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issie

More On Aldosterone And Renin

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Okay, here's the research on the renin - it kind of came up empty. But I have a little more info on it and aldosterone.

This is also at the bottom of the other research, but didn't know if you'd go back and look at it again - rather long. Hope this is intriging to you. Maybe, it will be one of the keys to our puzzle.

Just another little bit of information I've discovered.

(The following by Eberhard Ritz)

High salt reduces NO generation and increases endothelial cell stiffness

Renin is released in the kidneys and is stimulated by the sympathetic nerve action, renal artery hypotension and decreased sodium delivery to the kidneys.

Renin's function is to constrict resistance vessels, stimulate release of vasopression - which increases fluid and retention, stimulate the release of aldosterone which acts on the kidneys to increase sodium and fluid rention, stimulate thirst, facilitates norepinephrine release and inhibits re-uptake by nerve endings. (Articles from Cardiovascular Physiology Concepts by Richard Klabundle, PhD

When sodium is high, more sodium is reabsorbed and more potassium and hydrogen ion are excreted. Increased aldosterone is the transporter that regulates this and stimulates the reabsorption of sodium, which also increases the loss of potassium and hydrogen in the urine. ADH increases the permeability of the collecting duct to water, which leads to increased water reabsorption. If the kidney excretes more sodium, then water excretion will also increase. Increased sodium and water retention increases blood volume and contributes to elevated venous pressures which could lead to heart failure and pulmonary and systemic edema.

The next info comes from Medline Plus:

Renin is a protein released by kidney cells when you have decreased sodium levels or low blood volume. It plays a role in the release of aldosterone which helps control the body's salt and water balance.

If it's too high: Addison's disease, dehydration, cirrhosis, high bp, low potassium, renal tumors

too low: ADH therapy, sodium sensitive high bp, sodium retaining steriod - Florineff

Aldosterone is tested for certain fluid and electrolyte disorders, hard to control bp, low bp upon standing. It helps regulate bp and increases the reabsorption of sodium and water tne the release of potassium - this raises bp.

High levels indicate: Bartter syndrome, hyperaldosteronism from heart or kidney disease, low sodium

Low " " : Addison's disease, adrenal hyperplasia, hypoaldosteronism, very high salt diet

Hypokalemia is too low potassium in the blood: Symptoms are: Abnormal heart rhythms, breakdown of muscle fiber, constipation, fatigue, muscle weakness or spasms, paralysis (Which can occur when there is too much thyroid hormone in the blood - which causes low potassium - if you lower the thyroid hormone it will increase the potassium), can lead to kidney dammage

Wikipedia brings out that there is a relationship between aldosterone and cortisol. Licorice can inhibit a certain enzyme that helps with the converson of cortisol into cortisone. This could lead to mineralcorticoid excess syndrome. Anxiety increases aldosterone. Potassium levels as determined by sensors in the carotid artery determine the amount of aldosterone secreated. Aldesterone is increased with low sodium intakes.

The next part is from stopthethyroidmadness .com

If aldosterone gets too high, potassium levels get too low - this can cause muscle cramps, muscle weakness, numbness or tingling in extremities. But if too low - which can be commom in people with low cortisol - you excrete too much salt which leads to low blood pressure, low blood volume, high pulse and/or palpitations, dizziness and or lightheadedness when you stand, fatigue and craving for salt.

This article recommends sea salt because there is salt wasting. When sodium is excreted it takes water with it. They also recommend Florineff if the sea salt doesn't do enough. Florineff imitates what Aldosterone does. They also suggest that there may be a need for cortisol and the drug for this is Cortef.

To have mineralcorticoid activity means it controls electrolyte and water levels, by promoting sodium retention in the kidney - Florinef - Like Aldesterone

To have glucocorticoid activity means it controls carbohydrate, fat and protein metabolism and is anti inflammatory and allows thyroid hormones to get to your cells - Cortef - cortisol

This article had people telling how they had improved since starting to use both of these things along with Armour thyroid. Of course this would be if there are thyroid issues.

