit and taking Amlodipine 5mg to manage it! I know that it goes up sometimes now a days due to high stress and anxiety as well as aging! My BP issue started in my forties and I am 67 years old now!
This is so sad, and then the medical world wonder’s why, the public don’t listen to them, here’s a perfect example there’s something that can actually cure blood pressure problems but the medical world doesn’t want a cure so why is that
For those intrigued by the article, I suggest looking into the Society to Improve Diagnosis in Medicine, an organization made up of all medical stakeholders (patients included) dedicated to elimination of diagnostic error (the most common, costly and catastrophic type of medical error, and third leading cause of death in the US per current studies). Only with collaboration will we make an impact on health outcomes for patients. We need all of you to be involved in this movement, in order to affect the change that each of us wishes to see.
Sincerely,
Shawn Vainio MD FAAFP
I’m so tired of the medical system failing patients. Even when doctors are trying to improve, they’re met with opposition from colleagues, and it’s only the patients who suffer. How much easier would this be if doctors hadn’t decided having a higher weight was a disease state (against their own committee’s recommendation)? No wonder patients are losing confidence and trust in doctors.
Thank You so much for sharing this information I have noticed a remedial standardized test for hypertension
This person is clearly NOT a medical professional and the information presented is false and misleading. Doctors do not ‘overlook’ this diagnosis. The truth is that it is difficult to diagnose. Requires invasive testing and is a difficult operation with significant risk of complications when a low risk pill would have worked just as good.
What is invasive about the testing? I am not a doctor so please enlighten me. Thank you in advance.
It is always good to have a conversation with your Dr. My primary care physician is always willing to discuss things. Maybe you could learn from her. Patients know their bodies better than the Drs. Talk discuss pros and cons. I learned this while going through different Drs when first diagnosed with Lyme disease…
Your anger at this article is odd. “Overlooking” a diagnosis is exactly what you are saying… it’s difficult to diagnose, so it gets overlooked. A urine test is invasive? A scan of the adrenal glands is invasive? What “low risk pill” are you suggesting?
Your correct it seems simple to me take a few test to see. Why is that hard to do. I almost couldn’t find no BP meds to stop mine from sky rocketing. I know there’s a cause you just don’t get high blood pressure one day . Doctors should test for this. I believe I have this I could had no salt or any thing be talking and BP just sky rocket up. Let’s try to find some one who specializes in this.
So difficult to diagnose means don’t try? Is that the message?
Leaving the tumor there and simply taking a pill would have eliminated the patient’s symptoms just as effectively as removing the tumor? If this is true, why did the doctors perform the surgery?
Everyone is not the same & there are plenty of risks in pills which can actually kill some of us, especially when doctors treat us all the same.
I interpret this story as a cautionary tale for those people for whom trasitional medical treatment isn’t working; encouraging them to advocate for themselves when their diagnosis doesn’t make sense. Doctors are not infallible and a patient’s desire to seek more information and/or a second opinion should not be discouraged by anyone.
A low risk pill? Really? The woman may not be a medical professional but she obviously consulted with one who took the time and effort to understand the problem and went the extra mile to diagnose her. They didn’t throw a pill at her and send her home. Also her information is NOT misleading. I know because my adult daughter’s nephrologist recently told her the same thing. You are a DO. you’re not a specialist. Also, what low risk pill are you referring to? Ace inhibitors? Beta blockers? You are not willing to go the extra mile because it’s too ‘hard”….just give them a pill. I recently read a report by several clinicians who are very concerned about the use of HB pressure medicine and it’s connection to kidney damage. I had parents who took what you so loosely refer to as a ‘low risk” pill because their doctors said it was best. They both died while still on BP medicine which ruined their kidneys. The real truth is most clinicians do what their employer and big pharmaceutical companies tell them to do. Pills are big money-makers. The medical books you learn from are ones big pharma supply to medical schools.
I don’t believe many people take medical advice from the internet but the information they find is important because it gives them a base so that they can discuss it with their doctor. Clinicians today pale in comparison to clinicians in the past. Those clinicians didn’t have the technology but they used skill.
