andybonse Posted January 30, 2014 Report Share Posted January 30, 2014 Hi All,After vast research, I have personally determined my POTS is caused via my kidneys, whether it be nerve damage or receptor damage/inability.I recently took some blood tests of hormones which I arranged myself without a doctor:CortisolAldosteroneAngiotensin iiReninACTHCortisol was perfectly healthy range for the AM.ACTH, Perfect.So this suggests my adrenal glands are working and the pituitary gland is working fine also.Next, my Angiotensin ii(responsible for causing vasoconstriction and aldosterone secretion, plus signalling vasopressin secretion) was abnormally low, normal ranges 20-40, mine were 8. This is the big issue.Next, Renin, this was a normal value, which means my Angiotensin ii should be higher, unless there is some issue with the release of Angiotensin i or the conversion of angiotensin i into ii via ACE receptor problems/release.Next, because my Angiotensin ii is low, my Aldosterone was low also.The above explains, why I urinate so much of what I drink, and also why my diastolic BP is a low number, less vasoconstriction and low blood volume.We all know dehydration causes POTS, so the above clearly is either the main issue or a huge contributor.Plan of action:Fludrocortisone(will increase my aldosterone, retain salt and water increasing the blood volume to a more normal level)Midodrine(Once started on Fludrocortisone, to compensate for the lack of vasoconstriction)Now, I tried Midodrine first, and it helped a little, when I took a higher dose it made me worse, now heres why,Because vasoconstriction is controlled by angiotensin ii, the midodrine replaces that action which restores a normal peripheral resistance throughout the body, however because the blood volume is not been increased, vasoconstriction will not work anymore with a higher dose, it will actually decrease the blood flow too much because there is not enough blood to go around, so this causes less perfusion in the brain and organs.Boom, let me know what you think.Also, there is a study done by SR RAJ, which backs up exactly what I said above so I know im not going insane, just frustrated my doctor never even thought to test for this.Study: http://www.daxor.com/pdfs/raj_renin-aldosterone_circulation_2005.pdfIn the study, the participants aldosterones were 190 supine, mine were 160 upright, which means my supine levels would be even lower!!Andy Quote Link to comment Share on other sites More sharing options...
davecom Posted January 30, 2014 Report Share Posted January 30, 2014 I've seen the articles on antiotensin and POTS before. The question is - why is yours low. This analysis doesn't answer that. It could be a feedback loop. With that said, I hope fludrocortisone works for you. Good luck, and keep us posted. Quote Link to comment Share on other sites More sharing options...
andybonse Posted January 30, 2014 Author Report Share Posted January 30, 2014 I've seen the articles on antiotensin and POTS before. The question is - why is yours low. This analysis doesn't answer that. It could be a feedback loop. With that said, I hope fludrocortisone works for you. Good luck, and keep us posted.Thanks,Yes there is no explanation to why its low, but fathoming this out would be challenging and probably involve lots of tests to find something if at all anything.Could be the tiniest SF Nerve damaged or a receptor issue.One day maybe we can find out!Since the renin is there in a normal amount, its something to do with a receptor issue maybe? Maybe my lungs dont have ACE? haha, well I might look deeper when well enough, maybe some angiotensien tests. Quote Link to comment Share on other sites More sharing options...
gjensen Posted January 30, 2014 Report Share Posted January 30, 2014 Andy, if nothing else, your persistence is admirable. I hope to hear how it goes. Quote Link to comment Share on other sites More sharing options...
Raisin Posted January 31, 2014 Report Share Posted January 31, 2014 I think you are on to something! Keep going! I hope you have a doc who can appreciate your train of thought and assist your persuit. Quote Link to comment Share on other sites More sharing options...
andybonse Posted January 31, 2014 Author Report Share Posted January 31, 2014 Thanks guys,I hope to one day be a doctor and look into things fully. Quote Link to comment Share on other sites More sharing options...
sue1234 Posted January 31, 2014 Report Share Posted January 31, 2014 Did you have these done via Labcorp or Quest? I know all of my values except angiotensin II.My aldosterone continually comes in around 83 pmol/l (upright)! This seems way lower than the average of the POTS patients in the study. At the same time, my renin always comes back in mid-normal range. My vasopressin always comes in low also. It is confusing.I have a prescription to start Florinef, but I've been sick with either a bad cold or a feverless flu for most of January. I didn't want to start any new meds until I felt back to my "normal".Please keep us updated. I'd love for us to all hash this topic out to see if we can find out more on root causes. Quote Link to comment Share on other sites More sharing options...
andybonse Posted January 31, 2014 Author Report Share Posted January 31, 2014 Did you have these done via Labcorp or Quest? I know all of my values except angiotensin II.My aldosterone continually comes in around 83 pmol/l (upright)! This seems way lower than the average of the POTS patients in the study. At the same time, my renin always comes back in mid-normal range. My vasopressin always comes in low also. It is confusing.I have a prescription to start Florinef, but I've been sick with either a bad cold or a feverless flu for most of January. I didn't want to start any new meds until I felt back to my "normal".Please keep us updated. I'd love for us to all hash this topic out to see if we can find out more on root causes.I'm in the UK so I did them through a private hospital. Wow, thats low low! lol. Florinef will increase the alodsterone though so thats good news. Angiotensin ii stimulates release of vasopressin, so you may have it low.I pee a lot so can only assume my vasopressin is low too, but who knows.Start my Florinef next week now, going to have my electrolytes tested before I start, starting low and working my way up. Quote Link to comment Share on other sites More sharing options...
Katybug Posted January 31, 2014 Report Share Posted January 31, 2014 Andy,You might want to do a search on this forum for info on angiotensin ii and renin. I know a year and a half/two years ago rama and some others posted some very good articles on how these things relate to pots. It might help fill in the gaps for you and help you work with your docs. The info is definitely out there. Good luck to you. Quote Link to comment Share on other sites More sharing options...
andybonse Posted January 31, 2014 Author Report Share Posted January 31, 2014 Thanks,The research I've thus seen states, high angiotensin ii but low aldosterone. Not the same in my case, strange.Some doctors have said that I've spoke to online, that angiotensin ii is hard to measure so it may not below, however I pee a lot, which is a symptom of angiotensin ii, and low aldosterone so yeah I think the labs are correct.I will repeat them soon but its like $900 a time haha. Quote Link to comment Share on other sites More sharing options...
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