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I found this interesting because years ago - a doctor who did alternative testing said I was very deficient in cortisol. I had to take it at two differnt times in my life and any time I have surgery I have to use it. It makes me wonder if a little might be the key to taming the adrenal issues down. I did great with the cortisol this last time with my surgery - they didn't mention to me that they had an issue with my POTS during the surgery. I woke up fine and felt fine too. They hydrated me well too and I had I.V.'s for about 3 hours before I went into surgery.

My conclusion in regard to the renin is: I really don't think it is the key player here. It is mostly talked about in the light of hypertension. Some of us do have hypertension at times - but I still think it has something to do with the aldosterone. Maybe also the cortisol. These are both adrenal hormones.

An article I found from Dr. Wright's newsletters - found hearing loss in people low in aldesterone. He did give some places to get aldesterone compounded : Canada Global Drugs, www.canadaglobaldrugs.com, (866)323-2520; and Key Pharmacy, www.keypharmacy.net, (800)878-1322

This would require a RX and he recommends having electrolyte testing done regularly to make sure everything stays in balance in addition to keeping a check on the aldosterone.

Okay, I'm tired of researching this topic. Now, hoping a doctor will maybe see this and give us some feedback. I'm sure there has been testing done - but, I've only seen the one paper on it in regard to POTS and it really didn't give a solution.

For me, I want to get some of the Himalyian salt and start using it. Not do the high salt loading and see if the kind of salt makes a difference. See if my aldosterone levels will rebalance without the salt taking over the job. I'd rather try the natural salts with all the minerals - instead of the Florineff - which I did try and it gave me worse miagrains. It also made my BP go up too high and I swelled like mad. It could have been that they had me starting out too high with it. But, I didn't like it. Then, if that doesn't seem to do the trick - find a doctor who is willing to experiment with me and try the aldosterone and maybe the cortisol. I have to get my thyroid checked again too. I think my tumor there may be having an impact on it's function.

So, there's my hours and days worth of research - and the conclusions I've come to.

What's your conclusion???????

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Renin signals the release of aldosterone. If one does not have physical destruction of the adrenal glands (which I assume most of us don't), then our bodies should be receiving the signal (renin) to release more aldosterone. Since a lot of us tend to be hypovolemic, then it does not really make sure that we would have both low renin and low aldosterone. It is like our bodies aren't even sensing there is a problem. Hopefully that makes sense? My renin wasn't particularly low, but I also followed a salt restricted diet when I tested both aldosterone and renin. That's the best way to test for it to see what your body CAN produce when it's put to the test. If you are testing aldosterone and renin while supplementing with 4-5 grams of sodium, then it should be suppressed down to almost nothing. That's not abnormal at all.

One thing that I wanted to correct you on that is a pet peeve of mine...haha You said:

I found this interesting because years ago - a doctor who did alternative testing said I was very deficient in cortisol. I had to take it at two differnt times in my life and any time I have surgery I have to use it. It makes me wonder if a little might be the key to taming the adrenal issues down. Since I feel that I have the adrenal type of POTS - it makes me wonder. I did great with the cortisol this last time with my surgery - they didn't mention to me that they had an issue with my POTS during the surgery. I woke up fine and felt fine too. They hydrated me well too and I had I.V.'s for about 3 hours before I went into surgery.

The "adrenergic POTS" has nothing to do with adrenal function. I see this said a lot and it makes me go nuts. Sorry like I said, it is a weird pet peeve of mine! :lol: hyperadrenergic POTS is when the CNS is signally too much norepinephrine upon standing. I doubt the NE produced in these cases is even coming from the adrenal medulla. However there's no way to test where NE is coming from as it is chemically the same in the blood whether it comes from the CNS or adrenals. It is not adrenal pots, but rather adrenergic POTS as it is referring to the beta-adrenergic receptors in the body and NOT the adrenals.

I have tried the bio-identical aldosterone you listed and it did absolutely nothing for me. It's pricey too and not really feasible for most of us. I think it cost me about $200 for a 1 month supply!

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Cortisol does tame down the adrenals and the surges that you get when you have the hyper reactions that may be connected to the hyperadrenic POTS. With that reaction comes many types of things - like a fight or flight feeling, flushing, liable BP's - etc. Cortisol is a very calming hormone.