Oh they DONT? My primary care doctor overlooked this condition for SEVEN YEARS. and I lost EVERYTHING as a result. And I’ve got the records to PROVE it. PLEASE, wake up!
It does NOT require anything invasive to diagnose. In my case, all it took was ONE DOSE of spironolactone to see if my pressure would drop, and it dropped like a rock in 30 minutes. Do you have any idea how hard it is to get through a day taking 4 or 5 different blood pressure meds at once, because your doctor is trying to keep you alive and he is clueless about this condition? Please, don’t be part of the problem by telling people to ignore this — it’s real. See my story in one of the comments Become part of the solution. Again, I LOST EVERYTHING because of this. Well, almost, I still have my health now, thank God.
How do you come to that conclusion? Multiple sources from prestigious health care facilities and universities are quoted as well as links being provided.
Drs. do overlook it. My level came back high and he ignored it. Went to another dr and being checked for it now.
The one thing she made clear, sir, is: “Doctor so-and-so, I am fighting for my well-being, even my life. All I am asking of you is a referral. IS THIS STRICKEN FROM MY FREEDOM?
Difficult to diagnose doesnt mean impossible. Agree on the invasive testing (AVS) and adrenalectomy being significant procedures, but that’s the last resort after lots of non invasive testing. It’s up to the pcp, endocrinologist and surgeon to lay out the options on potential quality of life vs. risk of these procedures. And calling a pill low risk is a very diminishing statement.
Hormonal abnormalities can be caused by mold toxicity. I know for fact because my fiancé and cat died from Fungal Bronchiole Pneumonia Aspergillosis = Mold and their testosterone levels took a dive and nothing worked to help increase it.
Does this mean we are going to talk about adrenals now?
So glad I came across this article! Shared it with friends and family. Hoping the Endocrine Society and many more doctors who are sincerely interested in their patients well being and beating this disease, will see the need for this type of testing and possible cure.
Yet, I am very much aware that blood pressure medications are huge money makers for many pharmaceuticals.
Please don’t take medical advice from this article.
Everyone is not the same & there are plenty of risks in pills which can actually kill some of us, especially when doctors treat us all the same. I think most of us know that this article is medical INFORMATION, not advice. We hope to be able to get that from our providers.
So the woman in the article who finally received the correct diagnosis should have listened to your advice here?
🤣 That guy is the Multi-Billion Dollar Healthcare/Pharma Lobby’s first line of defense. They have cozy relationships with the government and Big media. Fortunately, Big media has very little-to-no tentacles into web content and social media. That’s why this article needs to go viral.
Why not? Is there a danger in getting tested for it with blood tests?
Why? My daughter has been taking high doses of HBP meds and has maintained a very high pulse rate. I’m concerned because she’s adopted and we have no history to compare her situation to. I don’t want her kidneys to be damaged.
Yes I believe this information on high blood pressure is correct.
Why not?
Why do you say that? The article refers to multiple studies, quotes prominent individuals at prestigious health care facilities and provides relevant links.
I think anyone that has high blood pressure would rather get a surgery filling great one day filling like death the next.
The real fact is doctors
are
Getting payed big bucks to push pills.
Why do you think we have a drug addiction problem in this country?
All them college degrees at work.
I’m currently on four BP meds and have been for years with no relief. I’ve never heard of this before. Please don’t be a hater.
I’m guessing the pandemic made mush of the medical profession. It almost appears as if Me. Garrison is heartbroken finding out an MD isn’t GOD.
Are you a doctor or medical personnel? Just simply asking.
Visual: Malte Mueller/fStop via Getty Images
In early 2013, after Erin Consuegra gave birth to her second child at age 28, her health nosedived. She developed worrying symptoms, including extreme fatigue, fluttery heart beats, and high blood pressure. She said her doctor prescribed blood pressure medication and chalked it up to stress.
But Consuegra, an elementary school teacher by training, didn’t buy it. “It’s like, you think staying home all day with two kids is causing these real medical issues?” she said. “It was offensive to just write it all off to stress and anxiety.”
Researching her symptoms online and through family members in the medical field, Consuegra learned of a little-known syndrome called primary aldosteronism, in which one or both adrenal glands, small structures that sit atop the kidneys, overproduce a hormone called aldosterone. Aldosterone increases blood pressure by sending sodium and water into the bloodstream, increasing blood volume. It also lowers potassium, a mineral that Consuegra was deficient in.
Her primary care physician agreed to run a blood test to screen for the condition but insisted that the result was normal and balked at Consuegra’s request to see a specialist. “She took it as me questioning her,” Consuegra said. Getting a referral, she added, “took a lot of fighting, a lot of tears, a lot of advocacy on my part.”
Consuegra’s story has a relatively happy ending. Doctors at Vanderbilt University Medical Center eventually diagnosed her with primary aldosteronism and found a small noncancerous tumor, or adenoma, in one of her adrenal glands — known to often be a cause of the condition. After doctors removed the gland in July 2014, her symptoms disappeared.
Millions of other patients are not so lucky. More than six decades after primary aldosteronism was first described in the medical literature, less than 1 percent of cases are diagnosed and treated despite evidence that it is a common cause of high blood pressure, or hypertension.
The syndrome shows up in people with mild, moderate, and severe hypertension — and even in those with normal blood pressure — according to a comprehensive 2020 study. “The prevalence of primary aldosteronism is high and largely unrecognized,” the study authors wrote in the Annals of Internal Medicine, adding that it may account for high blood pressure that has no identifiable cause and is typically attributed to genetics, poor diet, lack of exercise, and obesity.
Closing the diagnosis and treatment gap poses a series of challenges, experts say. Many physicians haven’t gotten the message that primary aldosteronism is common, so they don’t look for it. Screening tests can be tricky to interpret and miss a lot of cases. Complicating matters, primary care groups, whose members treat the bulk of hypertension, have so far declined to help develop relevant guidelines. Research on the syndrome lags behind other diseases, and only a few health systems have a cadre of knowledgeable specialists who provide coordinated care.
Clinicians may dismiss telltale symptoms, leaving patients to turn to Google, bounce from doctor to doctor, or go undiagnosed for years. “Unfortunately, I think my story is super-typical,” said Consuegra, whose frustrations led her to start a patient Facebook group. “I don’t think anyone has had an easy road to diagnosis.”
As a result, patients take standard blood pressure medications that do little or no good and miss out on effective treatments that include not only surgery but low-salt diets and targeted drugs. Missed diagnoses pose additional dangers: Excess aldosterone is toxic to the heart, blood vessels, kidneys, and other organs. Compared to patients with garden-variety hypertension, those with primary aldosteronism have greater risk of kidney disease, heart failure, coronary artery disease, and stroke.
With nearly half of U.S. adults, or 116 million people, classified as having high blood pressure, some experts have warned of a public health crisis hidden in plain sight — one that will demand widespread changes in hypertension treatment. They’ve called on clinicians to increase their vigilance and more readily prescribe drugs that block aldosterone’s effects.
“My personal frustration is seeing patients who’ve clearly had primary aldosteronism for more than a decade and now have irreversible kidney damage,” which may require dialysis, said endocrinologist William Young Jr. of the Mayo Clinic. Young treats about 250 primary aldosteronism patients a year but “compared to what’s going on out there,” he said, “that’s miniscule.”
The push for greater recognition of primary aldosteronism isn’t new. Since 2008, the Endocrine Society, a medical organization dedicated to the advancement of hormone science and public health, has recommended screening patients who have red flags such as low potassium, an adrenal mass that shows up on a scan, or drug-resistant hypertension — defined as blood pressure that is uncontrolled despite the patient taking three different kinds of antihypertensive medications at their maximally tolerated doses. A family history of early-onset hypertension or stroke before age 40 are other signs. In 2017, the American College of Cardiology and the American Heart Association incorporated the directive into a hypertension treatment guideline.