Norepinephrine is synthesized from dopamine and released from the adrenal medulla into the blood, and is a neurotransmitter in the central nervous system and sympathethetic nervous system where it is released from noradrenergic neurons. (Widipedia)

In fact, there is one article I didn't talk about from the Journal of Clinical Investigation - that said if you have low renin hypertension and you have dopamine infusion it will suppress aldosterone. So if Norepinephrine is synthesized from dopamine and we have too much of it (because of a hyperadrenic response) we will have low aldosterone. That's probably why when they thought I had Parkinson's (before my POTS diagnosis), the treatment made me alot worse. It was upping my dopamine levels and this was wrong for me.

According to the paper by Dr. Raj - most POTS patients did not have low renin. But, did have low aldestrone. Whether the renin isn't signaling for the production of aldosterone or the salt has caused the aldosterone component of the axis to stop producing - who knows? My question is - how wise is it to stop the production of aldostrone (with salt)? If you don't take in enough salt that day and your aldosterone/renin axis is compromised by what you've possibly done - how are you going to feel if the aldosterone is not there to regulate the fluid and salt levels that are in your body? And if salt pulls fluid out of your body to be processed (because it's a refined, no mineral salt) aren't we defeating the purpose and imbalancing our electrolytes? Maybe the idea of an unrefined type salt with all the minerals would work better. At least we wouldn't unbalance some other component if it were in it's natural unrefined state. And cause our body to have to work harder to eliminate a processed substance that has been heated and turned into something else. (Note my research on salt in a previous post.)

Sorry the aldosterone didn't work for you. What will work for one, won't work for another and everyone has such complex issues associated with their dysautonomia. We are all in the lab and are the guinea pigs for this illness. We just have to keep looking for what will give us the best quality of life that we can have - for each person that will probably be very different.

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In my experience, cortisol replacement has done little to nothing for my POTS. In fact I think at times it is has made it worse. It does not tame down the NE dumps I get from standing. If it did then my tilt-table test should have been normal and my plasma catecholamine that were taken within 30 minutes of a stress dose of hydrocortisone would have been low or normal. So from my own experience of stress dosing during these NE dumps (up too 100mg of HC!!), I do not believe that the NE surges we experience is coming from the adrenals whatsoever. I've been taking hydrocortisone for over a year now for adrenal insufficiency and I doubt there is much function left of the adrenals. People with no adrenals at all still have norepinephrine in their systems from the CNS with non-detectable levels of epinephrine since that one is only produced in the medulla. Here's a study done on sheep that supports that. Those on glucocorticoid replacement actually secrete more norepinephrine than normal controls, so maybe that is why I am worse off these days. Because of this, I am trying to wean off of the HC if that's even possible at this point.

Even still the word "adrenergic" is not referring to the adrenals. It is referring to the noreadrenergic neurons from the nervous system as described in that snippet from wikipedia.

Some doctors say that low renin and low aldosterone can in fact mean hypopituitary function but according to this old study it doesn't appear to be related to ACTH or cortisol deficiency. http://www.ncbi.nlm.nih.gov/pubmed/518024

By ingesting salt, you aren't stopping aldosterone from working. It is doing what it is supposed to do by suppressing itself. One of its main roles is retaining sodium, so if you are ingesting more than needed it will reduce itself and allow your body to excrete it. If you stop ingesting sodium, then it will rise as needed. I'm not one who believe in taking all of this sodium. I don't really think it does anything, personally especially since most American's diets are already quite full of sodium in processed foods.

If you haven't had aldosterone checked while under a strict salt restriction for at least 24 hours, then I don't think you can determine what is happening with it. There's no way to interpret the results if you are ingesting salt.

Since your cortisol levels were low, an ACTH stim test might be something to think about and you could also check for adrenal antibodies and 21-hydroxylase antibodies.

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From Raj's article:

Patients with orthostatic tachycardia who were also hypovolemic have low levels of standing plasma renin activity and aldosterone compared to normovolemic patients [21,22].

Of course, not all patients with POTS are hypovolemic. Hypertensive patients and patients with CHF tend to have lower renin and aldosterone as a compensatory mechanism to decrease blood pressure. Even POTS patients who do not fit into the hyperadrenergic category, have higher levels of circulatory NE. Perhaps this is compensatory due to selective peripheral denervation. Researchers are still debating. At any rate, vessel constriction at the level of the kidneys would reduce renin secretion. Our bodies could think we are hypertensive, and therefore, the low renin, low aldosterone despite hypovolemia. Fixing the hypovolemia may help, but does not address the root problem.

I had my renin and aldosterone tested during a water/ salt deprivation protocol in the hospital. It was not pleasant, but it was an accurate way of obtaining results.

The Florinef and DDAVP have helped, but I still have POTS.

In a non-POTS or POTS patients without hypovolemia from low aldosterone, if they ingest salt, aldosterone will naturally drop. In a hypovolemic POTS patients who is consuming normal amounts of salt, aldosterone is low to begin with. Many POTS specialist recommend the high salt diet because aldosterone is already low, and these patients need the extra salt. The only way to know is to have renin and aldosterone tested after a sodium fast under the guidance of a qualified doctor who is familiar with POTS.

Sorry to butt in.... I am always game for a renin/ aldosterone discussion, since I've been affected by this issue. :)

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Issie~

Wow - great job on the research! These are topics I really don't know much about, and with my brain fog today it was a little difficult to comprehend everything, so I'll give it another read later. I also feel better without eating as much salt as my doctor advised me to eat, and will be trying Himalayan salt, too. I am hypotensive, but all of that salt is wearing on my stomach.

Cheers,

Jana

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Thanks for the appreciation. I had a few days of my brain working.

It's so funny that today, I got a newsletter from Dr.Rowen about using salt to lower your blood pressure. When people used salt with the minerals in it, it lowered their BP and made their arteries less stiff. This was a 12 month study. He brought out how important having the potassium and magnesium with the salt was for cellular energy production and muscle relaxation. He said these two minerals reduce over activity of the sympathetic nervous system, and boost the function of the parasympathetic system. His recommendation was either the Celtic sea salt or the Himalayan salt.

Okay, this was my conclusion too. I'm still wondering about the need for over salting with a refined product. And wondering if aldosterone replacement might not be the better option (if found low). Maybe it would adjust itself back to more normal if we change the type of salt we use and not overload on it.

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TXPOTS,

Thanks for butting in - that's my intention. To have lots of people butt in - I think this is an important discussion. (I guess so, I've put alot of hours into it.)

In regard to your observations about POTS patients having low aldosterone anyway - why not replace what's low. Don't lower it more with salt. If the aldosterone is elevated won't it cause more fluid retention and therefore decrease the hypovolemic problem?

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I enjoy this topic, too.

I read that on labtestsonline.?, it says that a low-normal aldosterone coupled with a low renin could mean Cushing's syndrome(not C. disease??). I had a low aldosterone along with an inappropriately normal renin.

I have always told my endos that I feel Addison-like(tired, lightheaded, like "death warmed over" at times), and yet I look Cushing's-like(belly fat, facial hair, thin skin). It is so complicated, and I guess that's why I keep seeking endo help along with cardio.

So, anyone else with low aldo/low renin combo? That might be what you were talking about, Issie. And, of course, it all interplays with cortisol.

There is obviously something here the doctors could research--would love to be first in line!

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TXPOTS,

Thanks for butting in - that's my intention. To have lots of people butt in - I think this is an important discussion. (I guess so, I've put alot of hours into it.)

In regard to your observations about POTS patients having low aldosterone anyway - why not replace what's low. Don't lower it more with salt. If the aldosterone is elevated won't it cause more fluid retention and therefore decrease the hypovolemic problem?

I agree. I did not find the excessive salt consumption without Florinef helpful. I started feeling better after starting Florinef. I still consume a salty diet, but not the massive amounts I was instructed to take before Florinef. Plus, I think the excessive sodium gave me interstitial cystitis. I had to see a urologist who had me cut down on the salt from 10gm sodium/ day to 4gm sodium/ day.

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it says that a low-normal aldosterone coupled with a low renin could mean Cushing's syndrome(not C. disease??).

There is obviously something here the doctors could research--would love to be first in line!