Screening usually entails a roughly $150 blood test called the aldosterone-to-renin ratio, or ARR. Renin is an enzyme produced by the kidneys that triggers a chain reaction that leads to aldosterone production. When renin is low, aldosterone should be low. But in people with primary aldosteronism, aldosterone can be elevated even when renin is low.
A positive ARR can be followed by additional tests to confirm the diagnosis and determine whether surgery is an option. If one gland is secreting excess aldosterone, removing that gland may cure or improve the disease. Usually both glands are affected, in which case surgery isn’t recommended and patients take one of two drugs that block aldosterone.
But physicians haven’t followed the guidelines. Recent U.S. studies found ARR screening rates for high-risk patients ranging from 1.3 percent in an urban health system to 3.3 percent at an academic medical center. The largest analysis, which was published in 2021 and involved 269,010 patients with drug-resistant hypertension treated in the U.S. Veterans Health Administration, revealed that just 1.6 percent were tested.
The data show primary aldosteronism is “not top of mind for gatekeepers of hypertension,” said Vivek Bhalla, a kidney specialist who directs the Stanford Hypertension Center. Bhalla said he was astounded when a 2020 analysis he led revealed that just 2.1 percent of patients with drug-resistant hypertension were screened.
Yet even those tiny percentages may downplay the problem because they don’t account for people without recognizable risk factors, who may nonetheless be on a path to developing severe disease. Some experts suggest studying the cost-effectiveness of expanding the population of patients who should be screened, a point underscored by the 2020 Annals study, which estimated that the syndrome affects one in six people with mild hypertension and one in five with moderate hypertension.
More troubling, the study showed that ARR fails to detect a large fraction of cases, yielding a positive result in people who have the condition as little as 22 percent of the time. False positive results, on the other hand, are uncommon. The authors wrote that ARR “can be a simple and useful screening method” but cautioned against overreliance, noting that arbitrarily high cutoff values and aldosterone’s tendency to fluctuate likely contribute to underdiagnosis.
Those revelations “really changed the whole landscape,” said Sandra Taler, a Mayo Clinic kidney and hypertension specialist who was not involved in the research. She added that she’s become “more meticulous” in looking for primary aldosteronism as a result. “The point of this study is there may not be any clues and it could still be present,” she said. “And if you don’t look for it you won’t find it.”
Experts have put forth various explanations for the lack of screening, including the complexity of the process and concerns over expensive follow-up procedures. Given the sheer volume of hypertension patients, physicians typically don’t focus on finding root causes. “The temptation for a physician seeing a new patient with hypertension is to say — ‘Let’s just start off with getting your blood pressure down, and then take it from there,’” Australian medical researcher John Funder, who led the Endocrine Society’s most recent guideline effort, wrote in a 2020 editorial in Hypertension.
There are also historic misperceptions that primary aldosteronism is rare and characterized by symptoms such as potassium deficiency. University of Michigan physician Jerome Conn is credited with first describing the syndrome in medical literature in 1956 based on a woman with extreme symptoms that included temporary and occasional paralysis from the hips down. Although Conn and others postulated that rogue aldosterone production is a common cause of hypertension, it took until the 1980s for diagnostic advances to confirm their hunch.
In his editorial, Funder cited “residual ignorance” from the days when medical schools taught that primary aldosteronism was a mild and rare form of hypertension affecting less than 1 percent of patients. Others cite ongoing gaps in educating physicians who think it is too complicated or don’t know they should be testing people for primary aldosteronism. Specialty societies have not paired screening recommendations with aggressive efforts to educate physicians about the disorder’s prevalence, acknowledged Robert Carey, a professor of medicine at the University of Virginia School of Medicine and Endocrine Society past president, who helped develop the guidelines.
At some institutions, that’s changing. Varun Sharma, an associate professor of general internal medicine at Georgetown University, said he wasn’t taught how or when to diagnose primary aldosteronism during his medical training. A few years ago he began testing some patients with hypertension and was surprised by frequent positive results. “That was what made me push and also made me feel comfortable telling residents that we ought to be screening more,” he said.