Yes, that is what I found out. (Did I mis- type somewhere in regard to Cushings vs. Conn's Disease?) I couldn't find it. In Conns's disease the alodosterone is too high and causes high BP.

NOPE.........you can't be first in line -- I'm the first guinea pig - you can be the second!!!!!!! LOL

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I have low-normal renin and aldosterone.

I have high-normal cortisol, but it does not double with stimulation. :huh:

I am also on a VERY steady diet (my son has a severe food allergy, so I make almost all of our food from scratch and we can't really eat out.) I take in an average of 1750mg of sodium a day and without dDAVP, I go hypernatremic with fluid deprivation.

I have orthostatic hyper-tension with tachycardia and hyper-adrenergic responses to my ANS tests.

Where do I fit in your research?

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Firewatcher, I forgot to say in my post of levels, the last time my endo checked my 8 am cortisol, it was high-normal for me, too. It was 17(the lab paper had 19 as the upper limit). I don't know--maybe we are *almost* Cushing's???? I have the ortho hypertension also, but normal on sitting. Is our cortisol raised to help us overcome some other deficiency? I know I feel worse in the morning.

And, Cushing's people normally have higher b/p, so I guess their aldosterone is lowered to counteract that. But, we aren't a full-time high b/p, so don't know why our aldo/renin sets up like theirs.

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Cortisol can be raised by everyday stress. And goodness knows - we're under alot of it.... I had a doctor tell me one time that she felt that my cortisol stays high and then it comes to a point where it starts to malfunction - for an overload reason - then it bottoms out. I don't know if her theory is correct. But, they call this adrenal exhaustion. Also, certain meds - like birth control can cause your cortisol to be high. Hyperthyroidism another reason. also pitutary issues.

I personally think, that due to the stress of our constant swings with our BP's and pulses and all that goes along with POTS - messes up our adrenals and we are in a adrenal exhaust mode. Possibly taxing ourselves even more with refined, mineral-less (is that a word) salt that imbalances our electroylytes even more and lowers our aldosterone (and maybe our renin) and then we really have adrenal dysfunction - and the circle continues with making our POTS worse - in the long run. We know our autonomic system is wacky - but are we imbalancing it more??????

Firewatcher, I think you are still in the same boat with the rest of us. I have the swings with all those things too. What you're describing sounds "pretty spot on". You don't want to fluid deprive yourself - but what we need to figure out is how to get our body to regulate the fluid properly to where we get the benefit of it and it hydrates us properly. That's my main issue in this research. I never feel hydrated and I know I take in enough fluid. Refined salt requires alot of water for processing (see previous post on salt). I'm coming to the conclusion that we need all the minerals in our salt for it to benefit us and for us to hydrate properly. And we probably don't need as much salt if this process works properly in our body. It might take some doing to get it to work properly - if we created a dysfunction by what we've done with foods, supplements or even drugs.

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@TXPOTS-I'm glad that your doctor knew to do the renin and aldosterone tests while under salt restriction. I'm impressed!

@Issie I know that you've been reading stopthethyroidmadness. I post on forums run by people who gain their knowledge from the site and while it is good information, they do not understand POTS at all. Years ago, I was one of the few who posted on their yahoo groups with severe POTS. Now more and more people are showing symptoms of it on there! The mods would tell me that I just need to add in a little salt and to increase my florinef and all will be well. Even to this day I have to explain that is not necessarily true at all. You can't explain severe POTS to someone who doesn't have it and they do not understand that it is way more complicated than adding in a little hydrocortisone, salt and florinef. If it were that easy, then we wouldn't be here!! :P

A lot of us are replacing "aldosterone" by taking florinef. It is not bio-identical but it helps the body to retain sodium. Ingesting large amounts of salt without taking florinef is pretty useless because you will be excreting all of that sodium in your urine regardless of how much you take. Low aldostone=salt wasting. That reason alone is why I'm pretty much against salt loading. However, when you add in florinef with salt, then that combo makes a lot more sense because you will start to retain the sodium. Some people however, do not need sodium because they tend to go hypernatremia which is seen in diabetes inspidus. I have one of those diagnoses too, but replacing ADH with DDAVP has done nothing to help the POTS. Sure I urinate less on it, but I don't notice anything else, so I stopped taking it since it wasn't severe. I still question that diagnosis any way.

Last year, I thought cortisol was the key to my answers as well. Because I started researching as you have been and the pieces seemed to fall into place. I hypothesized if I got on hydrocortisone to replace low cortisol levels and went on florinef, then I'd be fixed. I also saw forums that focus solely on adrenals telling me the same thing. I was excited and couldn't wait!! For the first 1-2 months I felt good and had more energy, but after those initial few months things got worse and worse. I had more energy but what good does it do me if I can't stand up to use it? LOL Then I was told it was my thyroid, then sex hormones, then it was my ferritin blah blah blah. I was told it was more and more. Looking back I wish I had been less trusting because I spent another year of my life going down a path that made me feel worse. My heat intolerance is worse than ever. My HR increases upon standing are at least doubling these days and my overall quality of life has dropped significantly. I have a hard time admitting to myself that I was wrong about all of this.

There is probably a tiny percentage of people on here who have true Addison's Disease and would benefit greatly from hydrocortisone replacement. The problem is finding an endo that knows how to interpret the stim results. If you don't double, then that means you are Addison's or if you don't hit 20 then that means you are Addison's too. However if you have secondary adrenal insufficiency due to pituitary issues, then you won't only double from the baseline, but likely triple or even go 4x's. Most endos don't understand how to interpret results like that and will tell you all is "normal".

To recap, I have tried DDAVP, florinef, high doses of HC, low doses of HC and even that bio-identical aldosterone. Even while taking all of those meds, I still had POTS.

I hope that you find relief in replacing cortisol, aldosterone and whatever else you decided to pursue. I'm just letting you know that it wasn't the answer for me. :( I wish it were that simple.

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I can't find my stim. test from a few years ago, but I was one of those that at least tripled. Is that really something I should have addressed? I can't exactly remember my baseline, but it was somewhere around 10, but the ending number was in the mid 30s. I was told everything was normal--I HAVE LEARNED TO HATE THAT WORD! There is nothing NORMAL about my health issues, if they would care to look a little closer!

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Last year, I thought cortisol was the key to my answers as well. Because I started researching as you have been and the pieces seemed to fall into place. I hypothesized if I got on hydrocortisone to replace low cortisol levels and went on florinef, then I'd be fixed. I also saw forums that focus solely on adrenals telling me the same thing. I was excited and couldn't wait!! For the first 1-2 months I felt good and had more energy, but after those initial few months things got worse and worse. I had more energy but what good does it do me if I can't stand up to use it? LOL Then I was told it was my thyroid, then sex hormones, then it was my ferritin blah blah blah. I was told it was more and more.

To recap, I have tried DDAVP, florinef, high doses of HC, low doses of HC and even that bio-identical aldosterone. Even while taking all of those meds, I still had POTS.

I hope that you find relief in replacing cortisol, aldosterone and whatever else you decided to pursue. I'm just letting you know that it wasn't the answer for me. :( I wish it were that simple.

Dana,

Thanks for the input and explanations of what you've been through and what you've tried.

I found being on cortef two differnet times in my life - that when you take it for a while. In the end, I got worse too. But, what I do think is that at certain times, MAYBE, we might need a little bit. I don't believe that if your levels are normal, you need to mess with hormones, because you will imbalance something else - if it's not needed. But, if your body is truly deficient in a hormone, than you probably will get some benefit from using it. With us POTS patients who are so sensitive to meds. A small amount is the key. In my case, my liver doesn't process hormones correctly and I don't throw them off properly. If I supplement with something, I use very little and maybe only twice a week.

Back to the cortisol - whenever I've had surgeries (I've had allot of them), I've found that having cortisol is VERY IMPORTANT for me to not crash. I've almost been lost on the table, and that was with the cortisol. They couldn't figure out why my BP kept tanking - now we know it's POTS. But, instead of the cortisol giving me energy in the end - I was extremely tired. Maybe it was too much, don't know. I only use it now for surgeries. (Hope I don't have to have any more of those.) But, if my levels were to bottom out again - I would probably use it, but only on a limited basis and not every day 3 times a day.