Similarly, Bradley Changstrom, an assistant professor of medicine at the University of Colorado School of Medicine, doesn’t recall learning about primary aldosteronism as a common cause of hypertension when he was a resident. But he said, “Once I started looking for it I started finding it all the time, practically speaking once a month or so.”
“I think if physicians realize how common this truly is,” he added, “they would start to look for it more often.”
To increase detection, experts have suggested removing a requirement that patients take a hiatus from blood pressure medications prior to screening, liberalizing cutoffs for a positive ARR result, and bypassing ARR for urine excretion tests, which are more reliable but cost more. Some have suggested wider prescribing of drugs to treat primary aldosteronism, even as a first-line hypertension therapy.
“Once I started looking for it I started finding it all the time, practically speaking once a month or so,” said Changstrom.
Carey said it will be critical to involve primary care societies — including the American Academy of Family Physicians and the American College of Physicians — in developing the next guideline, which he said will take at least two years. He said their endorsement would provide “the strongest message regarding the validity of the recommendations” but such collaboration can be challenging because societies “want to keep their guidelines under their control.”
Primary care groups declined to participate in a multi-society task force that developed the 2017 ACC/AHA hypertension guideline, which famously expanded the definition of hypertension to include about 30 million more U.S. adults as well as endorsing primary aldosteronism screening.
The ACP and the AAFP declined interview requests from Undark. In an email, the AAFP said it updates its members on research and “would welcome the Endocrine Society to reach out to us directly to discuss guideline opportunities.”
Greater focus on excess aldosterone could advance national progress on blood pressure control, which has stalled, according to the 2020 U.S. Surgeon General’s Call to Action to Control Hypertension. Although that 48-page document, like much public health messaging, doesn’t mention primary aldosteronism or aldosterone, it notes that only about one in four U.S. adults with hypertension has it under control. Hypertension is a leading risk factor for heart disease and contributes to half a million U.S. deaths annually. Primary aldosteronism, Taler said, “opens up a whole area of research in terms of looking for the cause of high blood pressure.”
More detection won’t be a silver bullet. No health care system is prepared for a glut of newly diagnosed primary aldosteronism patients, says Carey. Only a handful of U.S. medical centers have a cadre of relevant experts — particularly scarce are radiologists adept a procedure to determine whether surgery is feasible. Care is also often uncoordinated. Bhalla said he created Stanford’s hypertension center in 2015 because “it was clear that there was no expert that had taken these people under their wing,” referring to patients with primary aldosteronism, but his institution isn’t unique. “We practice in these silos in medicine,” he said. “And that is not healthy for patient care.”
Sweeping improvements are needed in diagnosis and treatment, said Marianne Leenaerts, co-founder of the Primary Aldosteronism Foundation, a patient group launched in 2019. The only drug approved by the U.S. Food and Drug Administration to treat primary aldosteronism, spironolactone, was developed in the late 1950s. It usually lowers blood pressure but has nasty side effects that include erectile dysfunction and painful breast growth in men, and irregular menstrual cycles in women. Another drug of the same class, eplerenone, is prescribed off-label. The Endocrine Society’s guideline notes that eplerenone has fewer side effects but is less potent than spironolactone and must be taken more often.
Two new classes of drugs are in testing. Clinical trials are underway for new scanning techniques and procedures that could spare the adrenal gland.
Yet for millions of patients, advances are slow in coming.
Leenaerts, who lives in Canada, believes she had primary aldosteronism for 25 years before it was diagnosed in 2017. Both of her adrenal glands produce excess aldosterone, which means she is not a candidate for surgery, and she does not tolerate either available drug. Instead, she tries to manage her disease with a standard blood pressure-lowering drug and a strict low-sodium, high-potassium diet. At age 58, her liver and kidney functions are declining, and she has insomnia, difficulties with memory and focus, and painful inflammation. Primary aldosteronism has cut short her productive years, she said. While new drugs might help, she added, “At the speed at which I’m declining, it may be too late for me.”
Mary Chris Jaklevic is a veteran health care journalist based in the Midwest.