I too have thyroid issues, hormone issues, adrenal issues - I think our bodies are just sick (not in the good way, but in the bad way.) Some of us just have multiple dysfunctions and when one goes, it seems all the other ones go too.

I feel your frustration and feelings of dilemma. It is very tiring and it's hard to find doctors who are willing to take on such complexities. When case as ours are so complex - we do research ourselves - because our doctors don't have the time to do the research. Then we hope that they will listen to us and help us find solutions to give us a better quality of life. This may or may not be possible. But, we don't give up and we continue in our journey - hoping for answers and solutions.

I know you wonder if you've made yourself worse in what you've done with the meds. But, you can wean off of some of them and then you will be able to see if your body will bounce back. It may take a while, but if your doc is willing to help you do that - you will at least know if they were helping or not.

Thanks again for your input - I will seriously consider it when I decide IF I want to go this route and try these hormones. It is a fine balancing act when you mess with hormones. You can't synthetically put things into your body and think the results will be as good as what God has given us naturally. I know!!!!!!

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@sue Yes if you more than tripled, then I'd get a morning ACTH level checked and see if you can find an endo who understands secondary AI. Not many do though!

@issie If you decide to go down that path, I am more than willing to help you out. :) I have been weaning off hydrocortisone and currently I'm on a really low dose at 15mg daily. I used to take 30mg, so I am already at half my old dose. I split the 15mg throughout the day, so it is more natural to what the body does. My cortisol was really bad when I was tested. My ACTH was also elevated, which points to a primary adrenal problem. So maybe I do have adrenal issues independent of the POTS. Like you said, I really won't know until I come off of the HC which might take months. When you go on HC your CRH and ACTH are suppressed, so it takes time for them to restart again. Some studies show it can take up to a year for that to happen, that's why going on HC isn't something to take lightly! You essentially make yourself adrenal insufficient. You also have to worry about stress dosing and wearing a medic alert bracelet at all times just in case something happens and you can't speak for yourself. It isn't fun.

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This is all so interesting, I only wish I could add something useful! Thanks to Issie and to those who have given input.

You are welcome - thanks for the acknowledgement!!!!!! Keep reading there's more rather lengthy discussions on this subject. "Out of the Box thinking", "Cortisol, Aldesterone, Renin) and now recently "Cortisol . . . (can't remember the name - but it's ongoing right now.)

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The "adrenergic POTS" has nothing to do with adrenal function. I see this said a lot and it makes me go nuts. Sorry like I said, it is a weird pet peeve of mine! laugh.gif hyperadrenergic POTS is when the CNS is signally too much norepinephrine upon standing. I doubt the NE produced in these cases is even coming from the adrenal medulla. However there's no way to test where NE is coming from as it is chemically the same in the blood whether it comes from the CNS or adrenals. It is not adrenal pots, but rather adrenergic POTS as it is referring to the beta-adrenergic receptors in the body and NOT the adrenals.

I have tried the bio-identical aldosterone you listed and it did absolutely nothing for me. It's pricey too and not really feasible for most of us. I think it cost me about $200 for a 1 month supply!

Your quoting theory as fact. None of the elevated NE in any form of POTS is released by the adrenal medulla, rather it is said to be leaking out of the sympathetic ganglions because of faulty neuronal reuptake into the blood stream. This is actually theory rather than proven fact. No one really as of yet knows and some even speculate that reduced NET is an adaptive consequence. The evidence that increased NE occurs due to CNS disfunction is at this stage zero. There is also beta recepto sensitivity in POTS making many look like they are hyper when in fact they arent. Since elevated NE in essential hypertension results in INCREASED cerebral blood flow why does it do the opposite in POTS?

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There appears to be other mechanisms that might account for low blood volume and inappropriate renin aldosterone responses in POTS - increased angiotensin II and perhaps elevated kidney dopamine levels or reception. Both have potent effects potentially on salt status and volume.

In a recent study it was found that ang II mediated vasoconstriction was ineffectual in many POTs patients despite elevated levels, but that the kidney was not desensitized to these increased level, perhaps underlying the volume deficit in this guys.

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